By Mike Woods
Well, it turns out winter wasn’t quite finished! We had this article queued up in anticipation of some less fluffy conditions. Alas, the information will be relevant soon enough…
With the advent of spring skiing comes the risk of hard falls. The terrain becomes less forgiving, and we see a handful of shoulder separations in our physical therapy clinic each year.
A separated shoulder is the common term for an acromioclavicular (AC) joint sprain. This joint is the connection between your collarbone (clavicle) and shoulder blade, the only boney attachment between your arm and your trunk.
A separated shoulder usually results from direct impact on the side or top of the shoulder, typically from a fall to the side or a football tackle when the player is driven down onto their shoulder. We can also see this injury in hockey, lacrosse, and bike crashes.
AC joint injuries are classically graded on a I to III scale by severity (although there are 6 types of AC sprains – don’t get confused!). Grade I injuries are characterized by minor disruption of the surrounding ligaments resulting in local pain, but no deformity. Injuries that present with a visible bump, or step deformity, on the shoulder, are indicative of more extensive (Grade II) or complete (Grade III) tearing of the ligaments that surround the joint and anchor the collarbone down.
Other signs of an AC joint injury include pain with movement, most significantly when the arm is overhead, bearing weight or reaching across your body (e.g. applying deodorant).
For Grade I and II injuries, non-surgical management is usually best. X-rays may be necessary only if there is a questionable clavicle fracture. The shoulder may need to be immobilized for a short time (a few days to a couple of weeks). A targeted rehab program that addresses mobility, strength, and coordination of the surrounding muscles is essential.
The best treatment options for Grade III separations are less clear. Traditionally, these injuries were handled surgically. More recently however, orthopedic surgeons and physical therapists have begun to question this approach. A recent systematic review of the most up-to-date research reported comparable results when considering pain, motion, strength, and function of the shoulder regardless of whether a surgical or physical-therapy-only approach was utilized. Non-operative patients tend to report improved satisfaction with their short-term recovery, and experience fewer complications. The only clear advantage to a surgical approach was an improved cosmetic appearance. So, with few exceptions, notably overhead athletes and shoulder models, this injury probably only requires some time at your sports physical therapy clinic and most athletes can expect a good recovery.
So, get out there and enjoy an extended winter season—just make sure your edges are sharp and steer clear of the trees!
See our blog at www.VASTAsports.com for much more information on common injuries and more detail on AC joint injuries including research and more specific management strategies.
Mike Woods is a sports physical therapist at VASTA Performance Training and Physical Therapy. Mike and his wife live in Huntington.