Separated Shoulder Specialist

Are you an athlete who participates in contact sports? If so, you may be at risk of separating your shoulder. An AC joint injury or a CC ligament injury is typically caused by blunt trauma to the shoulder or by a fall onto the shoulder. Separated shoulder specialist, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan and New York City, NY who have sustained an AC joint or CC ligament injury. Contact Dr. Williams’ team today!

212-606-1855
Request an Appointment

What is an acromioclavicular (AC) joint injury?

The shoulder is comprised of three joints: the acromioclavicular joint, the sternoclavicular joint, and the glenohumeral joint. The joint which connects the highest portion of the shoulder (acromion) with the collarbone (clavicle) is known as the acromioclavicular (AC) joint. The AC joint is commonly injured or separated. A separation occurs when the joint ligaments are pulled away from their bony anchoring points; accordingly, an AC joint shoulder separation is the result of the acromion being pulled away from the clavicle. This type of AC joint injury can be mild, where the ligaments are simply stretched; or, in the case of severe separations, the ligaments are torn as a result of blunt force trauma to the shoulder. These types of AC joint injuries are common among athletes that participate in contact sports (football and wrestling) and cyclists. Dr. Riley J. Williams, orthopedic shoulder specialist serving patients in Manhattan, New York City, and the surrounding New York boroughs, has the knowledge and understanding, as well as substantial experience in treating patients who have experienced an AC joint injury.

What is a coracoclavicular (CC) ligament injury?

The coracoclavicular ligaments anchor the shoulder blade (scapula) to the clavicle. The CC ligaments run from the coracoid process on the scapula to the inferior margin of the clavicle near the outer end of the bone.  An injury to the CC ligaments is a common co-injury seen in shoulder trauma, especially fall onto the shoulder. A CC ligament injury is considered part of the acromioclavicular joint injury spectrum and is often seen in tandem with other shoulder injuries, such as glenoid labrum tears and shoulder dislocations.

Is a separated shoulder different from a shoulder dislocation?

Yes. A shoulder dislocation occurs at the glenohumeral joint where the head of the humerus (upper arm bone) is dislodged from the shoulder socket (glenoid) of the shoulder blade. A shoulder dislocation is resolved by manually manipulating the humeral head back into the socket. It is common that the ligaments of the glenohumeral joint are torn as a result of a dislocation.

In contrast, a separated shoulder at the AC joint. The AC joint capsule and coracoclavicular (CC) ligaments are pulled or torn during such an injury. The coracoclavicular (CC) ligaments anchor the scapula to the clavicle by attaching the coracoid process, a bony prominence of the shoulder blade, to the inferior (underside) surface of the clavicle. The method of treatment for torn CC ligaments is surgical reconstruction.

How are AC joint injuries classified?

AC joint injuries are rated by the severity of injury to the AC joint capsule and surrounding ligaments and graded into six different classifications.

Grade 1: Minimal to no AC joint displacement. The AC joint capsule might be stretched or partially torn. There is no obvious shoulder deformity as the AC joint capsule and CC ligaments remain intact. This is the most common type of AC joint injury.

Grade 2: Minimal to moderate AC joint displacement. The AC ligament is completely torn. The CC ligaments may remain intact or encounter a partial tear. This type of injury can predispose the AC joint to arthritis due to misalignment of the joint.

Grade 3: Complete separation of the AC joint. There is often an obvious shoulder deformity with this  injury as the ligaments and cartilage of the AC joint in addition to the CC ligaments are completely torn.

Grades 4-6: The most severe types of AC joint injuries that involve the complete disruption of the AC joint capsule in addition to the CC ligaments. This occurs from a high-impact force directly on the shoulder seen with motor vehicle collisions. Other more severe muscle injuries occur with these high grade conditions. These instances are rare and require surgical reconstruction.

CLICK IMAGE TO ENLARGE

What are the symptoms of a separated shoulder?

Symptoms of a separated shoulder can range from a mild sprain with slight separation to an obvious visual deformity with severe separations. Other complaints include:

Grade 1:

  • Pain at the joint and with arm movement
  • Bruising surrounding the joint

Grade 2:

  • Pain at the joint and with arm movement
  • Swelling, bruising
  • Mild CC ligament tenderness with palpation
  • Collarbone might move if manipulated

Grade 3:

  • Severe pain at the AC joint capsule and CC ligaments immediately following an injury
  • Decreased arm range of motion
  • Visible AC joint instability with palpation
  • Obvious visual deformity at the top of the shoulder blade

How is an AC joint injury diagnosed?

An AC joint injury can be easily diagnosed if there is a visual deformity at the top portion of the shoulder blade. However, separations lacking an obvious visual deformity are more difficult to detect. Dr. Williams will obtain an extensive medical history and physical examination to differentiate between classifications of AC joint injuries. Diagnostic testing, including x-rays and magnetic resonance imaging (MRI), may be requested to identify any damage to the structures surrounding the AC joint.

What is the treatment for a separated shoulder?

Non-surgical treatment:

The lower grades of AC joint separations are often successfully managed with conservative treatment options. A sling might be applied by Dr. Williams to immobilize the AC joint for proper healing of the ligaments. A combination of rest, ice, and anti-inflammatory medications are also recommended. Although pain might persist months after an AC joint injury, completion of a physical rehabilitation program aids in regaining strength and range of motion back to the AC joint.

Surgical treatment:

In the cases of higher grades of shoulder separations, or if conservative therapy is unsuccessful, Dr. Williams may recommend surgical reconstruction of the AC joint complex. This minimally invasive procedure involves a small camera and special surgical instruments to restore AC joint stability. This can be completed by simply repairing and tightening the torn ligaments and capsule. However, in certain instances, the use of a soft tissue tendon graft may be required to reconstruct the AC joint and injured CC ligaments. Similar to conservative therapies, completing a physical rehabilitation program after surgical reconstruction is imperative in restoring the range of motion and strength of the AC joint. These surgical interventions are most effective when post-operative instructions are carefully followed, and patients can expect full recovery to normal activities within 3-6 months.

For more information on acromioclavicular (AC) joint injuries, shoulder separations, and coracoclavicular (CC) joint injuries, or on the excellent treatment options available for your shoulder pain, please contact the office of Dr. Riley J. Williams, orthopedic shoulder specialist serving Manhattan, New York City, and the surrounding New York boroughs, NY.