Physical Therapy for Shoulder Separation

NB Physical Therapy, Louisville, Colorado

If you’ve experienced this injury, physical therapy for shoulder separation or AC separation needs to be implemented properly to ensure no further issues. At NB Physical Therapy in Louisville, we’ve helped a number of patients who have suffered a shoulder separation, one of the most common sports injuries.

How Does Shoulder Separation Happen?

Frequent in contact sports like football, hockey and rugby – as well as physically demanding sports like biking, snowboarding and skiing, injury to the AC area is usually caused by an upended fall. During the fall, your arm is held close to the body so that the top of the shoulder takes the brunt of the impact and pushes down the shoulder blade. Because your collarbone is attached to your rib cage under the neck, it cannot move with the shoulder blade. The result is the stretching and tearing of your AC joint ligaments.

What Happens with a Shoulder Separation?

As soon as you’re injured, you’ll immediately feel pain in your shoulder and experience limited shoulder motion. Bruising and swelling may occur, sometimes causing the shoulder-end of the collarbone to look distended. In some cases, an x-ray (with a weight held) may be ordered by your physician to check for an actual AC joint separation or a broken collarbone.

Let’s look at your anatomy to break this down further.

At the tip of your shoulder, the collarbone (clavicle) connects to your shoulder blade (scapula) at the AC joint. Also in your shoulder, the clavicle attaches to a bony structure on the shoulder blade called the coracoid process. Supporting the joints are tough connective tissues called ligaments. Acromioclavicular ligaments surround where the acromion of the scapula and clavicle meet. The other ligaments are called coracoclavicular.

Now, you also have a pad of cartilage within the joint between the clavicle and the acromion. Its job is to allow gliding and twisting motions of one bone on the other. In a shoulder separation injury where the ligaments are completely torn, there is nothing holding the collarbone against the acromion. It can then lift out of place and damage this important cartilage.

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How Bad Is My Shoulder Separation?

At NB Physical Therapy, we explain to our patients that shoulder separations are “typed” based on how severely the collarbone has separated from the shoulder blade:

  • Type I: No physical separation of the joint. However, there can be bruising, swelling and joint tenderness. You may have limited shoulder motion, primarily with forward, cross-body reach.
  • Type II: Possible partial tear of the AC ligaments. You may also have stretched coracoclavicular ligaments and a slight separation of the collarbone from the shoulder blade. AC joint cartilage may or may not be injured.
  • Type III: Both the AC and CC ligaments are torn. The collarbone has dislocated from the shoulder blade and a bump is prominent at the joint. The cartilage may be injured. Severe pain is present.
  • Type IV: All the damage of Type III, plus the tip of the clavicle has been forced backward.
  • Type V: The same damage as Type III, but with more than 100% elevation of the clavicle. When looking at the contour of the collarbone, a significant “step-off” will be easily noticed.

Treatment and Physical Therapy for Shoulder Separation

Like many ligament injuries, initial treatment for any separation above a Type I includes immobilizing the shoulder. Apply ice every 2 hours for 20 minutes at a time and take pain medication. Eventually, as the pain subsides, you can begin physical therapy for the shoulder separation to increase your mobility and strengthen shoulder muscles.

At NB Physical Therapy, we’ll create a personalized program that will protect recovering ligaments. We’ll focus on healing ligaments short and tight while keeping your shoulder mobile and strong. Remember, exercises done without assistance from a therapist can lead to more issues. We’re here to help, so if you live in Louisville or any nearby area, feel free to get in touch.

Full function for a Type I injury often returns in about two weeks. For more severe shoulder separations, pain goes away in about three weeks, but returning to sports and other activities will likely take another few weeks. If you still have pain or other symptoms, resuming activity can lead to reinjury.

In Type IV and V injuries, surgery is often needed to hold the collarbone in place. However, some people maintain decent arm function even without surgery. Your physician will make the best decision for your health, however, AC surgery isn’t very common as most injuries don’t fall into Type IV or V.