Shoulder separation

A shoulder separation is an injury to the area where ligaments hold your collarbone to the highest point of your shoulder blade, called the acromioclavicular joint (AC joint).

How shoulder separations happen

A separation of the AC joint is not an injury to the shoulder joint itself. It is most commonly caused by a fall directly onto the shoulder.

Many shoulder separations are treated without surgery

In a mild separation, the ligaments might only be stretched, while a severe separation means ligaments are torn. We frequently treat shoulder separations, and for most of our patients, surgery is not necessary.

How are shoulder separations different from shoulder dislocations?

Two hikers at sunset

A separated shoulder is different from a dislocated shoulder, which is when the shoulder joint comes apart.

In a shoulder separation, the AC ligament and/or other AC joint ligaments are torn from incidents like bad falls, car accidents and sports injuries. This causes the separation of the collarbone and the shoulder blade. The shoulder blade actually moves downward from the weight of the upper arm bone, creating a bulge above the shoulder.

If you have experienced a fall or accident and have a bulge and other common symptoms like pain and swelling in your shoulder, see a UCHealth provider right away. We will work together on the best treatment plan for your case.

Conservative treatment is usually enough for most cases, and you can regain full shoulder function within a few weeks.

Symptoms and types of shoulder separations

Signs and symptoms

According to the American Academy of Orthopedic Surgeons, the most common signs and symptoms include:

  • Shoulder pain.
  • Shoulder or arm weakness.
  • Shoulder bruising or swelling.
  • Limited shoulder movement.
  • A bump and swelling at the top of your shoulder.

From mild to more severe

A separated shoulder can range from a mild sprain without a bump to severe pain with a very large bump:

  • A mild shoulder separation involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays.
  • A more serious injury tears the AC ligament and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment with a smaller bump.
  • The most severe shoulder separation completely tears both the AC and CC ligaments. The AC joint is noticeably out of position, with a larger bump.

A mild separation might heal on its own, but a more serious separation requires treatment.

With a large deformity, it may take 12 weeks or longer for pain-free function to return. In severe cases, surgery is required.

Treatment options

Your provider will work with you to develop a personalized treatment plan.

Nonsurgical treatments

Nonsurgical treatments enable most of our patients to return to full function, even if there is still a bump on that shoulder. These include:

  • Ice. Reduces shoulder pain and swelling – use a cold pack for 15 to 20 minutes at a time.
  • Medications. Over-the-counter (OTC) pain relievers such as acetaminophen, ibuprofen and naproxen may help ease shoulder pain.
  • Physical therapy. A physical therapist will teach you exercises to increase flexibility, strengthen your shoulder and return range of motion.
  • Rest. Your provider may prescribe a sling to take pressure off your shoulder. Try to avoid activities that aggravate your shoulder pain, especially crossing the affected arm in front of your body.

Nonsurgical treatments help most of our patients heal from a shoulder separation, even those who have incurred severe injuries.

When surgery is called for

If pain persists or the deformity is severe, however, your provider will recommend surgery. Your surgeon might recommend trimming back the end of the collarbone so that it does not rub against the shoulder blade bone.

For a significant deformity, your surgeon might reconstruct the ligaments that attach to the underside of the collarbone. This type of surgery works well even if it is done long after the problem started. We perform these procedures either arthroscopically or as open surgery, whatever is best for your case.

Physical therapy will be required after any surgical procedure.

Man doing plank exercise

Life after a shoulder separation

Fat tire rider on a snowy road

The majority of our patients fully recover after conservative treatment, sometimes only needing a few weeks to heal.

You may always have a bump on your shoulder, but it won’t affect your range of motion or the ability to enjoy your favorite activities.