Shoulder pain? Could this be a separated shoulder?

Have you ever hit your shoulder while playing cricket with a drive? Or have you ever slipped and fallen while riding a bike and hit your shoulder on the ground? It's normal for your shoulder to hurt when that happens. But have you ever noticed that sometimes, along with that pain, there's a small lump that looks like a lump on top of your shoulder? Many people get scared when they see this. They think, "Oh, I wonder if my shoulder bone will pop out." Today we're going to talk about such a condition. In medical terms, this is called a "Separated Shoulder."

What exactly is a separated shoulder?

Simply put, this is an injury to a joint in your shoulder. But it's not a dislocated shoulder, as many people think. The two are completely different.

Think about it, your shoulder is a complex system of parts. Where your collarbone (which we medically call the ``clavicle``) connects to the top of your shoulder blade (the ``acromion``), there is a small joint. This joint is called the ``acromioclavicular joint`` or AC joint.

This joint is like a little bridge. To keep this bridge strong, that is, to keep the two bones together, there are strong ligaments or bands (`ligaments`). In an accident, for example, if you fall hard on the shoulder, these ligaments (`ligaments`) can be stretched or torn. When these ligaments are torn or stretched, the collarbone (clavicle) and the shoulder bone (acromion) move slightly apart from each other. This is what we call a Separated Shoulder.

This condition is so common that some studies suggest that 40% of shoulder injuries involve the AC joint. It is especially common among people who play contact sports like rugby and football.

How do you know if you have this condition? (Symptoms)

The symptoms of a separated shoulder vary depending on the severity of the injury. Some people may only have mild pain, while others may be unable to move their shoulder due to severe pain. Let's take a look at the main symptoms.

Why is this happening? (Main reasons)

The main cause of this condition is a direct fall onto the shoulder. The impact of such a fall can tear the ligaments we talked about.

There are several situations where this could happen:

• Sports accidents: Collision or falling during sports such as rugby, football, and hockey. In our country, injuries like this can occur when a player falls while fielding a ball while playing cricket.
• Falls: If you injure your shoulder, such as when you slip and fall in the bathroom or fall down the stairs.
• Car accidents: Especially in motorcycle accidents, when the shoulder hits the ground.

How does a doctor diagnose this?

When you go to see a doctor with shoulder pain, he will first ask you about the accident and your symptoms. Then he will examine your shoulder.

• Physical examination: The doctor will feel your shoulder and check for any pain, swelling, or bone spurs. Sometimes they will ask you to lift your arm slightly with a weight. If the bone spurs appear to be more prominent, this can give you a better idea of ​​the injury.
• Imaging Tests: To determine the exact severity of the injury, your doctor may refer you for certain tests.
• Shoulder X-ray: This can clearly show how far apart the two bones are.
• Ultrasound scan: This helps to check for damage to the ligaments.
• MRI scan (Magnetic Resonance Imaging): This is not necessary in most cases. However, if the injury is complex, an MRI may be ordered to more clearly see the damage to the ligaments and surrounding soft tissues.

After these tests, depending on the nature of your injury, your doctor may refer you to an orthopedic surgeon . He or she will decide on the treatment based on the severity of the injury.

Classification of injury severity

Doctors classify separated shoulder injuries into 6 main categories based on their severity. The most commonly used classification is the Rockwood classification. This classification determines whether surgery is needed and how long it will take to heal.

What is the treatment for this?

Fortunately, most separated shoulder injuries (especially types I, II, and some types III) can be treated without surgery. The treatment method depends on the severity of the injury.

Nonsurgical Treatment

• Rest and immobilization: It is important to rest your arm in the early days until the pain subsides. Your doctor may recommend using a sling to immobilize your arm. This will help prevent unnecessary shoulder movement and help the ligaments heal.
• Ice: During the first 48-72 days, applying ice to the injured area for 15-20 minutes every 2-3 hours can greatly reduce pain and swelling.
• Painkillers: To control pain, your doctor may prescribe general painkillers like paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen and naproxen).
• Physical Therapy: Once the pain has subsided, physical therapy exercises are very important to help restore shoulder mobility and strengthen the muscles around the shoulder. But remember, these exercises should only be started after getting approval from a orthopedic specialist.
• Avoiding heavy lifting: You should completely avoid lifting weights until the wound heals, usually for 8-12 weeks.

Surgical Treatment

Surgery may be necessary for more serious injuries (types IV, V, VI), or type III injuries that do not respond to nonsurgical treatment. If a type III injury occurs, especially in a young, active, or athletic person, your doctor is more likely to recommend surgery. Surgery involves:

• Repair or strengthen torn ligaments.
• Using special devices (such as pins, wires, or plates) to move the collarbone and shoulder blade back into the correct position and stabilize them.
• Sometimes, if the injury has been going on for a long time, it may be necessary to reconstruct the ligament using tissue taken from another part of the body (graft tissue).

How long will it take to heal?

The recovery time depends on the severity of the injury and the treatment you received.

If you have surgery, the recovery time will be even longer. You won't be able to use your shoulder much for about 6 weeks after surgery. With physical therapy, it can take about 6 months to fully recover.

Things you can do for yourself during recovery

Once you have your doctor's approval, there are simple exercises you can do at home to strengthen your shoulder and increase flexibility.

1. Range-of-motion exercises

These can be started first after the pain subsides.

• Pendulum stretch:
• Stand near something like a table, place your good hand on the table, and lean forward slightly.
• Allow the injured arm to hang freely down.
• Now relax the muscles in your shoulder and move your arm forward and backward, side to side, and in circles.
• Do it without weights at first. After a few days, if there is no pain, you can do it while holding a small weight, such as a water bottle.

• Wall climbing:
• Stand facing a wall.
• Place the fingertips of the injured hand on the wall.
• Now, like a spider, slowly crawl up the wall with your fingers. Go as high as you can, hold for about 30 seconds, then slowly crawl back down.

2. Muscle-strengthening exercises

You can start these after you recover a little.

• Scapular squeezes:
• Lie down on the floor, bend your knees, and keep your feet on the floor.
• Keep both arms straight at your sides.
• Now squeeze your shoulder blades together as if you were pulling them towards your spine.
• Hold for about 5 seconds, then relax. Do this about 20 times.

Most importantly: Don't force any exercise through pain. If any exercise increases your pain, stop and talk to your doctor or physical therapist.

When should you see a doctor?

If you have any of the following symptoms after a shoulder injury, you should definitely see a doctor immediately. If necessary, go to the Emergency Department (ETU) of the nearest hospital.

• If there is severe pain .
• If there is a clearly visible lump or deformity on the shoulder.
• If you have numbness or loss of feeling in your hands or fingers.
• If your fingers feel cold or pale .
• If your hand feels lifeless .
• If it is difficult to move the hand normally.

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