Does your shoulder look like it's on one side? Is this what you mean by 'Separated Shoulder'?

Have you ever fallen, hit your shoulder really hard, and thought, "Oh my god, my shoulder's dislocated!"? It may not be a 'dislocation' as you think, but a 'separated shoulder' . That's a different story. Today, we'll talk about what a separated shoulder is, why it happens, what the symptoms are, how to treat it, and what you can do to prevent it from happening again.

What is a 'separated shoulder'?

Simply put, a separated shoulder is a condition that occurs in the acromioclavicular joint in your shoulder. This joint is where your collarbone, the clavicle , meets the top part of your shoulder blade, the acromion . Think of it like a bridge.

The important thing is, this is not an injury to the main ball-and-socket joint in your shoulder. There's no problem there. What's happening here is that the ligaments between the clavicle and the acromion – the bands that hold the joint together – are being stretched or torn . When this happens, the connection between the collarbone and the shoulder blade becomes loose, and the two begin to separate, or move apart. That's why it's called a shoulder separation. Some people also call it an AC joint separation.

How common is this condition?

It's more common than you think. Some studies suggest that as many as 40% of all shoulder injuries are caused by acromioclavicular joint injuries! This is especially common among people who play collision sports like football, lacrosse, and hockey. AC joint separations account for 9% of all injuries in these sports.

What are the symptoms of this?

The symptoms of a shoulder dislocation can vary from person to person. It depends on the severity of the injury. Some people may only have mild pain, while others may have severe pain and other symptoms. See if you have any of these:

• A pain right at the top of the shoulder: right where the collarbone ends.
• A lump on the top of the shoulder, like a lump: This is the most obvious sign for most people. This is what happens when the ligaments tear, causing the shoulder blade to drop down under the weight of your arm. Then the top of the clavicle bulges out. It looks like a little lump.
• Inability to move the shoulder properly: It may feel difficult to raise or rotate the arm.
• Swelling and pain when pressed: The hand may feel sore and swollen.
• Bruising: Sometimes it can turn blue and look bruised.

Why is there such a separation of shoulders?

This is often caused by a fall directly onto the outside of the shoulder . If the fall is too hard, the ligaments can tear. For example, you fall off your bike, or you slip and hit your shoulder while playing sports, or you get hit by someone while playing sports.

For example, if a football player dives to catch a ball and hits the back of his shoulder and slides, his arm can be pinned down and cause this type of injury. This can also happen in car accidents.

What complications can this cause?

Although most people recover completely after treatment, sometimes the lump may remain. Also, some people may have ongoing pain, even though it may seem like a minor injury. This can be caused by bones rubbing together, arthritis, or damage to the cartilage that acts as a cushion between the bones in the shoulder joint .

How does a doctor recognize this?

When you go to see a doctor, he will first ask you about your current symptoms and how this happened. Then he will do a physical examination . The doctor may ask you to hold a small weight in your hand. If you do this, you can see that the collarbone is protruding upwards, which will help confirm the injury.

Depending on the nature of the disorder, the doctor may also order certain imaging tests . These include:

• Shoulder X-ray
• Ultrasound examination
• MRI (Magnetic Resonance Imaging) test

You may also be asked to hold a weight in your hand during these tests, so that the injury can be clearly seen in the images.

After these tests, your doctor may refer you to an orthopedic surgeon . This specialist can determine the severity of your shoulder dislocation. They use a classification system called the Rockwood classification of AC joint injuries. This classifies the injury from Type I (minor damage to the AC ligament, where the joint is still intact) to Type VI (complete tear of the ligament, where the joint is completely detached). This classification will determine the treatment, whether surgery is needed, how long the treatment will last, and what the long-term effects will be.

Different grades of shoulder separation

Shoulder dislocations can range from minor to very serious. Doctors classify these ``Acromioclavicular joint`` dislocations based on the extent of the injury and how many ligaments are damaged. The ``Rockwood classification`` mentioned earlier is the most commonly used. Let's look at some of its details:

• Type I: Your acromioclavicular (AC) ligaments may be slightly stretched or torn. However, the other ligaments that help stabilize your clavicle , the coracoclavicular (CC) ligaments, are not damaged. You may have some swelling and tenderness. This should heal on its own in a few weeks.
• Type II: Here your AC ligaments are completely torn, and your CC ligaments are stretched or slightly torn. There may be significant swelling along with mild tightness.
• Type III: In this case, both the AC ligaments and CC ligaments are completely torn. Your AC joint may look like a big lump and may be very swollen. The CC joint may also be very painful when pressed.
• Type IV: This is where the ligament is torn, causing your collarbone to be pushed back and stuck behind the acromioclavicular joint. This is a more serious injury and may require surgery .
• Type V: The ligament is torn, and the end of the clavicle (clavicle bone) is pulled into a muscle above the acromioclavicular joint. This is also serious and may require surgery.
• Type VI: The ligament is torn, and the clavicle is pushed down and trapped under the coracoid, which is part of your shoulder blade. This is a very rare but very serious condition. Surgery is required.

How is this treated?

The good news is that most people can recover from a shoulder separation within two to twelve weeks without surgery. Nonsurgical treatments include:

• Using a sling: This helps keep the shoulder in one place until it heals.
• Ice packs and painkillers: Your doctor may recommend NSAIDs (Nonsteroidal anti-inflammatory drugs) , such as Ibuprofen and Naproxen , or aspirin or acetaminophen, to reduce pain.
• Physical therapy or an exercise program: Once your shoulder has healed, these can help strengthen the muscles and ligaments in your shoulder. However, you should get approval from your orthopedic specialist before starting a rehabilitation program.
• Avoid lifting weights for 8 to 12 weeks after the injury has healed.

In some severe cases (such as Rockwood grades IV, V, and VI), or if nonsurgical treatments do not provide the desired results, surgery may be necessary. If your fingers are numb, feel cold, have weak arm muscles, or have severe shoulder deformity, this indicates a more serious condition. Surgical treatments may include:

• Cutting off the end of the clavicle: This will stop it from touching the shoulder blade.
• Reattaching torn ligaments to the underside of the ankle bone: This surgery can be done even after a long period of time since the injury. However, if the injury has been ongoing for a long time, a graft tissue may be needed to rebuild the ligaments.

Can shoulder separation be prevented?

There is no surefire way to prevent a shoulder dislocation completely. However, it can be helpful to be aware of some factors that increase the risk of shoulder injury. Things like these can put your shoulder at risk:

• Repetitive motions using the shoulder.
• Aging .
• Overuse or strain of the shoulders, especially in people over 65 years of age .
• Manual labor .
• Participating in sports that involve collisions with other people or on the ground.
• Accidents and falls .

What can I expect if I have a dislocated shoulder?

You can expect to experience pain and swelling, especially if the injury is severe. But the good news is that the prognosis for most acromioclavicular joint injuries is generally good.

Most shoulder dislocations are treated non-surgically. Your recovery time from a minor shoulder dislocation can range from a few days to less than six weeks . Depending on the severity of the injury, you should be able to return to normal activities within three months.

But if you need surgery to separate your shoulder, the recovery time may be longer. You may not be able to use your shoulder for up to six weeks. It may take about six months to gradually return to normal activities.

How can I take care of myself? Are there exercises I can do at home?

Yes, there are exercises that can help your shoulder heal faster. But remember, before starting any shoulder exercises, you should talk to your orthopedic surgeon. Start them as he says, and when he says.

Range-of-motion exercises

These exercises will help you maintain mobility in your joints and keep your shoulder muscles and tendons flexible. Try doing these exercises once or twice a day for about five minutes.

• Pendulum stretch:
• Relax your shoulder muscles.
• Sitting or standing, bring your injured arm close to your body, straight down.
• Wave your hand back and forth, then side to side. Then, draw small circles with your hand.
• Do this without weights for the first three to seven days. Then gradually add 1-2 pounds (0.5-1 kg) of weight per week. Over time, you can gradually increase the diameter of the circle.

• Wall climbing:
• Use your good hand and hold your disabled hand against the wall.
• Now use your fingers to slowly move up the wall (just like a spider moving up a wall).
• Use your other hand and body to give this a little help.
• Hold it for about 30 seconds and then relax.
• Do this about four times, trying to go a little higher each time.

Muscle-strengthening exercises

These exercises will help strengthen your shoulder muscles and prevent further injury. You can usually start these exercises a week or two after starting the pendulum stretch. An example of this is scapular squeezes. Try doing these two to three times a day.

• Scapular squeezes:
• Lie on your back, knees bent, and feet flat on the floor.
• Hold your arms straight out, palms facing up, and about 6-12 inches (15-30 cm) away from your sides.
• Now press your shoulder blades down and together (towards the middle of your spine). At this point, your lower back should be pressed into the floor.
• Hold for five seconds, then relax. Do this 20 times.
• Keep your neck relaxed and don't raise your shoulders. You should feel the muscles between your shoulder blades tighten.

When should you see a doctor about a shoulder dislocation?

After a shoulder injury, you should definitely seek medical advice if you have any of these symptoms:

• Severe pain.
• Weakness in your hand or fingers.
• If your fingers are numb or feel cold.
• If it is difficult to move your hand normally.
• If it looks like a lump on your shoulder and it looks distorted.

Remember: If you have any of these symptoms, do not self-medicate at home. See a doctor immediately.

What questions should I ask my doctor?

If you have a dislocated shoulder, it's a good idea to ask your doctor these questions:

• What type or grade of shoulder separation do I have?
• What kind of treatment do you recommend?
• What can I do at home to help me recover?
• How long will it take to recover from this disorder?
• What can I do to prevent my shoulder from dislocating again?

What is the difference between a 'Separated Shoulder' and a 'Dislocated Shoulder'?

This is something that many people get confused about. These two are good!

• Separated Shoulder: This is a ligament injury to your acromioclavicular joint . This is where your collarbone (clavicle) meets the top of your shoulder blade (acromion).
• Dislocated Shoulder: This happens to your glenohumeral joint . That's where your upper arm bone (humerus) connects to the shoulder socket. This is when the ball-like part of the arm bone comes out of the joint.

Simply put, in a 'separated shoulder' the collarbone comes up, while in a 'dislocated shoulder' the entire shoulder joint comes off.

Finally, things to remember (Take-Home Message)

A shoulder dislocation is a shoulder injury that can cause pain and swelling. While most of these injuries are minor, some can be serious and require surgery. It can happen to anyone, not just athletes, who have had a fall or other accident to the shoulder.

If this happens to you, the most important thing is to rest and not strain your shoulder. It may get better on its own in a few days. But, if it doesn't, definitely see a doctor to find out exactly what's wrong. If you get the right treatment quickly, you'll be able to recover quickly and get back to your normal activities!

` Shoulder separation, AC joint, shoulder injuries, shoulder pain, ligament tears, sports injuries, physical therapy