AC joint separation, known in its full medical term as acromioclavicular joint separation, is a relatively common injury for those who are physically active. Though there are variations, AC joint separations make up approximately 12% of all shoulder injuries in clinical practice.
You may have also heard an AC joint separation referred to as a shoulder separation. Despite how frequently they occur, not everyone knows how AC joint separations work. Therefore, we’ve written this complete guide to provide useful information about AC Joint separation injuries.
First, we’ll outline the structure of the shoulder itself and the three main types of AC joint separation. Then, we’ll cover how a shoulder separation diagnosis works before describing non-surgical and surgical treatment and the potential recovery times for patients.
The Structure of the Shoulder
To better understand how an AC joint separation injury can occur, we first need to explain the structure of the shoulder itself.
Your shoulder is primarily made up of three different bones. The first bone is your clavicle, which is also referred to as your collarbone. The second is your scapula, also known as your shoulder blade. And lastly, your humerus, which is your upper arm bone. These bones are connected by various associated muscles, ligaments, and tendons, which are also known as soft tissue structures.
By working together with the joints of these bones, your shoulder can move comfortably while the joints themselves remain in place. Due to its position on the human body, the shoulder is crucial to many forms of physical exercise.
Your shoulders are necessary for keeping good posture and contributing towards upper body strength. This is why many AC joint separation patients are athletes or people who often engage in physical activity.
The AC joint itself is located at the very top of your shoulder. It’s the joint that connects the clavicle to the acromion, which is part of your scapula.
Now that we’ve outlined the anatomy of the shoulder let’s dive into the symptoms of AC joint separation.
The Symptoms of AC Joint Separation
The symptoms of a separated acromioclavicular joint can vary depending on the cause and the patient. There are three degrees of severity for AC joint separation injuries, which are classified as type 1, type 2, and type 3. They’re also sometimes referred to as grade 1, grade 2, and grade 3 injuries and differ as follows:
Type 1/Grade 1: This is the most common acromioclavicular joint separation and is the least severe. These are AC injuries where patients have slightly torn or damaged the AC ligament, but there’s only a slight displacement with no significant damage.
Type 2/Grade 2: These are injuries where there’s a partial displacement of the separated acromioclavicular joint itself that might not be obvious to find during a physical examination. Grade 2 injuries usually involve torn AC ligaments, but the coracoclavicular (CC) ligaments should still be intact.
Type 3/Grade 3: These are the most severe AC joint separation injuries and need complete separation. Patients are likely to tear both AC and CC ligaments during a grade 3 injury. These injuries should be obvious to find on an initial physical examination and may also involve significant bumps on the shoulder or other forms of deformity.
Some notable symptoms occur for most AC joint separation injuries and will increase in severity depending on whether they’re type 1, 2, or 3. These can include:
- pain at the top of the shoulder,
- swelling or bruising around the shoulder area,
- a tender feeling when touching the AC joint,
- visible deformities on the shoulder, such as bumps,
- being unable to move the shoulder the way one usually would or carry as much weight using that arm.
If athletes or individuals are experiencing several of these symptoms, they’ll need to have a thorough AC joint separation diagnosis to figure out the severity of the problem.
What is AC Joint Separation Diagnosis?
As with any physical injury or illness, you have to be correctly diagnosed with AC separation before accessing treatment.
The first stage in the diagnosis process involves a physical examination. This will begin with reviewing a patient’s medical history to check whether they’ve experienced shoulder problems or other issues before inspecting the joints.
For grade 3 AC joint separation injuries, it can sometimes be immediately apparent that the problem is a shoulder separation. This will depend on whether or not the patient has visible deformities on their shoulder.
A doctor will inspect the shoulder, including pressing softly on the AC joint itself to check its strength and durability. Patients may also need to move their affected arm around where possible so that the doctor can review their range of motion. This can help a doctor determine which specific parts of the shoulder are causing the pain or are otherwise weakened by the injury.
Depending on whether or not the problem is apparent, the patient could need to undergo an X-ray. This can provide a clearer picture of the problem and allow a doctor to assess the severity of an AC separation grade injury.
Non-surgical Treatment
Most doctors will treat grade 1-3 AC joint separations without surgery. Some of the most common treatments can include:
- placing ice on the shoulder itself to reduce swelling and any current pain,
- prescribing a protective sling for the shoulder and an extended rest period for at least 1-2 weeks for the patient. Sometimes, a doctor may prescribe more complicated supports,
- taking specific pain and anti-inflammatory medications as prescribed by a doctor,
- organising a rehabilitative program to strengthen the shoulder and return it to normal. These types of programs are particularly important for athletes who have experienced AC joint separations, but usually, anyone who’s suffered will need to undergo some form of rehabilitation on their shoulder.
In most cases, it is advisable to undergo non-surgical attempts before considering a surgical procedure for AC joint separation.
However, there are situations where the surgical treatment process will be necessary.
Surgical Treatment
Doctors typically reserve surgical treatments of AC joint separation injuries for severe cases or patients who have not responded to non-surgical treatment procedures. In particular cases, such as for high-performing athletes who regularly put a large amount of pressure on their shoulders, surgery may be recommended after an initial examination.
Individuals who have experienced a severe AC joint separation will need a surgeon to complete the procedure. Our website provides a list of surgeons including practitioners from around the UK who specialise in performing surgery to repair AC joints.
The most common surgical procedure to repair a shoulder separation involves reconstructing the torn CC ligaments. A surgeon might then remove a small portion of the shoulder end of the clavicle, also known as the distal.
The AC Joint is then stabilised by pins, plates, screws, or sutures. Some more advanced shoulder reconstruction techniques can include shoulder stabilisation systems. At Lockdown, we have developed the LSSS stabilisation system that aids in the repair of injured AC Joints.
AC Joint Separation Recovery Time
Recovery after non-surgical treatment of a shoulder separation often is completed within two to three months, provided the injury isn’t too severe. As a general rule, every patient differs. It can take an average of two weeks to recover from a grade 1 injury, six weeks for a grade 2 injury, and 12 weeks for a grade 3 injury, where surgery isn’t required.
If surgery is required to reconstruct the shoulder, the recovery process will take longer. Some surgical procedures can take an estimated four to six months before a full recovery.
With Lockdown’s LSSS stablistation system, the goal is to ensure recovery times are as short as possible. The average recovery time for patients involved in an LSSS procedure is 12 weeks.
