Acromioclavicular (AC) Separation

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The acromioclavicular (AC) joint is the meeting of the clavicle and the acromion (roof of the scapula). This union is joined by the acromioclavicular ligament AC separations typically occur when there is a fall on the shoulder.
This can cause a disruption or separation of the ligament holding the clavicle and the scapula resulting in shoulder pain. Football and hockey are common sports activities where AC separations are seen.

AC separations are graded on the degree of injury to the tissues.

  • Grade I: A mild AC separation, the ligaments are stretched, but not torn with shoulder pain.
  • Grade II: A moderate AC separation, some of the ligaments are torn. These sprains may involve some loss of function and significant shoulder pain.
  • Grade III: A severe AC separation, there is a complete tear all the way through the ligament. These are significant injuries that require medical or surgical care to ensure recovery. As the ligament tears away from the bone, it may also take a small chip of bone with it, resulting in an avulsion fracture.
Symptoms include:
  • Shoulder pain with swelling and deformity with grade III AC separation.
  • Bruising with a bump over the injury site.
  • Tearing or popping sensation with movement.
  • Inability to move arm away from the body due to severe pain.
Non-surgical treatment
  • Protection from further injury with a sling or brace.
  • Rest, limiting movement of the injured shoulder as much as possible.
  • Cold therapy to stimulate blood flow and relieve the pain associated with inflammation. Cold therapy should be applied several times over the course of the day.
  • Nonsteroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen, Motrin, Naprosyn and Celebrex may be used to decrease shoulder pain. Be sure to talk to your doctor before starting these medications.
Surgical treatment

Grade III AC separations in which the ligaments may be severely torn and where the collarbone is compromised may require surgical repair to hold the collarbone in place. The AC joint is relocated and torn ligaments are repaired. The surgeon may use a screw or some other fixation to hold the joint in place as the ligaments heal.

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AC Separation