Shoulder injuries rank very high in terms of how common they occur in athletics, especially in contact sports. Our athletic injury series this week will cover a separated shoulder, otherwise known as a sprained acromioclavicular (AC) joint. Sports such as hockey, football, rugby, and even skiing/snowboarding have been known to have high incidences of these injuries due to the trauma that is experienced with these sports. We’ll cover a variety of important topics when it comes to this injury, and how best to manage it!
Separated Shoulder Anatomy
Your AC joint is comprised of the very end of the collarbone and your shoulder blade. Around this joint, there are a lot of strong, broad ligaments that gives the joint the stability required to perform high level activity. The two main ligaments we are concerned about with this injury are the acromioclavicular (AC) ligament, and the coracoclavicular (CC) ligament. The coracoclavicular ligament has different portions of the ligament that attach to different areas of the shoulder to give it added support. However, the more severe the shoulder separation, the potential for a longer recovery.
Mechanism of Injury
A separated shoulder normally occurs with a direct fall onto the shoulder. This can either cause a minor sprain of the ligaments, or a more significant issue. If the trauma to the tissue is severe enough, some athletes will display a significant deformity at the top of the shoulder where it looks as if the collarbone is sticking too far up. That is usually an indication that the ligaments have been compromised and that more attention should be focused to the shoulder.
Even though it looks like the collarbone is too high, it is actually the shoulder blade that has sunk down due to the ligamentous structures around the joint failing to support the shoulder blade. Even though the aesthetics of this doesn’t look great, we’ll dive a little deeper as to why a higher grade separated shoulder may do just fine with conservative measures compared to other options. While you can injure your AC joint with repetitive overuse over time, we’re covering the traumatic separated shoulder.
Severity of Separation/Sprain
Below is an example of the severity you might see when dealing with AC joint sprains. You can see there is a lot more involved than just the ligament tissues being inflamed. In addition, your deltoid and trapezius muscles attach to these areas, which can compromise shoulder function as well. The top three sprains listed below can normally be managed conservatively. However, the bottom three normally require surgical intervention to address the instability in the shoulder itself.
Regardless of the severity of the shoulder separation, most athletes will initially be immobilized in a sling. This will reduce any excess strain on the healing tissue and get the pain under control. The important thing to rule out first and foremost is a fracture. Although landing on your shoulder is highly likely to cause a shoulder separation, it is also a high risk for a collarbone fracture as well. Once a fracture is ruled out, then it is a matter of regaining good shoulder motion and stability throughout that full range of motion. Here are some things to consider during the recovery process:
- Improve upper back mobility. Improving the ability for your upper back (thoracic spine) to be in a more upright position is important. It allows the shoulder blade to move more efficiently, which then allows the shoulder to move better. The likelihood of you getting into extreme ranges of motion is unlikely with poor postural positioning.
- Improve shoulder blade position and stability. This ties in to the first point as upper back stiffness causes inefficiency of movement through the shoulder blade region. If you are slouched forward, it causes the shoulder blade to rest in a forward tilt as well. This then puts excess stress on the top of the shoulder when moving the arm in different directions.
- Work on regaining dynamic control and stability through muscles around the shoulder. Improving good efficiency throughout the whole system is crucial to reduce undue stress on the healing ligaments on top of the shoulder.
A shoulder separation can recover well when managed conservatively. There is no one size fits all treatment when it comes to this injury, it has a ton of variability. Even higher grade sprains can recover fully albeit with a shoulder that looks a tad different. This type of injury is a perfect example of how severity of pain and tissue damage aren’t always directly correlated. With that being said, there are times where significant instability in the shoulder should be addressed surgically. We’ll be posting on our instagram page some recovery methods we use with our athletes! Be sure to tune in this week!