A separated shoulder, otherwise known as an acromioclavicular separation or AC separation, is a common injury to the acromioclavicular joint. This is not the same as a shoulder dislocation as that involves a dislocation of the Glenohumeral joint. The AC joint is located at the distal end of the clavicle, know as the acromial end, and attaches to the acromion of the scapula. Although this is part of the shoulder, a dislocation and a separation are completely different. The first level of separation occurs when the capsule of the AC joint is damaged (known as a grade 1).
Most non-surgical treatment options include physical therapy to build up the muscles around the joint, helping stabilize the joint. Literature regarding long-term follow-up after surgical repair of type III injuries is scarce, and those treated nonoperatively generally do quite well. Many studies have come to the conclusion that non-surgical treatment is as good as or better than surgical treatment, or that anything attained because of surgery is quite limited. It appears that after a while, the body “remodels” the joint, either expanding the distal clavicle or causing it to atrophy. One study suggests that quarterbacks with type III injuries on their dominant side may possibly do better with surgery. There may also be the potential that surgical repair may be less painful in the long run.
Type 2 separations have always been treated non-surgically, initially. However, the risks of arthritis with type 2 separations are greatly increased. If this becomes severe, the Mumford procedure or distal clavicle excision can be performed.
There have been many surgeries described to fix complete acromioclavicular separations, including recently arthroscopic. There is no consensus on which surgery is best. Several surgeries have been described with pins or hooks. Another surgery performs muscle transfer.
A common surgery is some form of Modified Weaver-Dunn procedure, which involves cutting off the end of the clavicle portion, partially sacrificing the coracoacromial ligament and suturing the displaced acromial end to the lateral aspect of the clavicle for stabilization, then often some form of additional support is introduced to replace the coracoclavicular ligament(s). Variations of this support includes grafting of tendons from the leg or the use of synthetic sutures or suture anchors. Other surgeries have used a Rockwood screw that is inserted initially and then removed after 12 weeks. Physical therapy is always recommended after surgery, and most patients get flexibility back, although possibly somewhat limited.
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