Background and Etiology

The shoulder is formed by three bones, the upper arm (humerus), collar bone (clavicle), and the shoulder blade (scapula). At the top of the shoulder there is a protective arch formed by the inferior aspect of the acromion and coracoid process of the scapula with the coracoacromial ligament spanning between them. This arch overlies the head of the humerus and is called the coracoacromial arch.

The shoulder blade (scapula) and collar bone (clavicle) are joined together at the tip of the shoulder. This is called the acromioclavicular joint. The superior and inferior acromioclavicular ligaments and coracoclavicular ligament hold together the two ends of the scapula and clavicle. In a shoulder separation, these ligaments are partially or completely torn. There are six levels of shoulder separation that vary based on the severity of the injury.

Type 1: the acromioclavicular ligament is partially torn, but the coracoclavicular ligament is intact.

Type 2: the acromioclavicular ligament is completely torn, and the coracoclavicular ligament is intact or partially torn. The collarbone is partially separated from the acromion.

Type 3: the acromioclavicular ligament and coracoclavicular ligament are completely torn. The collar bone and acromion are completely separated.

Types 4 through 6: are more severe and involve the tearing of muscle in addition to the joint separation.

A shoulder separation usually occurs due to a direct injury or blow to the top of the shoulder (for example, from football, hockey or other high contact sports) or a fall onto an outstretched arm (FOOSH injury).

  • Immediate pain at the time of injury
  • Tenderness of the acromioclavicular joint
  • Swelling and bruising
  • Pain that limits movement
  • Possible bump or step down deformity where the acromion is separated from the clavicle.

The treatment for a shoulder separation will depend on the severity of the injury and what type of separation (1-6) you have.

Type 1-2: separations are usually placed in a sling to reduce pain and support the injury site. Early physical therapy is initiated to prevent a frozen shoulder, improve range of motion and initiate light strengthening.

Type 3: separations are sometimes treated with surgery, while in other cases a sling and therapy can be successful. Evidence shows that a nonsurgical approach to these injuries is just as effective as surgery. Individuals who participate in over head sporting activities or laborers who perform heavy lifting may benefit from surgery.

Type 4-6: separations should be evaluated for surgery by a trained professional.

Physical Therapy treatment following a shoulder separation will depend on the severity of the injury. If surgery is not required, treatment will be focused on restoration of shoulder motion near the end of the shoulder immobilization period. It is important to get the shoulder moving while protecting the acromioclavicular joint to avoid a frozen shoulder.

As the pain subsides, strengthening exercises should be initiated to prevent muscle weakness and atrophy. Physical therapy following surgery for a shoulder separation will be delayed, but will have the same goals and purpose. Common interventions in the treatment of a shoulder separation include:

  • Manual Therapeutic Technique (MTT): hands on care including mobilization, soft tissue massage and manual stretching to regain mobility and range of motion of the shoulder while protecting the acromioclavicular joint.
  • Therapeutic Exercises (TE) to regain range of motion and strengthen the shoulder and surrounding joints. Rotator cuff and shoulder strengthening exercises to dynamically depress and stabilize the humeral head and prevent it from irritating the acromioclavicular joint. Strengthening of the trapezius and deltoid muscles to support the acromioclavicular joint should also be initiated.
  • Neuromuscular re-education to begin retraining the upper extremity and the person overall to use the involved upper extremity in daily activities. Scapular and shoulder stabilization exercises to improve stability of shoulder and support the acromioclavicular joint may also be initiated.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain at the shoulder.
  • Home program that includes stretching and strengthening exercises as well as instructions to help restore motion and strength of the shoulder girdle.
  • Initially, medical management of the separated shoulder should focus on reducing the inflammation and pain, and resting the joint.
  • Application of ice to reduce inflammation
  • Anti-inflammatory medications and pain medication to help reduce inflammation and pain.
  • Use of a sling to immobilize the shoulder
  • Initiation of early physical therapy
  • In the case of severe separations, surgery may be required to regain full motion and function.

Prognosis

Patients with simple separations typically do well, especially when the ligaments are not badly damaged. More severe cases that require surgery take longer to recover but most people do recover full function in a short period of time.

Schedule an
Appointment!

Get back to doing what you love.

We are dedicated physical therapists that genuinely care. We strive to restore you to your former self, no matter the injury.

SCHEDULE APPOINTMENT

Real People, Real Testimonials.

I have been a customer at Twin Boro in the Hadley Center Mall, South Plainfield off and on for over a year, in the care of Brianna Patane. I am writing to commend the staff there on their friendly and helpful customer service and professional and personal approach to physical therapy. In particular I want to let you know what an asset to Twin Boro Brianna is. She is an outstanding physical therapist who provides a great exercise program to use both onsite and at home, and also utilizes deep massage to increase blood flow to the injured area, which also helps make the injured area feel better. Her friendly and professional approach to PT made my experience there more enjoyable then I ever thought PT could be, and the results and improvement to my injury were noticeable at once and were long-lasting. Not only are her PT skills top notch, but her enjoyment of working with people made it a joy to have her as my physical therapist. She is the best! Having a 41-year career myself, I know employees like Brianna do not come along every day, and my suggestion is that Twin Boro do whatever is necessary to keep this valuable employee on your staff. She is a tremendous physical therapist.

Lisa W.

"Eric was an excellent physical therapist. I made tremendous improvement during my time there. Rachel & Brittany were always smiling and creating a positive environment. Highly recommend using twinboro EHT!!!"

Ella G.

“I loved being a patient at your facility because your therapist went by my and the doctors needs. I was there not only at the old location in somerset but also I went to the new location to in North Brunswick, which I loved it was bigger and better. All of the therapist are so friendly and nice and treated you with respect. I was treated by not only Melvie but also Nick and both are so professional and gentle of the way they did my treatments. If I ever need to have physical therapy in the future I will definitely come back to your facility for you are very professional and well organized. I have been to other places but your facility beats them all.”

Christine

"I went from being almost totally debilitated by a pelvic fracture to being able to negotiate 6 flights of stairs. Therapy was intense, therapist are knowledgeable, helpful,encouraging and respectful. I highly recommend this facility."

Stephanie R.

View all Testimonials

We have 23 convenient locations

We love being close to our patients. Find out which of our premier facilities is nearest you!

VIew a list of all locations