Shoulder separation
| Separated shoulder | |
|---|---|
| Synonyms | acromioclavicular separation, AC joint separation, AC separation |
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| A Separated Shoulder XRay modified to easily show bones. Notice the separation between the end of the collarbone and the scapula. | |
| Classification and external resources | |
| Specialty | orthopedics |
| ICD-10 | S43.1 |
| ICD-9-CM | 831.04, 831.14 |
| eMedicine | orthoped/462 |
A separated shoulder (also known as acromioclavicular separation, AC separation), is a common injury to the acromioclavicular joint. It is a joint dislocation, but it is not called a dislocated shoulder, as that term refers to a glenohumeral joint (shoulder joint) dislocation. The AC joint is located at the distal end of the clavicle, known as the acromial end, and attaches to the acromion of the scapula. Although this is part of the shoulder, a dislocated shoulder and a separated shoulder are completely different. Acromioclavicular separation occurs as a result of a downward force being applied to the superior part of the acromion, either by something striking the top of the acromion or by falling directly on it. The injury is more likely to occur if the shoulder is struck with the hand outstretched. Despite the scapula pulling on the clavicle during impact, the clavicle remains in its general fixed position because of the sternoclavicular joint ligaments.
The trauma to the shoulder affects the ligaments holding the two bones—the scapula and the clavicle—together. This injury does not always involve bone fractures; however if the impact to the shoulder is severe, fractures may occur.
There are four types of soft tissue disruptions that may cause acromioclavicular separation:
Separated shoulders often occur in people who participate in sports such as football, soccer, horseback riding, hockey, parkour, combat sports, rowing, rugby, snowboarding, skateboarding, crack the whip, cycling, roller derby and wrestling. The separation is classified into 6 types, with 1 through 3 increasing in severity, and 4 through 6 being the most severe. The most common mechanism of injury is a fall on the tip of the shoulder or also a fall on an outstretched hand. In falls where the force is transmitted indirectly, often only the acromioclavular ligament is affected, and the coracoclavicular ligaments remain unharmed. In ice hockey, the separation is sometimes due to a lateral force, as when one gets forcefully checked into the side of the rink.
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