This week I want to discuss a relatively rare and sometimes confusing sports injury: the shoulder separation. This injury generally results from a direct blow to the top of the shoulder, such as when a quarterback is sacked and the shoulder is driven into the ground.
Treatment of these injuries has evolved over time and demonstrate the progress in technology we have in sports medicine, as we can now treat many of these cases that need surgery with arthroscopic surgery instead of open surgery.
In contrast to shoulder dislocations, which occur when the ball (humeral head) comes out of the socket (glenoid), shoulder separations occur when the collar bone (clavicle) dissociates from the top of the shoulder blade (acromion). Shoulder separations are also commonly called “AC separations” (acromion-clavicle separation).
An important difference between the glenohumeral joint and the AC joint is that the AC joint is not a gliding joint with articular cartilage responsible for shoulder motion. See the images below for the injured shoulder, the arthroscopically repaired AC separation, and a view of the skin portals used in such a case.
Most cases of AC separations are low-grade injuries treated without surgery, and often athletes don’t miss much competition. There are even quarterbacks in the NFL that have had shoulder separations to their throwing shoulders and have not lost much time to the injury while continuing to compete at an elite level.
In severe or symptomatic chronic cases, surgical fixation and/or reconstruction can be considered to restore the anatomy and treat the symptoms. Historically, AC surgery was done through an open technique but recently, arthroscopic techniques have been developed.
Arthroscopic AC surgery minimizes surgical pain and can be done on an outpatient basis. As orthopedic sports medicine continues to advance, arthroscopic techniques will continue to be developed as an alternative to open surgery, and this injury pattern highlights that trend.
Bryan Warme, MD
