An AC joint separation can cause pain at the top of the shoulder, visible deformity, and difficulty lifting or carrying objects. Although many of these injuries improve with nonsurgical care, more severe or persistent separations may require surgery to restore stability.
Dr. Brian Cohen has performed more than 30,000 orthopedic surgical procedures and provides individualized AC joint separation treatment in Columbus, OH. He evaluates the severity and timing of the injury, shoulder stability, activity demands, and response to nonsurgical care before recommending treatment.
About AC Joint Separation
The acromioclavicular, or AC, joint is located where the clavicle meets the acromion at the highest point of the shoulder blade. Ligaments surrounding the joint help maintain alignment between these bones.
An AC joint separation, also called a shoulder separation, occurs when these stabilizing ligaments are stretched or torn. Mild injuries may involve an AC ligament sprain, while more severe separations can damage both the AC and coracoclavicular ligaments and create a visible bump at the top of the shoulder.
AC Joint Separation Causes
An AC joint separation usually results from a sudden traumatic injury. Common causes include:
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Falling directly onto the top or outer portion of the shoulder
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A direct blow during football, hockey, wrestling, or another contact sport
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Falling from a bicycle or horse
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A motor vehicle collision
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Falling onto an outstretched hand and transmitting force into the shoulder
The severity of the separation depends on the direction and amount of force placed on the joint and its supporting ligaments.
AC Joint Separation Symptoms
Symptoms vary according to the severity of the ligament damage. They may include:
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Pain and tenderness at the top of the shoulder
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Swelling or bruising around the AC joint
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Pain when lifting or moving the arm
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Reduced shoulder strength or range of motion
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A feeling of instability
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Popping, clicking, or catching with movement
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A visible bump or change in the contour of the shoulder
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Discomfort when lifting, reaching, carrying, or lying on the injured side
Anyone who develops these symptoms after a fall or direct impact should seek prompt evaluation. An open wound, severe deformity, numbness, weakness, or a pale or cold arm requires urgent medical attention.
Diagnosing AC Joint Separation
Diagnosis begins with a discussion of how the injury occurred and the symptoms that followed. Dr. Cohen or one of his orthopedic colleagues will examine the shoulder for tenderness over the AC joint, swelling, bruising, deformity, range of motion, strength, and stability.
X-rays are typically used to evaluate joint alignment and rule out an associated fracture. Additional or comparison views may occasionally help clarify the severity of the separation. MRI may be considered when symptoms suggest damage to the rotator cuff, labrum, or other surrounding soft tissues.
AC Joint Separation Grades
AC joint separations are commonly classified from Grade I through Grade VI according to the extent of ligament damage and displacement.
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Grade I: The AC ligament is sprained, but the joint remains aligned.
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Grade II: The AC ligament is torn, and the coracoclavicular ligaments are sprained or partially injured.
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Grade III: Both the AC and coracoclavicular ligaments are torn, producing more noticeable displacement.
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Grades IV through VI: These less common injuries involve significant displacement of the clavicle or shoulder blade and more extensive soft-tissue damage.
Treatment depends on the grade and timing of the injury, the amount and direction of displacement, persistent pain or instability, overall health, and the patient’s work and athletic demands.
AC Joint Repair with Arthrex® Dog Bone™ Button
AC Joint Separation Nonsurgical Treatment
Grade I and Grade II injuries are generally treated without surgery. Many Grade III separations can also improve with nonsurgical care, depending on the patient’s symptoms, activity demands, and degree of instability.
Treatment may include:
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A sling to support the arm and improve comfort
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Ice to reduce pain and swelling
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Pain-relieving or anti-inflammatory medication when appropriate
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Temporary limits on lifting, reaching, and sports
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Gentle range-of-motion exercises as pain improves
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Physical therapy to restore motion, strength, and shoulder control
A visible bump may remain even when pain and shoulder function improve. Dr. Cohen monitors recovery and determines when work, lifting, and athletic activities can safely resume.
AC Joint Separation Surgery Options
Surgery may be considered for certain high-grade separations, severe displacement, persistent pain or instability, major functional limitations, or symptoms that do not improve with appropriate nonsurgical treatment.
The procedure depends partly on whether the injury is acute or chronic:
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Acute AC joint repair: When the injury is treated soon after it occurs and the ligament tissue can still heal, surgery may reposition the joint and stabilize the damaged ligaments. Arthroscopic assistance, small incisions, or an open approach may be used.
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Chronic AC joint reconstruction: When the injury is older, or the original ligaments cannot heal reliably, reconstruction may use graft tissue to recreate the coracoclavicular ligaments and restore stability.
Fixation may involve sutures, buttons, grafts, or other surgical implants selected according to the injury. Dr. Cohen reviews the benefits, limitations, and risks of nonsurgical care, repair, and reconstruction before recommending a procedure.
Recovery and Rehabilitation
Recovery depends on the severity of the separation, treatment performed, and the patient’s activity needs. Early rehabilitation focuses on reducing pain and protecting the injured joint while maintaining movement in the elbow, wrist, and hand.
As healing progresses, physical therapy gradually restores:
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Shoulder range of motion
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Rotator cuff and shoulder-blade strength
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Joint control and stability
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Lifting and reaching ability
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Sport- or work-specific function
Patients recovering from surgery generally need a longer period of protection before strengthening begins. Return to contact sports, heavy lifting, and demanding work is based on healing, strength, stability, and functional progress rather than time alone.
Why Choose Dr. Cohen?
OVER 25+ YEARS OF EXPERIENCE
One of the first orthopedic surgeons employed by a large hospital. Dr. Cohen spent 20 years.
TRUSTED BY OVER 100,000+ PATIENTS WORLDWIDE
Over his distinguished career, Dr. Cohen has cultivated a reputation of excellence and trust among his patients and his peers.
UTILIZING THE LATEST TECHNOLOGY
To achieve the best surgical outcomes, Dr. Cohen uses the most advanced technologies and techniques, keeping his practice state-of-the-art.
PATIENT SAFETY IS TOP PRIORITY
An individualized, patient-focused process coupled with decades of training and experience helps ensure maximum safety for all of Dr. Cohen’s patients.
AC Joint Separation Care in Columbus, OH
An AC joint separation can cause pain, deformity, weakness, and difficulty using the arm. Dr. Cohen evaluates the injury grade, joint stability, timing, and activity demands before recommending rehabilitation, ligament repair, or reconstruction. To schedule a consultation with Dr. Brian Cohen, call (614) 788-0375.
