The acromio-clavicular joint ("AC joint ") is where the clavicle ("the "collar bone")is connected to the scapula (the "shoulder blade"). Ligaments form a strong connection between these bones. During activity and motion, there is some rotation that occurs between these bones, particularly when raising the arm overhead.
These bones are connected by ligaments which may be injured by falls, direct impacts and many other ways. Injuries to the AC joint are commonly referred to as "shoulder separations." From a medical point of view such acute injuries are diagnosed as sprains of the AC joint or if the ligaments are completely torn it may be called an AC joint dislocation. Sometimes AC joint injuries can include a combination of fractures and ligament injuries. Careful evaluation of x-rays and sometimes other types of tests (MRI or CT scans) are always necessary to define the injury accurately.
Treatment of AC Sprains "Shoulder separations"
Sprains can be partial tears or complete tears. If the tear is partial, some healing of the ligaments should be expected. It may take months for the pain to decrease depending on how severe the injury was. There may be a noticeable swelling or deformity where the lateral end of the clavicle appears to "stick up." The more complete the ligament injury the more it may appear prominent. In severe cases the end of the clavicle may be shifted towards the back or more rarely in other directions. In general partial ligament injuries (termed grade 1 and grade 2 sprains) are usually treated without surgery. Even there is a complete tear and deformity, return to good function (with a deformity) is very often possible. In patients who are very physically active, surgical repair of acute AC joint dislocations may be considered. Doctors do not all agree about when surgery should be done in these cases. I believe the decision is best individualized on the patients preferences, the exact nature of the injury and other circumstances involving work, family and sport desires. If surgery is not chosen initially in cases of AC joint dislocation (grade 3 or greater) and symptoms persist, later surgery can be done with a good success rate as well. If there are fractures in combination with the ligament injuries or fracture around the AC joint resulting in deformity, surgery is best in some cases.
What does the surgery do and how long is the recovery?
Depending on how recent the injury is and the exact pattern of ligament and bone injury, the exact technique may vary. In general the principle is to repair or reconstruct the torn ligaments and repair the fractures as needed. Recovery time after surgery varies based on the above. We like to begin early motion to prevent scar tissue from forming. Surgery is generally done as an outpatient, unless associated medical problems make admission necessary.
We will see you 2-3 days after surgery to change your bandage and check your motion. Sutures are removed about 7-10 days after surgery. You may have a shoulder brace for up to 6 weeks after surgery. Full recovery from AC joint surgery for these problems generally occurs between 3-6 months but is sometimes longer depending on the activities you must do and the severity of your condition. Often we suggest the assistance of a professional physical therapist in your post-operative recovery.