Shoulder Separation

CONDITION

A shoulder separation happens when ligaments, strong bands of tissue that attach bones to bones, are torn in the joint above the shoulder (Figure 1). The outside end of the collarbone (clavicle) and a bone that sticks up from the shoulder blade (acromion) are attached by two ligaments to make up this joint.

• True separation of the bones happens when the end of the collarbone moves up and away from the acromion after both ligaments are torn.
• It is still called a separation when only one ligament is torn or when ligaments are only partially torn, but the collarbone is not completely above the acromion.

Figure 1.

CAUSES

Falls on the outside or point of the shoulder or falls on an outstretched arm can cause shoulder separation. Athletes in contact sports such as football and cyclists that fall over their handlebars can get shoulder separations.

SYMPTOMS AND SIGNS

• You will have pain and swelling on the top of the shoulder.
• You will notice a bump on top of your shoulder, especially when you tear both ligaments (Figure 2).
• Arm movement out away from your body will increase pain.
• Collarbone fractures can happen with shoulder separations. Severe pain with crunching sounds may occur with a fracture.

Figure 2.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

• You are in severe pain.
• You hear any crunching and have a swollen bump that seems to move with your arm.
• You have any other injuries that are severe or are cause for concern.

Call your doctor during regular office hours if:

• You are in mild to moderate pain.
• You have a bump over the top of your shoulder that does not move when you use your arm and does not cause crunching noises.
• Pain limits use of your arm.

SELF-CARE AT HOME

• If you fell or otherwise injured your shoulder and have severe pain or crunching noises, consider using an arm sling and avoid lifting the arm up or out away from the body. Your arm should be bent at a right (90-degree) angle when in a sling.
  • Arm slings are often available at local drug stores.
  • A homemade sling can be made by wrapping a sheet around the arm and your neck and then tying ends together round your neck. Trim off any excess material with scissors.
• If your pain is mild to moderate, avoid doing things that increase your pain. These may include lifting your arm up, out and away from your body; putting it above your head; or reaching across or behind your body.
• Avoid lifting heavy things until your doctor looks at your shoulder.
• Wrap an ice pack or cold pack around the front of your shoulder and hold in place with platic wrap or an elastic wrap. Do this three times daily for 20 minutes at a time.
• You may take ibuprofen (Advil® or Motrin®) if you can tolerate it. (See the labels for dose and risks.
• If you can’t find a comfortable position in your bed, try sleeping in a recliner.
• You can do a few shoulder exercises, provided they don’t cause much pain.
  • Maintain shoulder motion by bending over at the waist and hanging your arm loosely down toward the floor. Swing your arm gently in small circles. Progress gradually to larger circles for one to two minutes in each direction. Do this two times daily.
  • If you have only mild to moderate pain, you may “walk” your fingers up the wall, pulling your arm with them (Figure 3). Stand facing the wall with your arm straight out in front of you. As your fingers pull your arm up the wall, move closer to the wall until your arm is above your head as far as pain will allow it to go. Return to your original position by walking your fingers back down the wall. Repeat the exercise, this time facing away from the wall (your body should be at a right angle to the wall), with your injured arm out to the side. Do the exercise five to 10 times in both positions once or twice a day.

  Figure 3.