Shoulder Injury : A-C Separation

The shoulder is composed of two major bones: the HUMERUS (arm bone) and the SCAPULA (shoulder blade), which provides the joint space for the humerus. The CLAVICLE, or "collar bone", connects to the scapula at the ACROMION (a bony projection off the scapula) and is secured by ligaments. When the ligaments are torn in this area, it will result in acromioclavicular separation (A-C separation). This injury occurs most commonly as the result of a fall onto the shoulder tip. Another injury seen with the same type of fall is the clavicle fracture. It is important to note that the elderly will frequently fracture at the shoulder (humerus), while the younger patient will either sustain an A-C separation, or a clavicle fracture.

Common symptoms in an A-C separation include a "bump" at the top contour of the shoulder that is tender to touch. Patients experience pain in the shoulder, but can still move at the shoulder joint. Pulling downward, on the extended arm causes discomfort. Bone x-rays can rule out a fracture, and special views done while holding weights in the hands, compared to views without weights, will show the separation. An examination for nerve and vascular integrity is always important. Any numbness, tingling, muscle weakness, or discoloration of the hand requires prompt evaluation. Associated nerve or blood vessel injury is rare with A-C separation.

Treatment of most A-C separations includes ice packs, extremity elevation, and a shoulder sling. Healing time is 3 to 4 weeks, depending on severity. Some special cases may require surgical repair of the A-C joint. Any patient placed in a sling must start early range of motion exercises for the shoulder to avoid the complication of "frozen shoulder". Acetaminophen, aspirin, or anti-inflammatories (Advil, Nuprin, Motrin, ibuprofen) are helpful to reduce pain. Your doctor can provide stronger pain medications if necessary. Average recovery period for this injury is 6 weeks. The orthopaedic surgeon is the expert in the management of this problem.

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