Shoulder separation is not an injury to the main shoulder joint itself. It is an injury to the top of the shoulder where the collarbone (clavicle) meets the top of the shoulder blade (acromion of the scapula).
It is not the same as a shoulder dislocation. A dislocated shoulder occurs when the arm bone comes out of the main shoulder joint.
About Your Injury
Most shoulder separation injuries are caused by falling onto the shoulder. This results in a tear in the tissue that connects the collarbone and top of the shoulder blade. These tears can also be caused by car accidents and sports injuries.
This injury can make the shoulder look abnormal from the end of a bone sticking up or the shoulder hanging lower than normal.
Pain is usually at the very top of the shoulder.
Your health care provider may have you hold onto a weight while examining you to see if your collarbone sticks out. An x-ray of your shoulder may help diagnose a shoulder separation. With subtle separations an MRI (advanced imaging) scan may be needed to accurately identify the presence and extent of the injury.
What to Expect
Most people recover from a shoulder separation without surgery, within 2 to 12 weeks. You will be treated with ice, medicines, a sling, and then exercises as you continue to heal.
Your recovery may be slower if you have:
- Arthritis in your shoulder joint
- Damaged cartilage (cushioning tissue) between your collarbone and top of your shoulder blade
- A severe shoulder separation
You may need surgery right away if you have:
- Numbness in your fingers
- Cold fingers
- Muscle weakness in your arm
- Severe deformity of the joint
Self-care at Home
Make an ice pack by putting ice in a sealable plastic bag and wrapping a cloth around it. Do not put the bag of ice directly on the area, as the ice could damage your skin.
On the first day of your injury, apply the ice for 20 minutes every hour while awake. After the first day, ice the area every 3 to 4 hours for 20 minutes each time. Do this for 2 days or longer, or as instructed by your provider.
For pain, you can take ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), aspirin, or acetaminophen (Tylenol). You can buy these pain medicines without a prescription.
- Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, liver disease, or have had stomach ulcers or bleeding.
- Do not take more than the amount recommended on the bottle.
- Do not give aspirin to children.
You may be given a shoulder sling to use for a few weeks.
- Once you have less pain, begin range of motion exercises so that your shoulder does not get stuck in place. This is called contracture or frozen shoulder. Check with your provider before doing any of these motions.
- After your injury has healed, do not lift heavy objects for 8 to 12 weeks are as instructed by your provider.
If you continue to have pain, your provider will probably ask you to come back in 1 week to decide if you need to:
- See an orthopedist (bone and joint doctor)
- Begin physical therapy or range of motion exercises
Most shoulder dislocations heal without serious consequences. In a severe injury, there may be long-term difficulties lifting heavy objects with the injured side.
When to Call the Doctor
Call your doctor or go to the emergency room right away if you have:
- Severe pain
- Weakness in your arm or fingers
- Numb or cold fingers
- A sharp decrease in how well you can move your arm
- A lump on top of your shoulder that makes your shoulder look abnormal
Separated shoulder - aftercare; Acromioclavicular joint separation - aftercare; A/C separation - aftercare
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Bengtzen RR, Daya MR. Shoulder. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 46.
Rizzo TD. Acromioclavicular injuries. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 10.
Scholten P, Stanos SP, Rivers WE, Prather H, Press J. Physical medicine and rehabilitation approaches to pain management. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen SP, eds. Essentials of Pain Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 58.
Review Date 3/28/2020
Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.