Treatment of a Separated Shoulder

shoulder separation
A shoulder separation occurs between the collarbone and shoulder blade. SMC Images / Getty Images

A shoulder separation and a shoulder dislocation are very different injuries, and the treatment of these conditions is very different!  Make sure you have a proper diagnoses before proceeding with any treatment plan.  Once you've been diagnosed with a shoulder separation, also called an acromioclavicular separation or AC separation, you can begin with the proper treatment.

The initial treatment of a separated shoulder consists of controlling the inflammation, and resting the joint.

The early steps of treatment should consist of:

  • Icing the Injury
    The inflammation from a separated shoulder can be controlled with ice placed on the joint every four hours for a period of 15 minutes. Icing can be done for the first several days until the swelling around the joint has subsided.
  • Rest the AC joint
    A sling to rest the joint can be worn until the pain has subsided and you can begin some simple exercises. Resting the joint will help minimize painful symptoms and allow healing to begin.
  • Anti-Inflammatory Medication
    Anti-inflammatory medication such as Advil or Motrin will also help to minimize the pain and inflammation--check with your doctor before using these medications.

Once the pain is under control, patients should be evaluated to determine the type of shoulder separation.  There are 6 types of separated shoulder, but most all are either type 1, 2, or 3.

Surgery or No Surgery?

Type I and type II shoulder separations are by far the most common types of separated shoulders, and these types of injuries rarely need surgery.

  Most all orthopedic surgeons recommend nonsurgical treatment, and only consider surgery in the unlikely event that pain and function do not improve after trying non-invasive treatments.

Type 4,5, and 6 shoulder separations almost always require surgery, but these are very uncommon injuries. The difficult decisions arise with patients with a type 3 shoulder separation.

There is controversy among orthopedic surgeons as to how to best manage patients with a type 3 shoulder separation. In the end, there is no 'right answer,' but there are some factors to consider when making this decision.

  • Non-surgical treatment for type 3 shoulder separations...
    Most evidence suggests that patients with type 3 shoulder separations do just as well without surgery, and avoid the potential risks of surgical treatment. These patients return to sports and work faster than patients who have surgery for this type of injury.
  • Surgery for type 3 shoulder separations...
    Recent studies have suggested that some athletes and heavy laborers may benefit from early surgical treatment of type III shoulder separations. These include athletes who participate in sports that require overhead throwing such as baseball. The potential benefit of early surgical treatment for type 3 shoulder separations remains unproven.

There are dozens of different surgical procedures that have been described for the treatment of a separated shoulder.

These surgeries attempt to stabilize the end of the clavicle in its proper position. Unfortunately, there are potential complications of surgery that make this simple idea a difficult task.

Most surgical procedures for treatment of a shoulder separation attempt to reconstruct the important coracoclavicular ligament, and temporarily hold the clavicle in position while the reconstructed ligament heals. A commonly performed procedure uses the nearby coracoacromial ligament, and moves it over to the clavicle. The clavicle is held in position with strong sutures or a metal screw while the ligament is healing into position.

Complications of Surgery

Complications of surgery for a shoulder separation include:

  • Loss of reduction of the clavicle (does not stay in proper position)
  • Clavicle fracture
  • Infection
  • Painful scar
  • Deltoid/Trapezius muscle detachment


Simovitch R, et al. Acromioclavicular Joint Injuries: Diagnosis and Management" J Am Acad Orthop Surg April 2009 ; 17:207-219.

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