Acromioclavicular injury is labeled as a type I, II, III, IV, V, or VI, depending upon the extent of injury and number of ligaments involved. The type of injury can usually be determined with a physical examination and x-rays.

• Type I injuries involve a sprain or partial tear of AC ligaments with no injury to the CC ligaments. This causes a tender AC joint that often has mild swelling. Type I sprains usually heal within a few weeks.

• Type II injuries involve a complete tear of the AC ligaments and a sprain or partial tear of the coracoclavicular (CC) ligaments. This causes a tender AC joint, often with significant swelling.

• Type III injuries involve a complete tear of both the AC and CC ligaments. The AC joint will appear abnormal, although swelling may obscure the degree of injury. People with type III injuries have significant tenderness of the CC ligaments, which helps distinguish type III from type II injuries. Type III injuries often take longer to heal (several weeks to months).

• Type IV, V, VI injuries are the most severe. Treatment often requires surgery.

Other causes of shoulder pain — Arthritis of the shoulder joint is a common cause of shoulder pain. Arthritis can occur after AC separation or as a natural part of the aging process.

Other possible causes of shoulder pain include rotator cuff tendonitis or tears, scapulothoracic bursitis, biceps tendonitis, frozen shoulder (also called adhesive capsulitis), and others.

SHOULDER SEPARATION TREATMENT

Pain relief — If needed, a pain medication such as acetaminophen (Tylenol®) can be taken; the usual dose of acetaminophen is two 375 mg tablets every four to six hours as needed. No more than 4000 mg of acetaminophen is recommended per day. Anyone with liver disease or who drinks alcohol regularly should speak with their healthcare provider before using acetaminophen.

A nonsteroidal antiinflammatory drug (NSAID), such as ibuprofen (eg, Advil®, Motrin®) or naproxen (eg, Aleve®) can also be used for pain.

Type 1 — Type I injuries are best treated initially with rest, ice, and protection, often with an arm sling. Ice can be applied for 15 minutes every four to six hours as needed. Rest includes avoiding overhead reaching, reaching across the chest, lifting, leaning on the elbows, and sleeping directly on the shoulder.

Range of motion exercises are recommended as soon as they can be tolerated.

Range of motion exercises — Range of motion exercises are recommended early in the recovery period. These exercises are intended to help maintain joint mobility and flexibility of the muscles and tendons in the shoulder. Pain should not exceed mild levels with any range of motion/flexibility exercise. Anyone who feels sharp or tearing pain while stretching should stop exercising immediately and consult with a healthcare provider.

• Weighted pendulum stretch — The weighted pendulum stretching exercise performs two functions:

• Gently stretches the space in which the tendons pass to relieve pressure on the tendons

• Prevents the development of a frozen (stiff) shoulder

This exercise can be started almost immediately after a shoulder injury. This exercise should be performed after heating for five minutes once or twice per day. The exercise is performed as follows:

• Relax your shoulder muscles

• While standing or sitting, keep your arm vertical and close to your body (bending over too far may pinch the rotator cuff tendons)

• Allow your arm to swing forward to back, then side to side, then in small circles in each direction (no greater than 1 foot in any direction). Only minimal pain should be felt.

• Stretch the arm only (without added weight) for three to seven days. Progress this exercise by adding 1 to 2 pounds (0.5 to 1 kg) each week and gradually increasing the diameter of the movements (not to exceed 18 to 24 inches or 45 to 60 cm )

• After a few weeks this exercise should be supplemented or replaced by other exercises to target specific areas of tightness/restriction. The pendulum stretch may be recommended as a warm up for more localized flexibility exercises and/or strengthening exercises.

When performed correctly the pendulum exercise should not result in more than mild discomfort. If more pain is felt, consult a healthcare provider for instructions.