How to Heal an AC Separation
We use our shoulders for a wide range of movements. They allow us to raise, swing, bend, and rotate our arms. Thanks to them, we can throw a ball and scratch our noses. Our shoulders are the most flexible joint in our bodies and also the most complex.
The flexibility of our shoulders does not come without issue — these remarkable structures are prone to injury.
One of the most common shoulder injuries is an acromioclavicular (AC) joint separation, also called a shoulder separation. AC separations are particularly common in active individuals, especially athletes who play contact sports.
AC Joint Anatomy
The AC joint is where the shoulder blade’s highest part (acromion of the scapula) meets the collarbone (clavicle). Muscles and ligaments surround and support the shoulder blade and collarbone.
An AC separation is a tear in one or more of these supportive ligaments — the acromioclavicular (AC) or the coracoclavicular ligament (CC). The severity of an AC joint separation is graded according to whether both ligaments are injured and the degree to which they are damaged.
AC separations are commonly caused by a fall onto the point of the shoulder or an outstretched arm (such as when tripping or going over a bike’s handlebars). Direct blows to the shoulder during sports like football or high-impact collisions like those in car accidents can also cause shoulder separations.
AC Joint Separation Symptoms
Common symptoms of shoulder separations are bruising, swelling, pain, and shoulder instability in the shoulder and arm. Symptoms generally last several days to a few months, depending on the severity of the injury.
Pain is usually worse when lifting one’s arm overhead or trying to sleep on that side. In higher-grade injuries, the collarbone may also lose its alignment with the shoulder blade.
AC joint separations are diagnosed by a physical exam from an orthopedic shoulder specialist. Sometimes the specialist will inject an anesthetic into the area to relieve pain as they manipulate the injury. Not all shoulder separations are visible, so an X-ray may also be necessary.
AC Joint Separation Grading
Shoulder separations are categorized by the degree to which the AC’s joints surrounding ligaments are stretched or torn. Injuries range from grade I to grade VI, with grade I being the most common.
Tearing only the acromioclavicular ligament, a grade I or II injury, isn’t serious. In fact, most of these injuries heal on their own. If the coracoclavicular ligaments rupture (as in a grade III injury), healing becomes more complicated due to the involvement of the entire shoulder.
Grades IV-VI are quite uncommon and involve tearing additional muscles across the shoulder and neck.
Grade I
- Most common
- Acromioclavicular ligament is either stretched or slightly torn
- Bruising, swelling, tenderness, minor pain
- May have a slight displacement
- General healing timeline is several days to 2 weeks
- Full release back to contact sports or activities requiring overhead motions can take longer
Grade II
- Acromioclavicular ligament is completely torn, but the coracoclavicular ligament remains intact
- Bruising, swelling, moderate to severe pain, pain when moving arm
- May have a small bump on top of the shoulder at the end of the collarbone
- Partial dislocation, but displacement may not be obvious
- General healing timeline is 2 to 6 weeks
Grade III
- Both ligaments are torn, as is the capsule surrounding the joint
- Bruising, swelling, pain, and possible popping noise with movement
- Displacement is usually obvious
- Shoulder may sag due to the weight of the arm, and the injured person often reflexively holds their arm close and supports their elbow
- Collarbone gets pushed up, causing a bump on the shoulder
- General healing timeline is 6 to 12 weeks
AC Joint Separation Treatment
Treatment for a shoulder separation depends on the grade of the injury. Most treatment protocols include icing and resting the injury, wearing a supportive arm sling, and taking pain and anti-inflammatory meds as directed by your orthopedic shoulder specialist.
Pain management also includes avoiding reaching over your head, across your body, leaning on your elbows, and sleeping on the injured shoulder. As you heal, your specialist will introduce AC joint separation exercises to restore normal range of motion and strength.
Good range of motion and pain-free function often return with proper care as recommended by your orthopedic shoulder specialist.
AC Separation Surgery
Even with a grade III separation, surgery is typically not required. If non-surgical treatments fail and pain continues for months, surgery becomes an option. It may also be recommended for young, active athletes or workers who frequently lift their arms overhead.
Grades IV-VI are the most severe types of AC separations and require immediate care from an orthopedic shoulder surgeon — surgery is likely necessary for these types of separations.
Regardless of whether an AC joint separation is treated surgically, complications can occur. The most common issues are a feeling of instability when lifting one’s arm overhead and the development of arthritis in the joint. If a separated AC joint results in a visible bump, the bump may remain even after the injury has healed.
If you’ve injured your shoulder or are experiencing shoulder pain and would like to talk to one of our orthopedic shoulder specialists, please contact us or comment below. We would be more than happy to discuss the next steps with you.
39 Comments
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I had a type I or II AC joint separation a week ago, a chiropractor realigned it and I resumed playing hockey. However there is still pain and a bump on my shoulder, I have full range of motion, will the bump go away or did I reinjure my shoulder?
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Hi Brianna,
It’s great that you have full range of motion, but the bump and lingering pain could indicate the injury hasn’t fully healed or that there’s still some inflammation. AC joint separations often leave a visible bump, which may or may not go away completely, depending on the severity. Since you resumed hockey so soon, it’s possible you aggravated the area. It might be a good idea to check in with an orthopedic specialist to assess the joint and ensure it’s healing properly. Rest and targeted rehab may also help reduce pain and improve recovery.
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I suffered from a grade 3 AC joint separation 20yrs ago. Decided to take the nonsurgical route and although I might have lost a little strength in pressing weight in front of over my head, things went well and didn’t have any issues. Fast forward to the present day and it seems I have reinjured that shoulder. I haven’t had an X-ray yet so I don’t know the extent of the damage, but I remember being in a lot more pain when the initial injury happened. I am a very active person and my good physical health is essential to my livelihood. I need to rehab this as fast as possible and was hoping you can at least point me in the right direction and get the ball rolling. Thank you
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Hi Ryan, for your recent shoulder concern, we recommend scheduling an appointment with an orthopedic specialist to get an accurate diagnosis and personalized treatment plan. Our team at Heiden Orthopedics is here to help you with any necessary imaging, evaluations, and tailored rehabilitation programs. Your health and well-being are our top priorities, and we’re committed to getting you back to your best as quickly as possible.
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I suffered an injury backpacking 1 year ago which is ongoing. The other night as I was sleeping on my right shoulder I heard a pop followed by pain. I then noticed a bump on my AC joint and my collarbone has sunken in on that side. I also have extreme tightness of SCM muscle (and intense ear pain). My scapula pain is also pretty bad. X-rays don’t show much. Do you think this is grade 1 or 2? Or something else?
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Hello,
I have been suffering with pain in my neck for over a year after some intense backpacking. last week i slept on my right shoulder (usually i sleep on the left), and heard a loud pop! Since then i have noticed a bump on my right shoulder, clavicle misalignment and i have really sore trapezius, scapula and SCM muscles (which is also causing ear pressure). My right scapula is also sticking out more than the left. Does this sound like a usual grade 1 or 2 AC join separation?
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Hi Tiana, thank you for reaching out. Your symptoms suggest a possible AC joint issue, but it’s essential to get a professional evaluation for an accurate diagnosis. Please feel free to schedule an appointment with us for a thorough assessment and personalized treatment plan by calling 435-615-8822.
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Hello, I believe I had a grade 1 separation a week ago. There is no instability in my shoulder but there was some intense pain in the beginning and now there is a bump. I almost have full range of motion back but was not able to see an orthopedist for a week. They identified the source of pain as a bicep tendon attachment point and have started me on some exercises. However they weren’t concerned with the bump after I showed them and they pushed on it. Without a sling will the bump go away?
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Hi Anthony. Thank you for sharing your experience. It’s great to hear that you’re regaining your range of motion. The bump you’re seeing is likely due to the separation and may reduce over time, but it can persist. Since your orthopedist wasn’t concerned and has started you on exercises, continuing those and following their advice is key. If you have any ongoing concerns, it’s always best to follow up with your orthopedist. Take care and wishing you a smooth recovery!
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Hello I suffered a grade 2 separation about a month ago. The first two weeks I could hardly move my arm but now I have full range of motion, doing push-ups and lifting weights again. Even exercises that most people have trouble with after this injury like dips I can do without pain. Do you think it’s possible my ligament regrew itself in this time? I still have a bump
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It’s encouraging that you’ve regained full range of motion and can perform strenuous exercises after your Grade 2 AC joint separation, suggesting effective adaptation and healing, likely through scar tissue formation and compensatory muscle strengthening. The remaining bump is a common outcome due to the partial tearing of the ligaments, which may permanently alter the alignment of your collarbone. To ensure ongoing recovery and prevent future issues, continue with targeted shoulder exercises, monitor for any pain or instability, and periodically consult with a healthcare professional for assessments. Regular strengthening and flexibility exercises are recommended to maintain shoulder health and prevent further injuries.
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I broke my collarbone about seven weeks ago. I now have a bump on my left shoulder. When I am lying down, I don’t have pain. But when I sit or walk for about 10 minutes, it gets very painful around the bump. Do you think I need surgery?
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I’m sorry to hear about your injury. It’s possible that the bump you’re feeling is a callus forming as your collarbone heals. However, the pain you’re experiencing could indicate that the bone is not healing properly, or there may be another issue such as a nonunion or malunion. It’s important to have this evaluated by a healthcare professional, preferably an orthopedic specialist, who can assess your condition and determine if surgery is necessary. They may recommend imaging tests such as X-rays to evaluate the bone healing.
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eamat min nawe c8 salihat am la
Traduire du texte avec votre appareil photo
I had an injury 21 days ago (degree 3) and I had the tape and a C8 stent done. Is the C8 stent valid or not?
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I had a type 3 AC ligament injury six weeks ago. Full range of movement has almost returned and I can do light exercises at the gym, however my clavicle is still sticking up noticeably (despite having it strapped up for the past three weeks). Is this something I am just going to have to live with or is there some way to bring it back down to where it used to be?
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It’s not uncommon for the clavicle to remain prominent after a Type 3 AC joint injury, as this type of injury can result in a permanent alteration in the alignment of the joint. Non-surgical treatment, like strapping, can help manage symptoms but may not fully restore the original contour of the clavicle. Surgical options are available that can potentially realign the joint more closely to its original position, particularly if you’re experiencing discomfort or functional limitations. It’s a good idea to discuss your concerns and treatment options with an orthopedic specialist who can provide guidance based on the specifics of your injury and recovery progress.
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and how can I cure it???
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Hi, I don’t have any pain in my shoulder and I’m free to move my arm. No pain when I sleep but the area of shoulder is protruding. So what type is that and does it have any negative impact on me? Is there something to worry about?
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It’s great that you’re not experiencing pain and can move your arm freely! A protruding area in the shoulder without pain could be due to a few reasons, such as a muscle imbalance, a benign growth like a lipoma, or a slight misalignment of the bones or joints. However, without a physical examination, it’s challenging to determine the exact cause. If you’re concerned or if the protrusion changes in size or shape, it’s a good idea to consult with an orthopedic specialist for a proper evaluation.
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Hi, I don’t have any pain in my shoulder and I’m free to move my arm. No pain when I sleep but the area is protruding. So what type is that and does it have any negative impact on me? Is there something to worry?
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I probably have a level 3 AC seperation (that was diagnosis I think). The clavicle appears to now be settled at about/perhaps/approx 3/8″ above it’s previous normal position in line w/ the acromion to now slightly offline. (Now a bump shows). If we assume that shortest ligament off the tip of the clavicle to the acromion (AC lig?) tore …w/out surgery, does that ligament have the potential to grow back at the new angled alignment, and very slightly longer, or is non surgical healing w/ such displacement dependent only on the other longer ligament(s?) healing/strengthening and compensating? (Just asking re most typical possibilities …Understanding that results vary).
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Hi Bruce, without surgery, the torn ligament might not grow back in the same way. Your body will try to heal and strengthen the other ligaments to compensate for the injury. It’s important to follow your doctor’s advice for the best outcome.
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I’m curious how a level 3 AC separation heals without surgery. If the ligaments are completely torn apart how do the re attach themselves together with a surgical procedure?
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Level 3 acromioclavicular (AC) joint separations, where the ligaments are completely torn, can often be managed without surgery. The body has a remarkable ability to heal, and in the case of AC joint injuries, the ligaments can gradually repair themselves over time. The initial treatment for a level 3 AC separation typically involves rest, ice, and immobilization to allow the body to begin the healing process. Physical therapy may also be recommended to help restore strength and range of motion once the acute phase has passed. While surgery can be an option for severe cases or if conservative treatments are not successful, many people with level 3 AC separations can achieve good outcomes without surgery. The torn ligaments may not reattach exactly as they were before the injury, but the body can often compensate and stabilize the joint adequately for normal function.
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I had surgery 12-12-2023z grade 3 . I am having MAJOR pain in my shoulder. I went weeks without pain medication. Not sure what’s going on . At the point a can’t sleep . Could something happen to the hardware they used in my shoulder
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It’s possible that there could be various reasons for your pain, such as inflammation, nerve irritation, or other issues related to the surgery or hardware. It’s essential to consult with your healthcare provider as soon as possible to determine the cause of your discomfort.
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Saya memiliki pemisah tipe 3 apakah bisa sembuh tanpa operasi ?
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I have a level 2 ac separation does The bone returns to its place
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I have a level 2 ac separation Does it heal?
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The healing time for a level 2 AC separation can vary from person to person, but typically it takes several weeks. Recovery time can vary based on factors like the severity of the injury, individual healing rates, and adherence to the treatment plan. It’s important to consult with your medical provider for a more accurate estimate of your specific case’s healing timeline.
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I have a level one AC separation, I am using a shoulder brace. I am still working and the brace can become loose or move out of place. I have taped the clavicle down to help when this happens. Is that okay to do?
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Hi Nick, taping the clavicle is a useful technique to provide extra support and stability to the joint while wearing a shoulder brace. However, it’s crucial to seek guidance from your healthcare provider, who can assess your injury and determine the proper way to use taping to support the shoulder brace. It’s important to ensure that the taping is done correctly to avoid any discomfort or complications. Always follow your healthcare provider’s recommendations to achieve the best results.
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I suffer pain for almost 18 months.. At first it was severe but now moderate some times mild according to my sleeping positions.. I took xray and it appears slightly down than normal.. Which grade is it? Will it heal on its own?
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Unless there is total separation of the clavicle and the acromion it can heal. This doesn’t mean it goes back to “normal” but that the inflammatory response in the ligament will become less. Without being able to view your x-rays it is impossible to actually label it’s grade.
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How are grades determined ? I can move my ac joint in and out of place and when it’s out of place (99% of time unless I put it in place ) my shoulder sags and the bone is out visibly
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I have a severe injury to my AC joint , and it’s been like this for years and I’m just now finding out what is wrong. I need help ,
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Do you know the “grade” of your injury? There are two ways the AC joint is surgically corrected – remove the distal part of the clavicle or sew the joint together.
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I have an AC joint separation grade III. How can I help it get better?
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For a Grade III AC joint separation, it’s important to manage pain and promote healing while maintaining joint function. Initially, rest the joint, apply ice to reduce swelling, and use a sling to support your arm and relieve pressure on the joint. Over-the-counter pain relievers can also help. Gradually, as pain permits, start physical therapy exercises to restore range of motion, strength, and function. It’s advisable to consult with an orthopedic specialist who can tailor a recovery plan specific to your needs and monitor your progress. Surgery might be considered if there’s significant pain or dysfunction after conservative treatment.