Nonsurgical Treatment Makes the Grade for Shoulder SeparationThere are still some injuries that do not have tried-and-true treatments. Shoulder separation is one of them. Despite many different treatment approaches, there is no general agreement on the best way to treat this problem.
Shoulder separation occurs when the collarbone gets pulled away from the bone it attaches to (the acromion) at the shoulder. This can happen because of a sports injury or car accident. It's called an AC separation. This type of injury is usually given a "grade" from I to IV to describe how far apart the joint has separated. An X-ray is used to determine the grade.
A grade I or II AC separation is often painful, especially with any movement of the arm overhead. There may not be any visible changes, but on examination the doctor or therapist may feel a larger space in the joint. Pressing on the joint increases the pain. With a grade III AC separation, the collarbone moves up so that it is no longer even with the acromion. This leaves a visible bump on top of the shoulder. With a grade IV separation, the joint is dislocated and an even larger bump is present.
Grades I and II are mainly treated without surgery. Surgery is usually recommended for a grade IV. Grade III falls into a gray zone. It remains unclear whether surgery is really necessary for a grade III AC separation.
A group of doctors and therapists studied 20 patients with grade III AC separations that were not treated with surgery. Instead, these patients were treated with slings for comfort. They also started range of motion exercises early. The researchers compared the results of these patients with those of patients in other studies who had surgery.
The researchers tested patients' range of motion and strength up to a year after injury. At the end of a year, most patients who did not have surgery (80 percent) were satisfied with their results. Patients who were not satisfied had other concerns, such as lawsuits and veterans' benefits. The "failure" rate of 20 percent was similar to that of patients who had surgery for this same problem.
The "wait and see" approach seems to work for most people with mild to moderate shoulder separations. Most people with grade III AC separations do well without surgery. A small number of people may need surgery, but this may be determined at a later date. Unfortunately, it is impossible to predict who will have a poor result without immediate surgery.
Theodore F. Schlegel, MD, et al. A Prospective Evaluation of Untreated Acute Grade III Acromioclavicular Separations. In The American Journal of Sports Medicine. November/December 2001. Vol. 39. No. 6. Pp. 699-703.
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