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Shoulder
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Shoulder Separation
Shoulder separation refers to an injury sustained to the area of the shoulder where the clavicle (collar bone) attaches to the scapula (shoulder blade) at the acromion. The injury is usually the result of a fall directly onto the tip of the shoulder. The ligaments that hold the clavicle and acromion together are sprained and this causes the clavicle to spring upward causing a bump to appear on the top of the shoulder.
The diagnosis is made based on the history of the injury, the physical exam findings and plain x-rays. The severity of the injury is graded on a scale of 1-3 depending on how far the clavicle is separated from the acromion. Symptoms include pain, swelling, bruising, reduced shoulder motion, and weakness of the shoulder.
Treatment should begin immediately after the injury and includes ice pack for 20 minutes every 3-4 hours for the first 2-3 days, and as needed thereafter to control pain and swelling. An arm sling may be indicated for more severe sprains to alleviate pain and rest the shoulder while the ligaments heal. You should continue to do regular range of motion exercises to prevent a frozen shoulder while the ligaments heal. Anti-inflammatories and pain medications may be used to control pain, swelling, and inflammation. After the initial period of healing has passed your physician will begin a range of motion and strengthening program to restore your shoulder back to normal. Only in rare circumstances is surgery needed to reconstruct the ligaments.
This type of injury may take 2-4 weeks to heal in Grade I sprains and will usually result in no permanent effects on shoulder function. The more severe separations may take 2-3 months to heal fully and may result in stiffness and weakness that may last even longer. The bump on the shoulder may be permanent but does not affect shoulder function.
We recommend that before you return to contact sports and other heavy work/exercise, that your shoulder be relatively free of pain, your range of motion be restored to normal, and your strength also be normal. People who participate in throwing sports will need to gradually build their tolerance to throwing.
APPROACH TO EXERCISE
Apply moist or dry heat for 15 minutes prior to beginning range of motion or stretching exercises. Hold stretches for 5-8 counts and repeat 3 times. Stretches should be taken to the point of mild discomfort and no farther, as the days progress you should try to take the stretch a little farther.
When you begin the strengthening exercises, you should begin with no weights and then gradually add weights as your strength returns. Trying to move too fast in this phase of your recovery may result in further injury and delay your recovery.
You can advance your program by adding to the number of repetitions or the number of sets of each exercise in between adding weight to your program. If you find that you are struggling with the home rehab program, formal Physical Therapy may be indicated. Please don't hesitate to ask your Physician or Physician Assistant for a referral. Re-injury can be avoided by having an ongoing strengthening program for the shoulder.
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