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A shoulder separation occurs after a fall or a sharp blow to the top of the shoulder. This injury is usually sports related. Some separations happen in car accidents or falls. This is not the same as a shoulder dislocation, which occurs at the large joint where the arm attaches to the shoulder, although the two may appear to be the same.

The shoulder separation, or acromioclavicular (AC) dislocation, is an injury to the junction between the collarbone and the shoulder. It is usually a soft-tissue or ligament injury but may include a fracture (broken bone).

Treatment

*Ice is an important treatment of most acute soft tissue injuries.
*Frequently, a sling is needed and helpful for the first few days after an injury. This helps to support the weight of the arm and to restrict motion. It is usually advised, however, to begin some motion exercises within a few days once the immediate pain has stopped.
*Pain relievers and anti-inflammatory medications may be advised, either over-the-counter or by prescription.
*You may require physical therapy, particularly once the immediate pain has stopped within a few days. The decision for this often is made during a follow-up visit. 
* Complete ligament rupture at the AC joint may require surgical repair by an orthopaedist.

Surgery

Some surgeons prefer to repair severe grade 3 AC separations, especially in high-level throwing athletes.

The surgery is usually done through a 4-inch incision over the AC joint. The surgeon starts by putting the joint into its correct position. A screw or some other type of fixation may be used to hold the clavicle in place while the ligaments heal.  The procedure can sometimes be done arthroscopically. 

To fix the joint using a screw, the surgeon inserts the screw through the top of the clavicle and into the coracoid process.

Some surgeons use surgical tape to connect the clavicle and coracoid. A small drill hole is made in the clavicle and corocoid. The surgical tape is looped through each hole and pulled snugly.

In some cases, sutures are also used to repair and reinforce the torn coracoclavicular ligaments.

When a screw is used, it is usually removed six to eight weeks after the surgery. If it is not removed, the screw will probably break.