Shoulder Separations

I hope everyone had a great weekend! It was beautiful here in Charleston, although it is starting to get hot. Quickly I want to congratulate two teams. The Academic Magnet High School girls’ soccer team won the state championship Friday. It is one of the high schools we cover, and the team has several former patients, so I could not happier for them. It is perennially one of the top academic schools in the United States, proving that it is possible to be smart and good at sports. Also, congratulations to the Lowcountry Highrollers All Stars. Despite a few injuries, our awesome roller derby team continued its undefeated season Saturday. It is great to work with these girls!

Next week’s Ask Dr. Geier column will be a little different, as I will describe a typical week for me at the request of a reader considering sports medicine and orthopaedic surgery as a career. Look out for that. Spoiler alert – I’m actually not that exciting, but it will still make for an interesting post.

As always, please keep in mind my disclaimer about not discussing specific medical advice online or by email.


Terry in Rochester, Indiana asks:

I have a type III shoulder separation since October 2010. I’m 47-year-old male who is very active in sports and active in mission trips that require rugged and heavy travel. I still have the same range of motion, but I lack the strength. At times when I use it during sports and piano, I experience pain.

1) Can you please tell me how many surgeries, for this injury, you have performed?
2) And what surgical technique do you use?

Thank you very much for your time and expertise. Terry

Surgery for shoulder separations (acromioclavicular joint separations, or AC separations) is actually not that common. I probably perform 5-10 of these surgeries each year, although they are among my favorite surgeries. The most common types of AC separations are the less severe ones, namely types I and II. They fortunately rarely require surgical treatment. Types V and VI, which are much more serious and usually require surgical treatment, are fairly uncommon. Type III AC separations, like the reader has, often do well with nonsurgical treatment. Even in athletic individuals, studies have shown fairly good outcomes with nonsurgical treatment for these injuries, so most sports medicine surgeons will at least offer and try nonoperative treatment for type III injuries first.

Notice the vertical separation between the end of the collarbone and tip of the shoulder blade on the right shoulder (left side of image). This is a type V AC separation, where there is more than 100% displacements at the joint.

A type III AC separation has a moderate amount of vertical instability of that joint. There is approximately 100% displacement between the end of the clavicle and the acromion. If surgical fixation is attempted, the surgeon uses a technique that reduces this vertical instability. Simply cutting off the end of the clavicle won’t change this instability. In the past, surgeons tried to take a ligament from one part of the shoulder and transfer it to the end of the clavicle to try to hold the end of the clavicle in position.

Newer techniques include implants that try to pull the clavicle down to the coracoid. I use a technique that takes a tendon, either from the patient himself or herself or from a donor. The tendon is looped under the coracoid and then passed through the end of the clavicle through two drill holes. It is anchored in the clavicle with absorbable screws in each drill hole, and then the tendon is sewn upon itself. The tendon reconstructs the ligaments that are torn in the injury, holding the end of the clavicle down in the appropriate position. Studies have shown that this technique, at least in simulated biomechanical studies, is among the strongest for stabilizing this joint. Readers who are considering surgery for AC separations should consult with their surgeons about the necessity of surgical treatment and the options for surgical fixation.

Have you suffered a shoulder separation? Did you have surgery for it, or did you let it heal on its own? Let me know about your experience!

136 Responses to Shoulder Separations

  1. I am a 37yr old woman who has fallen down the stairs, in result I now have an AC Separation type III. I am devastated to say the least!! I desperately desire surgery though my Orthopedic Surgeon keeps reminding me that most people “don’t” do it. Personally, I don’t care what MOST PEOPLE do, I would like to regain my sexy shoulders. My injury is fairly new, nearly 3-weeks old. I am due to return for a follow-up in a few weeks. Your enthusiasm in regards to AC Separation surgery excites me!! I would be extremely HAPPY if I could be under the care of a Dr. so confident and optimistic when it comes to this procedure.

    • Yes, typically type III AC separations are treated nonoperatively, as the results of nonoperative treatment are pretty good, even in athletic individuals. Surgical reconstruction can improve the cosmetic appearance, although there is an incision, and it still occasionally appears larger than the opposite side. And it requires a fairly aggressive rehab of the shoulder after 3-6 weeks of immobilization. But in some people, surgery is a good option. I hope that helps. Please go to the Contact section to send more information if I can help further.

    • Dear Dr. Geier,

      My name is Josh. I am a full year into post surgery for my GRADE 5 shoulder separation. After I received my surgery, my shoulder nearly as good as new. No bump, just a thin scar on the top of my shoulder. I am a full time working chef in a fast paced kitchen. I’m also a passionate and competitive basketball player. I made the unfortunate error of going back to work to soon, which made me believe to be the cause of the discomfort and pain I deal with now. The shoulder is still flat when I raise my arm, but when drooped, theres a slight bump. Most of all i am experiencing discomfort. I wonder if I had just waited and completed my therapy and allowed my shoulder to heal that I wouldn’t be dealing with the pain that i’m currently going through. The only thing that really numbs the pain is ATHLETIC TAPE holding my shoulder to my collar bone. When I look in the mirror and my shoulder is shrugged, I can press down on my collar bone to where it looks normal. I wonder if this can permanently be done through a second surgery. I am extremely happy that the surgery was successful in relieving me of my deformity, but the way I chose to recover has failed me. Now when I play basketball, I feel great! I can dribble, pass, shoot and even play through contact on my shoulder. Although I have lost some of my range, I do believe that it will come back through strength training. I feel most of my pain right when I wake up, probably from sleeping directly on my shoulder(DON’T DO THIS). My question to you Doctor is should I go into another surgery to alleviate the discomfort I now feel, or should I “suck it up,” and “be a man?” I truly believe the only way to completely fix my shoulder is to have my collar bone pulled down to where its aligned with my shoulder. Keep in mind I have 100% full range of motion, but still experience discomfort due to every day activities and slight heavy lifting. I am 23 years old, and I’d appreciate a 2nd, 3rd, and 4th opinion. Please give me some insight on what I should do, and please don’t tell me to see a doctor and get an x-ray because I’m already scheduled to due so.

      Thank you so much,

  2. I injured my shoulder in June 2010. AC separation III. Due to my active life style I chose to have the surgery. In late Febuary 2011 it failed. The pain was far worse from when I first had injured my shoulder. A 2nd surgery was performed in May 2011. Here I am now nearly 8 months later experiencing the worst pain of my life!! I still am unable to use my shoulder, cant sleep at night and needless to say the constant use of meds and pain killers has pretty much screwed up my stomach. Although I feel that surgery was my only option, I feel that I will end up regretting having the surgery for the rest of my life. I am going for yet another CT scan next week to find out why I am having so much pain. I never thought in a millions years I would end up this way. I used to work out every day and was a interior house painter for 15 years. Now, I sit home every day in the most unbelievable pain ever….I am losing my mind and honestly dont know what to do.

    • My orthopedic surgeon actually advised against surgery on my grade 3 separation, stating that in my profession that includes a lot of lifting, pulling etc as a Firefighter and as an otherwise active person with biking and weight lifting etc, it would be better to live with the deformity and if desired, address the deformity later in life when I retire. He said that usually fixing that deformity will increase the likelihood of failure.

    • Wow! I know this is old but, I’m in the same situation!! I had an ‘accident’ in July 2016, AC separation grade 4. I am a veteran so I had the surgery at my VA medical center. My surgeon, opted for doing just the hook plate fixation. Three weeks after my surgery I was calling, experiencing more pain than the original accident. I then found out from a nurse that she cut part of my clavicle off, used a ligament from in my shoulder and then put the plate in. (Before surgery she told me she wasn’t going to cut my clavicle or do a ligament because of my age and I smoke.) In December 2016, plate was removed. I actually have it, she gave it to me at my first follow up. I was soooo incredibly happy to bave that plate removed so I could go back to life with only ‘arthritic pain’. I was wrong! It is now Feb 7, 2017. I just went to my local emergency room last night. On top of the pain everyday that she tells me I shouldn’t be having, I started having pains everytime I moved my shoulder like someone is stabbing me with a knife. The hospital told me I have ANOTHER AC separation grade 3 now. I haven’t fell, I haven’t hit it, actually the opposite, I have babied it. I too am losing my mind over this. I sit in my house day in and out, now on meds for depression and anxiety. I don’t see a future pain free. Just a future with a doctor who just wants to cut me off my pain meds while I suffer more. What she gives me now still doesn’t keep me out of pain. But the hospital suggested I get a second opinion and an MRI. I can’t! I am a partial disabled veteran, even more crippled now with no insurance, can’t even work to get insurance to see another doctor! I don’t know what to do. My kids, granddaughter, husband, home and MY LIFE is suffering. (The accident happened when my autistic son picked me up and threw me down, I hit a door facing. I also lost him in the process, he was charged and the judge put a no contact order in for a year. So yeah, my life fell apart just 7 very long months ago.) Any suggestions would be greatly appreciated. I pray someone reads this with answers!!

  3. I just had 2 injections recently in my AC joint to try and relieve chronic pain from a old grade 2 AC seperation. My doctor want me to come back in 3 weeks for an MRI and possibly surgery if the pain in the AC joint does not let up. He talked about doing a distal clacical excision. My question is if this surgery relieves my pain will it also take care of the noticible prominence “bump” on the top of the shoulder also? I ask this only b/c I feel like I’d im going to have to go through surgery I would like to fix not only the pain but the deformity as well.

    • In general, distal clavicle excision (removing about 1 cm from the end of the clavicle) does relieve most of the pain coming from AC joint arthritis and injuries. The “bump” that most people have after an AC separation is the prominent end of the clavicle. Removing part of it should improve the prominence for patients, even though it might still no be as flat as it was before they were originally injured.

  4. Did both of my shoulders a little over 14 years ago. One is a type 3 and the other is a type 4. In both cases I think I was fortunate to get great doctors advise to not get surgery. Instead I spent two months in the pool for rehab progressing to breast stroke arms only, no feet. To this date I have no issues at all. Every doctor I have visited since tells my how smart it was not to get surgery as it leads to more complications down the road.

    • There is no question that surgery to reconstruct the injured ligaments is a big one. Depending on the nature of the separation, some require surgery. Fortunately most of the mild ones, while painful, do well with nonoperative treatment and rehabilitation. Thanks for sharing your experience!

  5. hi doctor,
    i had a “button and pulley” operation on my left shoulder after a type 3 ac seperation 4 1/2 weeks ago.
    i have failed to ask my doctor the “right” questions at post-op visits, simply because i am relying on my own decisions, nutrition, and body to tell myself that im going to be alright. if i recieved the #5 fiberwire from arthrex corp., do you think that i will be able to wakeboard again?? its my true passion and i honestly exert more force wakeboarding than anything else in life. the force of pull on the handle used to be great, and i am so very curious if i will be able to participate in fun behind our boat ever again? this, of course, includes hardcore tubing and waterskiing!
    thank you doctor.

    • Patrick, I can’t say specifically in your case. The goal with surgical repairs or reconstructions for AC separations is to get people back to all of the activities that they like to do. It takes a lot of work with therapy after surgery and a lot of time, but it often happens.

  6. I had an anatomical ac joint reconstruction with allograft 10 months ago, although my shoulder is much better than pre op, I am now having some pain around the coracoid…if I press firmly upon it I get a sharp pain throughout the shoulder.. What could this be? I’m scheduled for a ultrasound in 2 weeks..would this be of any use ? My age is 17 and I am healthy otherwise

    • Sorry Jeff, I don’t know that I can really say without examining you. Your surgeon can probably determine the cause by physical exam and possibly x-rays or MRI.

  7. I really like that you ask for peoples experiences and comments.

    Before talk about my injury, I would first like to say that I am and have been, very dismayed in general by the orthopedic community’s attitude towards separated shoulders. From the beginning I was treated like a petulant child who only cared about “looks”.

    In December of 2011 I had a grade 3 separation of my left shoulder. There was a massive 2 inch drop plus the “bump”. But not just a bump, my clavicle was (and still is) completely out of alignment with the clavicle now pushing into my back with a very noticeable up angle, approximately 25 degrees. Here I should note that I was told that the separation was “only a bad grade 2”. Later I have to come to find out I was lied to. It was a grade 3 at least, and most likely a 5. Reasoning was that I would want surgery and the doctor figured that it was fine like it was, and like you have mentioned, figured most separations “do ok on their own” according to the literature.

    I was told it was “normal” and that it would “heal” and “be fine”. It was not, and did not. I had a complete inability to move my left arm forward under load. As a hockey player I knew there was something wrong beyond what the sports doc told me. I was unable to shoot or stick handle up to nearly a year after the accident, I am left handed shot. As well, during this time my arm continued to droop badly. During this time all activity, physical and social, stopped. The continual fatigue and pain was too much. I lost 30 pounds of muscle; it was as if my body was in constant toxic shock.

    Finally after 10 months, a surgeon took my case on. I had the tightrope procedure with a tendon graft, clavicle top button with a toggle lock and suture material pulled tight to reduce the gap. Immediately there was improvement. In a week the pain was much less, even with the surgery pain. The fatigue left. Cosmetically however it is still messed up. As a body composition competitor, this is unacceptable. The deformity is massive and ends my current life. Even after surgery. Currently I have only 25% of the strength I had prior to the accident, despite full mobility. All contact sports are out, as is beach volleyball, and any other activity where my arm could sustain a hit.

    It has been a year since surgery and while it is a far improvement from what is was, I am still very disappointed with the aesthetics, it ends my competing. I do not have anywhere near the strength I once did, it is doubtful it will ever return. It is doubtful I will return to anywhere near my previous level of activity. In short, this injury was devastating to my life, and I really have not liked the “suck it up buttercup”, and “be a man attitude” I received.

    I read Terez Shelby’s comments and I have to agree with her attitude. For men, a large part of a males sexuality is how broad his shoulder are. I would like a surgeon to try explain to me how this is different than a woman who needs to have her breasts removed. A woman feels as that a large part of her sexuality is gone, and she is right. This is why doctors worked so hard to do something about it, now breast augmentation is standard to restore “cosmetic” appearance. Beyond a complete change in lifestyle, losing my shoulders meant losing my sexual appeal, and as a single male looking for a partner this is horrible, mentally debilitating. And there is no “just getting over it”. When a single woman looks at you and says “gross”, you know it, are aware of it “cosmetically”, and going to the beach, forget it. Nothing being a freak that people and kids point at, stare, and make comments constantly. I suggest any doctor with this attitude should have his shoulder badly separated and then talk to a male in this position. I was given the “a lot of hockey players have this” speach, like I was a 10 year old kid. I DON’T CARE IF THE ‘BIG BOYS” have it.

    I have reviewed the current literature on this injury, which after reviewing, I find is highly suspect in regards to the posts used to measure what acceptable means. Immediate surgery (acute) will be standard procedure in the next few years. Complete AC & CC ligament reconstruction using a tendon graft with tightrope and clavicle hookplate should be standard treatment now. Leaving the “bump” (it is not a bump, I do not appreciate the minimization of the injury by calling the entire injury a small bump) is professional folly. Leaving the injury means that almost all people will suffer daily and later life will have severe problems.

    I have decided to undergo surgery again (despite recovery time again … for a third time), this time with the hook plate to get my scapula up again and to get my clavicle back to at least semi-normal alignment. I do not expect miracles but it can, and will be better. I am disappointed I have had to do this all on my own.

  8. What Timothy says is so absolutely true – a man´s shoulder line is absolutely critical to his attractiveness. And a step deformity is not a cosmetic flaw, it´s a deformity (while a small scar is a cosmetic flaw that is well accepted). Acute stabilization using the tight rope technique should thus be a standard treatment. Why not reduce the ACJ with this relatively safe and minimally invasive technique? I was initially not informed about this option and now have to live with asymetrical shoulders for the rest of my life :(((

  9. I am a junior in high school who received a level 3 separation. I plan on playing college football and do not know whether surgery would be the right thing to do or to physical therapy. I still feel pain in my shoulder at times it is very painful. I do not know what to do?

    • Difficult question. Typically Types I and II AC separations do well without surgery, and Types IV, V, and VI usually do require surgery. Some studies have shown good success rates with nonoperative treatment of Type III AC injuries even in athletes, but many athletes have surgery if they are limited by pain, stiffness, or weakness.

  10. I had shoulder surgery on Sept 10th 2013, and it was a tear in the rotary cuff. However, I went to therapy and guess what happened the PT had me lift 25 pounds over my head. Now my shoulder is popping, clicking with great 9-10 pain level. I don’t have full range and now I have a bump on top of my shoulder. My doctor was angry, now I have to start over in therapy been to 45 sessions still hurts so the doc gave me a cortisone shot and now it hasn’t help at all. I think I might have to have surgery again?

  11. Timothy Edin has said a lot of what I am feeeling. My Orthopaedic Surgeon was badgering me that he would be wrong to even suggest surgery. Now that I have the energy to look for an alternative, my time for normal healing processes will soon pass, which means much mor invasiv surgery. How can I locate a surgeon who does the surgery (with regularity and good results) to get an evaluation. The literature always refers to the surgery as “controversial” which means some clearly believe it is often the better course of action. I would like to at least discuss this with someone doing the Bosworth screw or the suture method. PS – I have above average upper body strength and never broken a bone in my life (and all my teeth) – I think I’m a good candidate for surgery.

  12. Just went to the DR today he said it was a 3 or 4 with a little tear in the cuff. My coller bone sticks way more up than that pic. therapy is what he said I don’t think so. I think that won’t get rid of the musle for over compisating to get by.

  13. I just found out I have a partially separated ac joint in my left shoulder. I have seen my nurse prac two for this. Once to get on some meds before a trip when we didn’t know what was wrong and now after I had an xray that showed the problem. My dr, the nurse prac isn’t sure what to do and wants me to get another set of xrays with me holding weights. Im leary to do this, as when I hold weights its very painful and I also have a pinched nerve that gets worse. DO you think its wise to get another xray when we know the problem? I feel she should just send me to a specialist now so I can see someone who knows what they are looking at and I can start to recover. I have had this problem for over 2 months now. Also would physical therapy be an option? My pain is a lot less now but if I lift a little or do more chores then I get a throbbing pain and a pinched nerve. Please help.

    • Weighted x-rays are often used to determine the extent of injury on the injured side compared to the opposite side.

  14. Hello, thanks fort your answering section ans sorry fort m’y english i’m from France,

    Due to a grad 3 AC joint separation I had shoulder surgery the 12 june ”ACROLIG technic ” this was done one week after the separation .
    Now i have a smal bump in my shoulder ‘4-5mm high’ is it comon with other ac joint reconstruction technics ? As X rays does not show the joint can i ask fort another scan ”MRI?”.

    Thanks in advance for your answer

    • Omar, it is impossible for me to really say without being involved in your surgery and seeing you as a patient. It is not uncommon for surgery for a Type III AC separation to still have a slight prominence at the joint even after surgery, but your orthopaedic surgeon can evaluate you and give you a more specific answer.

      • Dr. Geier thank you for responding to my question regarding lump on shoulder, id like to elaborate, after surgery my bump had disappeared, but after 9 weeks bump reappeared size of a golf ball im concerned that I may have retorn the ligaments somehow, if I did what now? Id hate to go thru surgery again, what are my options?

  15. sir I have left shoulder pain and diagnosis AC joint subluxation I did Physio therapy little releaf but after joining work again same problem what shall i do can you give me your suggestion MRI for cervical spine did it shows C4- 5 disc , Left shoulder did MRI shows normal

    • I would address both of those problems with your orthopaedic surgeon. I can’t give you specific medical advice on this site since I am not involved in your care.

  16. My son is a college baseball player and ran into the outfield wall during a game and sustained a Grade 3.5 shoulder separation in his throwing shoulder. He was operated on about a week and a half after the injury. After the surgery the doctor told us he repaired it to about a Grade 1 with a button pulley system. We went for a follow up appointment yesterday and the x-rays showed it had spread out to about a 2-2.5 separation again. He said something obviously went wrong after the surgery, possible slippage of the pulley or something coming loose after surgery. He gave us the option to wait and rehab or go back next week to tighten the clavicle down again and check the ligaments. My son’s concern isn’t a bump on his shoulder, but rather getting things fixed as best as possible in order to get back on the field sometime in the fall, and certainly by next spring. Any input would be greatly appreciated!!!

    • I wish I could help, but I can’t really say much without seeing him and the x-rays. I’ll defer to whatever recommendation your orthopaedic surgeon gives. Good luck!

  17. Hey David,

    I took a massive slam whilst on a gap year snowboarding in whistler. I landed on my back and was lucky not to break any bones, however… I broke every ligament in my shoulder, except for one that was just about torn off anyway. my shoulder had dropped close to 1.5 cms. I undertook surgery and they inserted a graft to hold my shoulder in place, then they took the ligament that is unused to hold the rest of my shoulder in place. I am about 3 months from getting my sling off, a bump has risen however I was told it was simply the ligament ‘slipping’ a bit that is common after surgury. when it slipped I was really upset because I had taken such care of it and my perfect shoulder was suddenly not perfect again. I went for a ride on my bmx this weekend. I had so much fun I decided to go again the day after however I’ve been in terrible pain for the past 3days. I feel as though it was the ligament stretching because I had to take heavy pain killers to seduce the pain. I was wondering how much strength I should expect to have lost and when (if I ever will) have made full recovery. I was told the surgery had completely process had completely healed however I should undertake physio because my muscles are weak. I can push the bump on my shoulder inwards to make it flat and when I shrug my shoulder the bum raises. currently I feel as though I have lost 60% of my strength. do ligaments strengthen? I feel as though I won’t be able to throw my bike around unless I am in peak physical shape like I was when I played rugby (i.e. 4 days a week of gym for a year) and if I don’t remain in shape I won’t be able to participate in sports that I love because of my weak shoulder. p.s the xrays are on my instsagram ‘Le_Rupes’ if you are interested in looking at them.


    • I can’t say or give you specific medical advice, but I would definitely ask your surgeon. Generally we try to restore full motion and strength, although it can take many months of physical therapy.

  18. Hey David,

    I suffered a grade 2-3 separated shoulder snowboarding about a month ago, decided to go the non surgical route and I am very happy with my ROM and strength at this point. I have been doing strength training with resistance bands since week 2 and am able to do 5 pushups and 5 pull ups now pain free while doing them. However I wake up most mornings with alot of tightness and pinching pain in my ac joint. Am I pushing it too hard if I’m feeling this much pain in the morning? Don’t want to cause any long term damage. My pt said to train and listen to my body and while I’m training I feel great, it’s just the mornings where it kills. Thanks!

    • Dan, generally discomfort in the early weeks after AC injuries is not uncommon. Nice job on getting back to where you are now!

  19. HI David, I had a grade 5 AC seperation, I had a hook plate in for 5 months, I changed surgeons he said it is old technologie and that the hook plate was in to long, he removed it as I was suffering grinding of the bone from the hook, and survere Bursitis which I had had cortisone for when the plate was in. The plate has now been removed 3 months, physio is slow going, I am suffering a burning heating sensation in my shoulder, as well as very achy sore fore arm and elbow, any ideas what could be causing this? Physio suggested still Bursitis?

    Kind Regards in advance


    • Mandy, I wish I could tell you, but I would ask your orthopaedic surgeon his opinion on the cause of your continued symptoms.

  20. I separated my shoulder (Type III) 4 years ago. My doctor recommended that I rehab as surgery is relatively uncommon and is not proven to be better. I am highly athletic and compete used to compete at national championships in a throwing sport. The injury essentially ended my career even though I have done a good job of rehabbing it. My range of motion is much less than my uninjured arm and certain ranges result in quite a bit of discomfort.

    My question: Even though it has been a couple years, I think it is quite apparent that this injury continues to cause me discomfort and limitations. I would like to try the surgery to see if it would make things better. Can you do the surgery after 4 years or is everything scarred down to the point that it may cause greater issues?

    • Surgery can be done for chronic Type III AC injuries. The exact procedure can differ from those done acutely, but there are surgical options for patients with continued problems.

  21. Hi David,

    I separated my dominant right shoulder at grade 2 3 months ago. Even right after the incident at the basketball game, I was able to play longer and even make some shots.
    Doc told me he wouldn’t operate such a shoulder and wouldn’t even let his shoulder operated for such an injury.
    Now after 3 months of rehabilitation, I have almoat full ROM and %90 strentgh back. Excellent results so far.
    But I have still a problem, my acromion and scapula has also been malpositiioned, it’s not the ac joint (it is now stabiler than the healthy one on the other side) but shoulder blade and the scapula giving me a lot of pain and cracking sound. My arm and shoulder pit also moved down remarkably after the injury, in the beginning it wasn’t as such.

    This worries me a lot. As far as I understood ac joint reconstructruction injuries don’t help for acromin and scapula positioning, are there other surgery methods to help to improve this problem?

    Many thanks in advance

  22. Hey Doc,

    My question is: if a successfull TightRope procedure after three months comes (partially?) loose, what should I do?

    I had TighRope surgery on a AC Luxation Tossy 4, 13 days after a car crash. I used to be a enthousiastic bodybuilder, but I didn’t touch a weight at all during my 3 months after surgery. I didn’t need therapy since during checkups I regained full mobility without pain.

    This was past three months.

    After the second month of surgery (after the last and positive check-up) I have been driving my motorcycle (on-road) four times, for recreational purpose, had causal sexual intercourse and didn’t go to work at all. This is to demonstratie to you, the amount of activity I did.

    Two nights ago, I got a severe pain at the spot of surgery (This is three months after surgery). I couldn’t lift my arm without pain. I took painkillers and rested my arm until today. I have no more pains, but I am afraid that the TightRope came (partially?) loose. I don’t know whether I see the knob in the shoulder when I look in the mirror.

    I made an appointment with the X-Ray people in hospital to see whether it really did come loose.

    Thanks for your advice!

    • I can’t really tell you what you will need to do, as it will depend on what, if anything, actually happened to the repair. Your orthopaedic surgeon can determine if the fixation failed and if you need a revision surgery.

  23. My 12 yr old son was involved in a dirt bike accident at a national motocross race at 9 am He got on his bike and tried to race and ended up pulling off. He said his left arm felt like it was broken. Took him to the medic and they threw an ice pack on felt it and said it doesn’t appear broken and said it was up to us to get X-rays but it looked good. I chose to get X-rays. At the hospital the dr said it was not broken and sent us on our way. We let him swim in the pool and got him ready for his next moto that was at 5 pm figuring it was only bruised. Iced Advil and KT tape. Sent him out to race and he finished very slowly and in pain but not extreme pain at all the entire time. Finally I called my sister in law and sent her a pic of him standing and noticed he was dropping his left nipple looked pinched. She is in Orhopedic Trauma as a PA in an ER. She said he has a possible Grade III separation. I got 1 X-ray from the hospital and the bones do look like what I see as a Grade III. She said not much to do but let it heal and get X-rays again in a week since the hospital seemed to not provide all of them. Ok so now that he missed the biggest race of his life and rides 5 days a week. What is recovery time for a 12 yr old. He is concerned in how long until he can race again. Any recommendations for pt and when does that usually start. Will he be able to ride again anytime soon? He is In a sling all day. Ice and ibuprofen. Thanks for any information.

    • Every patient is different. An orthopaedic surgeon can give hi specific recommendations based on his specific injury and how he progresses. Typically physical therapy starts in the first few weeks of recovery. Full recovery can take 6 weeks or longer depending on what an athlete is trying to do in his or her sport.

  24. Dear Dr. David,

    I would like to have your opinion concerning removal of the “Tight Rope”

    15 weeks ago I had a single-rope “TightRope” on a grade 4 shoulder AC separation.. Surgery performed five days after injury

    First 4 weeks.. The clavicle was tucked back and reduced tightly.. After starting physiotherapy on week 6.. Slowly by week 8 I started noticing that the clavicle is rising.. For Example.. When i’m in a seated position and my arms are hanging loosely.. Or when I swing my arms downwards.. I can feel the clavicle bone to be higher than the other normal side.. The screw is noticeably sticking out as well— All of that as opposed to the first 4 weeks after the surgery

    From week 8 until week 15 it has somewhat remained the same..

    I have come to learn that this is a normal process for this type of surgery

    The top screw is now positioned in a very awkward place since it’s sitting exactly on the tip pointing upwards.. Does not feel good to the touch nor does it feel natural.. There is some discomfort once I wear a messenger bag.. But most of all.. I do not wish to keep something inside my body that possibly has no longer a function

    I have searched online for this topic.. However.. Very little people/doctors have discussed this issue..

    One website for medical studies advises to remove it after 12 weeks to avoid clavicle fracture in case of impact on the area.. Also.. Another doctor systematically removes it after 12 weeks.. But did not explain why

    Most importantly.. After I discussed this issue with the doctor who performed the surgery on my shoulder.. He said he would remove the whole system after 12 MONTHS have passed on the surgery (With the same arthroscopic procedure).. Explaining that this single-rope Tightrope surgery is designed to let completely loose after 12 months of fixation inside the body.. Meaning that it would NOT be acting as an extra ligament or support after one year

    I asked after 12 months does it make a difference in functionality if I keep it or remove it.. He said “No difference”.. However.. I would have to go through the same after-surgery process of immobilizing with sling.. Followed by physio

    At this point I decided to get another opinion from a doctor specialising in sports injuries.. After examining my shoulder.. Doctor #2 said that the results seem very good.. However.. He was concerned that once I remove the tight rope fixation at the mark of 12 months.. The ligaments “might” stretch.. Which might result in the clavicle bone to perhaps move upwards.. Note that this doctor does not exactly specialize in shoulder injuries like doctor #1 does.. And he has never performed a removal of Tight-Rope from any of his patients

    Hence.. I would like to know what you suggest.. Which doctor do you agree with most ?

    In your opinion.. What are the risks if any, to the removal of tight rope after a 12 month period

    Does tight ropes remain tight after 12 months in your experience ?

    If in fact it does become totally loose after a year ->

    Does scar tissue grow around the rope.. Adding a greater bond between the two bones ? And when removing/pulling out the rope.. Does it also remove scar tissue formation that grew around ?

    If a ligament has healed itself around that rope.. When removing the rope.. Does that disturb or damage the ligament leaving it weaker ?



    • I don’t know that I can give you specific advice. I don’t use that device and instead use a tendon graft. Typically surgeons don’t remove those devices unless there is a specific need. In theory if only the device is holding the bones in position and the ligaments did not heal, then the clavicle could displace again. Your surgeons can better advise you on the pros and cons specifically for your shoulder.

  25. I am a 27 year old male who has type 3 ac separation and when consulted with my surgeon he made it seem that if i didn’t have suegey that i would struggle in my career as a maintenance technician with job duties. So i had the surgery. But here i am 4 weeks later having to reepeat the surgey because the tight rope device used came undone and my shoulder is completely seprated again and pain is much worse and comes in different varieties from dull throbbing to sharp almost like pinching pain and i was curious if u have heard of these devices coming completely apart like this or if i should be seeking a second opinion from another local orthepdic surgeon im schedule for surgey Thursday September 10 your advice would be greatly appreciated

  26. Hello, I was in a MVA in 1999 and somehow the Dr’s missed my separated shoulder so it was never fixed. I was in the hospital for 3 months and I was on a lot of pain medication so I never felt any discomfort really, plus I was 17 at the time. Now 16 years later, its starting to give me problems. Its almost as if somethings being squished or pinched and it was just under my “lump” on my shoulder but now its in the back of my shoulder and towards the back of my neck. Im seeing the chiro on Monday and going from there I guess, they ordered xrays that I will be taking with me to my next appt. Im wondering if surgery is even an option at this point because it has been so long. Also, any idea why it would now give me problems? It started about a month ago but the last week, it has been getting progressively worse. Hard to lay down/sit sometimes without having it in a certain position. Any insight would be helpful.

    • Often orthopedic surgeons treat AC joint separations non-surgically. Having said that, it could be a good idea to see an orthopedic surgeon to determine the source of your pain and figure out treatment options.

  27. Hi dr. Geier , I am on week four after a grade 3-5 separation from riding bmx. I am extremely active and ride bmx professionally. The surgeon in the ER never even took my shirt off and only went off the X-rays during my exam. He said that my shoulder had been separated before and that it was an old injury that could not be fixed, and that I could only rehab it. My question is about the massive amount of skin tenting I have …..the distal end of my clavicle has an avulsion fracture that has left it sharp like a knife edge under my skin and I worry that it could burst through my skin at the slightest impact!!

    How much skin tenting warrants surgery ?

    I’m at week four , is the lump likely to decrease at all as all as the injury heals?

    Last question , what is the best reconstruction technique for contact athletes?

    Thanks again for any help

    • I’d probably see an orthopaedic surgeon and get advice based on your specific injury regarding possible surgeries if he or she feels you need it. Most surgeons use a reconstruction involve a graft or implant that attaches to or around the coracoid.

      • Thanks so much for the response!!! I have been taping my Shoulder with athletic tape for the last 4 weeks in an attempt to make it heal less pronounced and with less tenting……does taping it down do anything ? I am four weeks into this injury is it likely to get any less pronounced as time goes on and the shoulder remodels etc? Or will is stay looking like a knife under my skin? Thanks again for you responses , it’s vey cool that you take the time

  28. Hi DR., i am a 17 year old boy, about 4.5 – 4.7 on the tanner scale of pubertal development and i’ve suffered a possible grade 1 – 2 separation. I am not totally sure, as when i went to the hospital for assessment about a week or two after the injury i was told the subluxation was “not enough” to be classified as a separation and i was also not given much advice other than to lay off my weight training (specifically pressing movements which injured me in the first place). There is a slight bump on my shoulder now and i did not experience very much pain throughout the course of my injury (past 2-3 weeks) which further adds to my confusion on what grade the separation is.

    Anyways, my questions was, since i am still young and developing i wanted to know if this injury may affect my future athletic capabilities (not being able to do certain lifts due to loss of support from clavicle, specifically dead lifts as the very heavy loads pull on the arms) or cause further deformity due to future clavicular bone lengthening/growth? Also I am aware that adolescents have far better healing abilities due to our young age and was wondering if this trait would apply to this injury as well and specifically result in the reduction of the bump due to fast healing in tendons on its own?

    Right now i have no pain as well as full range of motion in my shoulder, with only very minuscule pain when i pull my elbow very far back to cause the end of my clavicle to push out at the top of my shoulder.

    • Typically Types I or II AC separations don’t limit athletes and athletic people returning to sports long-term. The only significant complication of a type II injury is arthritis developing years down the road. Generally, though, we treat those injuries without surgery regardless of age.

  29. Thanks for fielding questions! I have a Type II separation that occurred about 3 years ago. Rehab was great and I don’t experience any noticeable pain or ROM issues. However, I recently started working out again in the gym and I clearly have some pain in that shoulder and a clicking/popping sound when lifting weights. Would a new stint through rehab help or are there any exercises you would recommend to restrengthen and minimize the clicking and popping?

    • Physical therapy can be very helpful for someone trying to return to activity after a type II AC separation. Occasionally patients develop arthritis at the AC joint years after a type II injury, so an orthopaedic surgeon can obtain x-rays to see if that has happened.

  30. Hi Dr. I fell on my right shoulder and I have done x-ray and mri. My surgeon doctor say I have a type 5 ac joint separation. And that I need surgery and would take about 3 months for total recovery. Now he said he will use an alograft. When using grafts on shoulder surgery screws are necessary to use? The other thing is i do mechanics work. Would i gain the strength at least 90+% back to normal? Im looking for an advice before doing it. Do you think is worth to have it? Thanks in advance.

    • I would ask your surgeon about screws, because there are many different types of procedures for these injuries. Generally patients do require strength, although it can take a long time and a lot of rehab after surgery.

  31. Hello Dr,

    I was just wondering this as I wait for my next appointment with my doctor. I have a grade 3 seperation, and it healed very fast in 9 days when I had first visited with him. He asked what my job was, and because I said it was a desk job I wouldn’t require the surgery, but I like to do things such as rock climb, work out, bike, and kayaking. All things requiring shoulder strength. This was not mentioned though.

    Do you know if I have the option to tell my doctor I respect his decision, but suggest the surgery as I would rather have 100% strength in my shoulder over 90-95%. I also have big self confidence problems, so having this large lump on my shoulder is very embarassing.

    I am just wondering if I am able to push for surgery, or if a surgeon says “no” it stands at that. I would rather have a scar than a bump. One looks like a cool story while the other looks like a deformity.


    • It is your shoulder. You can ultimately make the decision. The surgeon doesn’t have to do it, though, so sometimes patients need to find another doctor.

      • Thanks, Dr Geier. I will keep this in mind. It’s just a tough call considering I have to choose between lack of strength and stability without surgery, or have both of those while sacrificing dexterity/mobility of the shoulder.

  32. Hi Dr. Geier,
    I injured my shoulder three weeks ago and just saw a doctor yesterday. He told me that I have experienced a shoulder subluxation. It’s been three weeks and the pain has been getting worse and it is painful to move my arm around so my trainer had thought rotator cuff. When I looked up the rotator cuff symptoms I had a lot of them. My pain is a lot worse at night and I can’t sleep on my shoulder. My range of motion is poor as well. Could there be a problem with both my rotator cuff and a shoulder subluxation?

  33. Hi Dr Geier,

    I had a ac joint separation grade 2-3 from surfing 2 years ago on my left shoulder. It hasn’t bothered me as much apart from getting stiff neck and upper back on the left side. Surfing is part of my lifestyle here and just recently I could feel a bit of sharp pain around the joint area. Any suggestions how long should i rest it for? Is it a risk to keep on surfing as the other tendons might give way?

    Thanks for your time!


  34. Hello Doctor David,

    I have sustained a grade 2 AC separation and understand that these injuries are typically treated with non-invasive methods. My question is; if i am dissatisfied with the bump on my shoulder for aesthetic reasons, and wish to get reconstructive surgery for my AC joint, how can i go about this?

    Would i have to have a discussion with my family practitioner or go straight to an orthopedic surgeon and make a request for a cosmetic surgery? Some of your advice would be highly appreciated.

    -Thank You

  35. Good day. I recently had scope surgery to repair my Grade 5 AC Joint separation. All seems to be healing well, as it hardly bothers me at all anymore, and it is feeling more structural (normal) lately when I am out of my sling doing minor household activities (getting dressed, preparing food, etc).

    I do have 2 concerns: (1) I have been recommended to be immobilized for a full 6 weeks in a sling – there has been a little mentioned of getting out of the sling and doing light lower arm/elbow exercises, but nothing else. I have done plenty of reading where, in the athletic world, patients are immediately put into regiments of cardio (recumbent cycle) & other massages & exercises. Am I missing out on helpful rehab waiting the full 6 weeks?

    And (2) after the 6 weeks & sling removal, when I start a rehab regiment (range of motion), is there any history of common rehab causing any re-injury of the joint/ligaments? I have a history of serious wrist damage and a severed FPL tendon. After 2 surgeries and 4 months of rehab, I was getting “released” to normal life on my last day of doctor/rehab visits, and my FPL tendon ruptured again. I had to do it all over again. So, this has put a slight “fear of God” into me as to initiating my AC Joint rehab regiment. Is there a standard “light” schedule as opposed to an “aggresive” rehab schedule for this injury/fix?

    Thanks for your time & insight,

    • That could be something you could discuss with your physical therapist – your concern of reinjury. He could adjust the rehab schedule if needed.

  36. Confused, depressed, uninsured, poor, Pain as hit by a sledge hammer… dr.:WHO looked `15; said injections, therapy… Said lots of hockey players have it..HE got up walked out…Bone is huge lump… neck arms killing me 8 mths after injury..xrays. mris ultras…$ 5,000 in photos…54 yr old farmer ready to die,,, been healthy all my life,now willing to smoke Rhino horn , Drink tiger blood….Cut my arm off… lost , sad, so strange to not be happy, surgery is not advised.. my therapy ha, 300 lb guy at 6;00 am walked to bathroom 10 mts, later,turned on golf show, talked about self,said roll ball on wall..IM not stupid, not lazy, 100% done.Live with it . GOD IS GOOD

  37. I had a level III AC separation in 2007. The Weaver-Dunn Procedure was used relocating the tendon from the shoulder area. There was a lot of arthritis in it at the time of the shoulder surgery (6 mths after injury due to MRSA). I have pretty severe chronic pain and was curious is it possible to reverse the surgery or basically set it free as it pulls and remains so tight in places and so weak in other areas.

  38. I have an ac joint grade 3 tear and I had surgery two weeks after having it. It’s been 5-6 months and there’s a bump still is that common for a bump to stay even after surgery. And will I be able to recover fully from this

  39. I’m 46 yo diagnosed with grade 4 separation of my right AC joint after a fall from a horse. I’m right handed and super confused about whether to undergo arthroscopic surgery to repair it. I’m getting conflicting advice – 2 physiotherapist friends are absolutely anti surgery and believe it will heal well on its own, but I’m very unsure.

  40. Hello, Dr. Geier,
    Three weeks ago, I fell on my left elbow and sustained a mild widening of the left shoulder AC joint space, with diisruption of the capsular ligaments (I am right handed). The MRI showed possible low-grade partial tear at the clavicular insertion of the coracoclavicular ligaments.
    My orthopedist said that it’s possible surgery, and I have an appointment with the surgeon tomorrow. After reading much material from internet sites such as this one, I am still concerned as to whether surgery is the best option.
    I taped my shoulder with kinesiology tape for about a week after the injury, based on some seemingly reliable internet sources. I also wore a sling periodically for two weeks, being that I’m not allowed to wear a sling at my job. My shoulder is improving slightly, but very slowly; minutely improving day by day. I have not tested it with much weight, so as to allow it to heal without stress. When I bend over forward, and stretch my arm out front and move it horizontally back, I feel a lot of pressure right at the joint, with pain the higher I raise it or if I continue doing it.
    I am an active 34 year old male, who of course wishes to return to full activity.
    Is there any helpful information you can provide me so that I can have a clearer understanding as to whether surgery or non-surgery is a better treatment?

    Thank you for any assistance you may provide on this matter.

    Cesar Turcios

  41. I had a grade 2 separation in my right shoulder a year an half ago. I am an active 22 year old but I have had a burning pain in my shoulder for the last year. What can I do to manage it?

  42. In 2010 I suffered a grade 3 AC separation after a auto wreck. After a couple weeks it healed well and other than the tenting it was good as new. 2 years later I was lifting moderate weight above my head and felt a shift in the joint area followed by strong pain and instability. I opted for surgery due to the fact I had what the Orthopedic called calcification and the was bone floating around. The separation was so violent initionally when the injury first occurred the ligament pulled bone off when it came free. Do you have any thoughts as to why after 2 years with no problems what could cause sudden pain and the instability I felt? I received the surgery and it failed after a couple months. That was 4 years ago and after experiencing a return of pain and growing limited movement I wonder if the fact that by my shoulder being structurely unsound and out of whack that ware and tear is tenfold? I do hard physical work and am discussing having yet another repair with my orthopedic. I feel that due to the pain and how it is getting harder to use my arm along with weakness I will likely do the repair. Have you heard of any case’s where the shoulder healed after a failed surgery (a ligament out of my leg was used to pull the clavicle down) and was practically 100% but began to deteriorate after an awkward movement or something similar?

  43. I had my arm broke 18 months ago and since then I have had a lot of pain with my arm. I’ve had a squared shoulder since. I asked my orthopedic surgeon about it,he said it was OK.I still have a lot of pain with the shoulder. What can I do. James

  44. Hey Doc, I had a Grade 3 Right Shoulder AC separation Feb 2013 and was in surgery 4 days post diagnosis for tendon reconstructive surgery facilitated by a LCP Clavicle Hook Plate. In late Jan’16 (just 2 days ago) I had the implant removed along with arthroscopic shoulder surgery to remove a bone spur.

    In your experience, what commentary can you share regarding the recovery on such injuries and also, would it be recommended to give up exercises (lifting 75-125% of my body weight) such as pullups, benchpress, dips, dead lifts? i am quite active and i hope i dont have to give up my active lifestyle. many thanks! -J

  45. I have a grade 2 Ac sprain which left me with a bump, and was told I developed OSTEOLYSIS in the joint. I was told I need the surgery that shaves off the tip of bone at the joint. The Mumford procedure. I was wondering if this would also help to reduce the bump from my Ac Separation? I am young and fit, the bump has really bothered me since I got it.

  46. I had a level 1 possibly 2 injury to my right shoulder 4 months ago falling off a bike with a 40 pound backpack on while riding down a dirt road. I was 3 days from getting ice/heat and anti inflammatory to help it out since I was camping in a wild area. I took 3 days off work when back and was taking ibprohen regularly to be able to work which was painting above my head and wallpapering. I didn’t lose any range of motion just pain and soreness, but my pain level is high. My work is done and rested my shoulder the last month. It still hurts in the morning and if I try to do push ups and lift heavy objects. I realize it did not heal properly and am curious if I might have to get surgery? Any info is helpful!! Thanks… Joe

  47. Hello, So I had a type 2 ac joint separation 2 years ago playing Football and I decided to play through it that game and the next. Well I let it heal after the season and after like 3-4 months it did. But I went to recruit training for the Marine Corps and whenever I would do a burpee exercise it would start to hurt again and that was like 5 months ago and today I was doing 8 count body builders and my shoulder just started hurting again and I am wondering if I permanently messed up my shoulder or does it need surgery.

  48. Hi doc. I am a student athlete and my event is Judo. I had a 3rd grade ACJ separation from a bad throw. After injuring it, I can barely move the affected arm. The doctor had me go under surgery (surgeon was payed by my school) so that I can go back to the sport and heal as fast as possible as I have to join a very important tournament later in the year. A tendon was grafted and tied around my coracoid and drilled via suture anchors.

    I’m not sure why, although my recovery is going really fast (less than a month out of surgery, I can already place my arm overhead without pain and even perform pushups). I can still see a bump at the end of my right clavicle, and I can press it down much easier than the good side. I can remember a time where I kind of felt pain trying to change my shirt 2 days after surgery. Do you think I may possibly have re-torn the graft? I’ve been moving a lot (even before getting cleared to do PT I am already almost completely mobile) as I feel little to no pain, but there’s a bump that I can’t help but be paranoid with. The thing that concerns me is that it hasn’t even been a month but I’m already moving as much as I am, but I have a moving bump, which only appeared around a week after surgery, though not as tall as when I first injured it.

    Should I worry about the movable bump my right clavicle makes? Or should I stay calm and feel blessed that I can move as much as I can 25 days post op? Does it sound like I tore the graft? Please tell me what you think. Doctors in my country can be very expensive.I cannot afford another surgery as it would not be funded by my university anymore. If ever it is actually re-torn, in your opinion, do you think it’s possible to tough it out and strengthen the muscles and still safely continue? The sport involves a lot of throwing and getting thrown…

  49. Hello Dr.Geier,

    I am a 33 year old male. I spend a lot of time sitting down at work, but I am very active after work. I play basketball couple times a week, soccer couple times a week and also work out couple times a week. My question is about my right shoulder separation.

    I separated my right shoulder when I was 13 years old. Not sure if it was type I, II, or III. I also broke my right Humerus right under the shoulder joint. After about 4 weeks wearing a full body cast I recovered. Haven’t really had any problems till I separated it again.

    September 2014, during a soccer game, I was slide tackled and I ended up landing on that same shoulder. My doctor diagnosed me with type III separation. He also recommended not to do a surgery, but just let the soft tissue heal. After few months I returned to my normal activities.

    Now a year and a half later I am experiencing pain in my neck and my right shoulder blade. The pain seems to be worse a day after I play basketball.

    What is causing my pain?
    Why now?
    What can I do to feel better besides pain killers?
    Would you recommend a surgery?
    Any other suggestions?

    Thank you

  50. Hi , my name is HAMZA from Morocco and i have been reading your articles for a while , and unfortunately i had a small accident while working out and it seems that i have an “AC separation” in my left shoulder, but my problem is that when i went to the doctor he said to just wait for it to heal , and i can’t do that i am afraid that my shoulder heals in that position and i will remain like that forever , and i wanted to ask cause the inner part of clavicle ( near the neck ) slightly went in , and i lost strength and muscles in my left arm . what should i do ? and what kind of doctor should i go see ?

  51. My husband landed on his shoulder while longboarding and the doctor says it is a grade 4 AC separation. We are in college and don’t have money to throw into surgery unless that is his best bet. We just want what will help him completely heal and get back to running and biking as soon as possible!

  52. I am hoping to join the Army National Guard. I had surgery such as this and was cleared to wrestle in college which I did for 4 years. Is this kind of injury progressive and will it keep me from joining the military?

  53. Hi Dr. Geier,

    I had a grade 5 seperation many years ago. Unfortunately the tightrope was placed incorrectly. This caused major pain and instabilty. Since I’ve had a revision surgery with no success. From my research I see that most of these tight rope or similar procedures don’t always work especially for revision surgery. But i’ve come across a surgeon who stopped using these procedures due to the high failure rate. He now uses surgilic along with a hook plate. He believes that the hook plate stabilizes the joint very well for 6 months until all the structures are healed. After 6 months he removes the plate and the surgilic remains. In theory do you think this procedure can be stable? speciffically for a 3rd revision surgery? thanks

  54. I am a 65 year old female. I have been rollerblading 10 miles every other day for 17 years. 4 weeks ago I fell going pretty fast and went off the concrete into the dirt. I had my arms outstretched and skid on my right side until my right hand hit a tree root causing me to stop abruptly. I have pain in my neck and right shoulder and down the back of my top right arm, across right side ochest and shoulderblade. I had an mri which shows torn bicep, 2 double tears in two different tendons. My dr is going to do surgery rotator cuff repair and sew bicep. My right side of chest is lower now, will the surgery fix that? Also nothing was said about the back of my arm. I have still been rollerblading and icing when I get home. My dr is talking about putting my arm in a sling after surgery for 3 months. Is this normal? I feel like I won’t be able to move it any more if I do this. At 65 I lose muscle so quickly. Do you think it is still safe to rollerblade up until I have surgery? Thank you

  55. I have an 17 year old, almost 18y.o, grade 3 ac separation with no united distal fracture, from a MVA when I was 17. About 2 years ago, I started noticing that it was becoming painful when I would do repetitive movements. Anyways, long story short, I am actually having a “right ac reconstruction with hamstring graft” in a few days. Im just curious about the recovery time, how I will feel after surgery and the success rate of this type of surgery. Driving and simple things like putting away dishes are a pain in the u know what. I plan on having another child and I want to be able to carry my baby around without pain and do my every day things without paying for it at the end of the day.
    Any input would be greatly appreciated.

  56. I fell on my shoulder 3 months ago from now, after xrays and ultra sound, doctoers have been confusing me by telling me that i have got AC sprain, Seperation, and they only gave physical therapy for 4 times, pain went away but i still have a bump above my shoulder.
    Ive been doing alot of researches, some cured by surgery some by KT tape, and some by only resting icing while holding shoulder in the right location!
    I also feel like my shoulder cant handle the pressure it used to take!
    Im wondering if i can cure my shoulder with no surgery?

  57. Hi David, I recently suffered a ac joint separation class 3 by 16mm… I’m a very active person play football and a amature weight lifter (heavy bench press ect), the reason I mention bench is because it seems to be the most effected from what I read… When consulting my surgeon he told me that the best chance to returning to 100% strength is with surgery, to your knowledge is it possible after surgery to get back to where I was if rehab and pt is correctly followed?

  58. Hi, I wonder if it possible to reduce small bump (2 grade ac joint dislocation) by significant developing muscles which hold the collarbone? and I’m not talking about covering, but about by pushing it to body. Probably this idea is only my imagination 🙂 but maybe legiments can be shorten a little by exercices?

  59. It’s been 2 years after my AC II separation, and I’m glad I did research prior to talking to the specialist that wanted to operate on me after 3 mins of consulting with me. He said he loved performing surgery. He warned me that by not operating on the shoulder I would get arthritis in my shoulder, and I felt bullied into scheduling the operation. Since surgery was the last route I wanted to take, I was referred to a sports medicine specialist and he put me through a rehab program and had a much better bed side manner in my opinion. After a few months of rehab, I felt much better working with my left shoulder. I still feel like its not as strong as my right, and am a little anxious about joining a boxing gym. I’ve seen feedback about what you should or shouldn’t do after the injury, but not much on what one can do years down the road from the injury. I think throwing punches with the arm is probably not a great idea, but I do think it’ll be a good way to strengthen the shoulder. Has anyone boxed after a few years removed from their AC II separation injury? Are we more prone to dislocate the shoulder now?

  60. Hello! I am a highschool student and have recently seperated shoulder in lacrosse. I fell directly on the shoulder. The doctor said it was a high grade one and I won’t need surgery and possibly no PT. Now nearly 3-4 weeks later I have full strength and I just get a little sore with throwing a football and stuff that I have to use my full range of motion. In lacrosse this isn’t a huge need to rotate your shoulders completely. Do you feel I’d be ok to go back to playing?

  61. It has now been over 7 years since my Grade 5 separation at age 57. I had surgeries to install a plate and to remove it after 6 months. The clavical and scapula were separated by 1.5″ and all ligaments were shredded beyond repair. My orthopedic surgeon recommended the surgery which would re-position the shoulder, hold it in place and allow scar tissue to form and hold the joint in place. At the time, I was unable to find anyone else who had had this procedure.
    My thoughts: I have had no pain. There was upon the removal of the plate a slight dropping of the shoulder yet hardly noticeable. Also, there has been no restriction in movement. Actually, I can reach further behind my back than with the other arm. Just posting this for the benefit of anyone else who might be considering this option.

  62. I am trying to figure out how and when I injured my AC Joint.

    I first noticed the bump following rotator cuff surgery at the end of March. I don’t remember any recent injuries that sound like those described as the source of AC problems. Years ago, my wife closed an SUV hatch on my shoulder, but it did not seem to bother me too much at the time and I don’t remember having the bump until recently.

    The rotator cuff injury initially appeared as bicep pain–I did not even realize it was connected to a shoulder injury. In March, however, I noticed pain the shoulder itself when I went off anti-inflammatory medication to prepare for the surgery. I had also noticed some popping noises starting back in January or February–after the rotator cuff injury had been diagnosed. When I stop taking the anti-inflamatory medications now, I do not feel pain in the bicep by I do feel pain in the shoulder.

    I don’t remember noticing the bump until after the surgery. At first, I thought it was the anchors for the sutures. Then I thought that maybe the flesh around my shoulder had shrunk (do to muscle atrophy while wearing the stabilizer or maybe because the bursa was removed) and then exposed a normal part of the shoulder that is usually hidden by muscle. My surgeon, however, says it is the AC joint and that we might consider surgery down the road if it causes too many problems.

    Could the rotator cuff surgery caused or aggravated an AC Joint injury?

    Is it possible that I had some sort of injury between January and March that caused the AC problem without noticing the injury itself?

    Shouldn’t I have noticed an injury that was strong enough to cause a noticeable bump in the AC joint and felt significant pain for weeks afterward?

  63. Hi, I’m 37 years old and had a grade 5 AC tear. It’s been about six weeks since the injury and I can’t decide if I should do surgery. My doctor said it’s up to me, she is not pressuring me either way. It’s on my dominate shoulder and I do like to play softball and golf. Other than softball and golf, I’m not really active, some lifting and playing with my kids. Most of the time I don’t have pain, I do have pain sometimes. Anytime I have to reach and lift, like getting my 6 month old out of her car seat or lifting anything when laying on my back. Certain other motions cause some pain too. The first 5 days after the injury was hell, I was almost crying every time I had to put on a shirt or button my pants (I know, sounds weird).

    What do you think? Surgery or Not?

  64. Similat to Toby S (26th July) I have what is being seen a a Level 5 injury but foer the most part am not now going through constant severe pain. It happend on 1st July after impacting my dominant side with a car whilst on my bike.
    Like Toby I can do most things, get it wrong however and I know it, mostly nearer the neck and down to the upper arm area.
    I am off to the fracture clinic in a couple of weeks to see if operating in the surgeons eyes is an option?
    My question is; can a level 5 repair naturally (except for the lump). I am a competitive cyclist and the thought of all that follows post surgey worries me as does now, falling off again for whatever reason.

    Many thanks

  65. I had arthroscopic distal clavicle resection 8 months ago. I get a crunch in in the joint still. Not the same as before the surgery, but still a crunch. Typically the crushing doesn’t hurt but I regularly get aching pain in the ac joint when it is over used it crunches too much in one day. Especially when I write with a pen for a long time pushing the pen hard against the paper. Then it aches afterwords. How long does it truly take for an ac joint to stop getting so achy after you’ve had surgery? Will the achy pain gradually become less frequent? And what can I do to speed up recovery?

  66. Jello!
    I had a type 3 (might have been 5) sepparation nearly 20 years ago. I did not have surgery (but at least i have a type 2 on the other shoulder to even them out). I am a very active 38-year old. I go through spert of pt, depending how often i get to a gym. Recently, i have begun to experience moderate to severe pain in this old injury for no apparent reason (no accute injuries, falls, etc.). It is only when i do particular movements with my neck or shoulder does it hurt. I am still climbing, biking and kayaking, but there are some things i just cant do because of the pain. I am concerned this could become chronic. I did not elect surgery all those years ago, and now i am starting to fear i might need to in the future. Let me know what you think, thanks.

  67. Hi Dr Geier

    I had a Grade IV AC seperation. My Dr performed a Modified Weaver Dunn Procedure, unfortunately 10 days after the operation I waa rushed into theather again because of Infection. It seems under control now but it has been 42 Days now and I noticed a bumped appeared near the incision sit ( from the scapula bone) , sometimes to bump is more prominent and is sensitive to the touch. I was wondering if the boney bump is normal or could it be that the ligament taken from the clavicle dit not attach properly, or is it due to muscle degenration and the bump will be better as soon as I am physically active, if Dr could give Dr opinion it would be greatly appreciated

  68. Hi Dr. Geier, I am thankful for your website – its been very helpful in my current situations. I was diagnosed with Grade 3 AC Separation 6 days ago. It happened during Brazilian Jiujitsu (Wrestling/Grappling) – a sport that I love so much. I am 32 years old and not planning to be highly competitive in the sport – however really planning to still be active (2-3x / week training). I am also hoping to be able to hit the gym (medium weight) to keep some muscle mass. Met with 2 surgeons: 1 recommended not to do surgery and the other recommended surgery, both surgeons know the goal is still to be active even though it is not in a competitive manner.

    So far – I really cant decide whats best for short-medium-and long term.. I want to be active but dont want to have many complications in the future because of my decision. Sometimes I think just to have surgery so I can perform near 100% in my sport but reading some articles online some people have problem in the long run. If you would be kind enough to let me know what you think – that would be greatly appreciated since these days are pretty hard for me and comment from you would definitely help me.

    Thanks Dr. Geier.

    • Generally people can return to exercise and even weights after they regain strength and range of motion from a type III AC separation. Occasionally they struggle and end up needing surgery.

  69. Hi dr.geier

    I’m a overhead athlete with a grade 3 seperation of the AC joint, I’m 30 years old it’s my dominant arm and I’m competitive, but I’m stable have full range of motion and very little pain, 5 weeks in. I’ve seen 4 doctors and 2 said no surgery and 2 said surgery, it’s a very hard decision for me. Your input in greatly appreciated.

  70. I have a 3 month old AC Level III and as I am doing PT I notice shifting of the clavicle and some noises. Is that normal? What do you expect after not having surgery.

  71. Hi Dr Geier
    I currently away from home travelling. I slipped a couple of months ago with my heavy backpack on. I was so worried about my coccyx that I did not realize I had damaged my shoulder. It has been sore for a few months and I thought it was due to my backpack. However since doing the research I now realise it’s a separated shoulder. It’s been over 4 months since the accident, is it too late to RICE and wear a sling?

  72. I just suffered a Grade 3 Separation a week ago. I dont meet with my PT for about a week and a half. Should I be keeping my are in a sling or is it ok to be moving it around? What kind of in house treatment do you recommend? Ice/Heat, Elevation, tape it up? thanks for the help.

  73. Hi Dr Geier,

    Discovered your blog in the course of research. I very much appreciate your patient participation and everyone who has commented.

    I tanked on my mountain bike in late May 2016. I suffered a cat III ac separation on my left shoulder. The left clavicle already has a plate holding it together dating back to 2005. Another epic tank. I can still ride. In fact I can still ride badass. Very very sore afterwards but I’m now riding without issue. Swimming freestyle (my other athletic passion) is a different story. It feels gross, it grinds, it creaks a lot. It doesn’t hurt “that” much but aches afterwards and I can only bear about 10-15 minutes as opposed to an hour nonstop.. Wiring equipment racks as part of my jobs hurts while I’m doing it when my arm is above shoulder. I have a pretty high toleration for pain but this is getting in the way.

    I’m not happy with, but ok with the quasi modo deformity. But I’m aware of this injury 24/7 and sometime much more than aware. Even driving feels weird/aches. Wincing pain is sporadic. Moderate to severe Aching after biking and swimming is guaranteed.

    I can live with this but ….. if I can make it go away with the straps and dead guy tendon I’d like to just get it done. I’ll skip ski season but I need to ride bike technical trails and swim freestyle or I’ll lose it. I’m 54 years of age. Being fit is part of my long term plan but also a huge part of my psyche and identity.

    I can live with this if need be but don’t want things to get worse. I’m very active for my age and want to keep it up. What I can’t figure out is if surgery will help, may help or will make it worse. Really hard to decide to go under the knife if worse is a possibility. I know you can’t make definitive statements. I’ve seen two surgeons and they think it is a low risk low nobrainer. This seems to me to be the same low risk mentality that brought us the 2000 dot com bust and the 2007 real estate bust. Nothing is a no brainer.

    Thanks all for your advise and time.

  74. Hi Dr Geier,

    Last year I had an injury on my right shoulder at work. I went through 4 months of physical therapy before it was decided that I needed surgery. I had a MRI done but it showed mild abnormalities. After the surgery it was found that I had a slap tear, bone spur digging into my rotator cuff and some other little things. Post surgery I went through another round of physical therapy for another 5 months. I still had popping issues and aggravated muscles in my shoulder blade area but I went back to work thinking that it was instability from my muscles and that it would get better over time. After about a month or so it got to the point where I couldn’t do my job. I am a mailman so the use of my right arm is much needed and constantly moves all day. So I went back to the doctor and had another MRI done which showed nothing like the last one did. So the doctor said there was nothing else he could do for me. When moving my arm continuously my shoulder gets really aggravated. I can take my left hand and put it under my right elbow and push up and my shoulder pops. The initial pop is uncomfortable and hurts but after it pops it feels better but still aches. After doing this so many times a day I think that is what causes my shoulder blade muscles to hurt. So my question is what could this be and is there really nothing else that can be done?

  75. Hi Dr. Greier. today I seperated my shoulder in a skiing accident. I went to an urgent care and they diagnosed it as a type III AC seperation. Since booking an orthopedic appointment takes about a week, will my shoulder suffer long term from only being in a sling without further treatment during this layover time? Your help is much appreciated, thanks!

  76. WW

    Severe Stage III( both AC & CC) separation at 60. Emerg Dr. put me in a sling and made an appointment with an Ortho. Big bump on my shoulder, golf bullish. I am very active, run , ski, chop wood etc. Ortho was horrified by the sling. Said it was the worst thing for my injury.

    We talked about options. I want to remain very active. I need full range of motion. I want to look good as I certainly don’t look my age. What to do…

    I decided a bump was better than a scar and plate. I am 3 weeks out. It burns like the Dickens when I work it BUT I can work it. In my case, the cure or surgery, would be worse than the injury. My father popped the pin in his shoulder and suffered consequences worse than if he had forgone surgery entirely.

    My choice is to live with the bump. I lift weights,swim, run , ski and am very attractive. My “bump’, doesn’t define me. It just is. If that is the worst of it, life is grand!!~

    I am contracting with a group of Psychologists who work with accident victims and pain. I was humbled when clients offered me best wishes. My injury and pain/discomfort pales in comparison to what these people experience on a daily basis.

    All I can say is choose carefully. A bump is a bump BUT….

  77. Hello Dr Geiger, I am 64 year old. About 15 to 20 years ago I had my acromion removed. In September I fell and now I have a 12mm rotator cuff tear greater than 50% of thickness. My question is: Is the removal of my acromion going to complicate surgery on my rotator cuff?

  78. Hi, I have a grade 3 separation, I am a boxer that competes and is/was planning on going pro within the next couple of years. My doctor is giving me the option to have surgery or not. My question is, what is the likely hood of this effecting boxers with it being a sport that has a lot of shoulder use? Will punching be painful after recovery or should I be fine? I just recently got injured so I just want to make the right decision for my career, thanks. I’m thinking of not opting for surgery though.

  79. Hello Dr. Greir

    3 days ago I was snowboarding and under rotated a backflip straight to my shoulder. The doctor I saw said I have a type III AC separation. I have kept my should elevated to where my collar bone is pretty much back into place since it happened. If I continue holding it in place will there be less of a deformity in my shoulder or will there still be a bump?

    Thanks, Kyle

  80. sir i’m josh, actually i have a little pain in my left shoulder for 4 years i recall, but not that much severe, i can put weight or do any work but i can’t move left arm to many directions as i move right arm, when i try to move it seems that the arm is locked or dislocated at shoulder joint which makes me unable to reach my left hand to right shoulder and joints make snapping sounds,and at shoulder point the joints move cosmetically awkward. i have seen many doctors but yet none of them have even recognized the actual problem, got many x-rays and the x-rays reports say that all joints are on their actual position, no dislocation nothing else. sir do you any idea about the problem?

  81. This is long…but I hope it helps:
    My experience for what its worth (48 YO male) – I suffered a GR3 (according to the 1st surgeon I saw) in 2012. He looked at my x-ray and said ‘I can fix it…go home and call me back if you decide you want it fixed…go try to live your lifestyle and see how it works, but if you want it fixed call me back.’ Me: “No MRI? Aren’t you even going to examine me?” Him: “Naw…I’ve seen enough of these…we’ll just go in and fix whatever needs to be fixed”. I ran out of there. This was one week post injury…I was in a sling, lots of pain, not taking meds (they were prescribed at the ER).
    So I resumed my active lifestyle…some things I just couldn’t do (couldn’t raise my arm past horizontal)…others I had to compensate how I did them and it hurt…alot.
    After 2 months post injury, I was at the point where I was considering surgery. I went to a different surgeon…he actually examined my shoulder. He said he would call it a grade 3-4. He pulled 18 case studies…9 had surgery, 9 didn’t…the general consensus from both groups was that they were happy with their decisions. He said ‘We can do surgery, but I strongly urge you to start some conditioning now that it has stabilized. (I had been following Doc #1’s advice for 7 weeks of ‘Do whatever you can and just let pain be your guide!) Doc 2 made it very clear that it was pretty routine surgery but highly invasive and a long recovery. He advised that surgery should be the treatment option if I did not have the performance and ROM that I wanted.
    June 2016 – I was riding my bike and had about an hour of repetitive jarring to the same shoulder. Not huge impacts…I wound up tearing my labrum. Went back to Doc 2 and he ordered an MRI. I scheduled surgery for Oct for convenience and still maintained a somewhat active lifestyle through the summer (lots of soreness post-activity though). Although never stated by the doc, I suspect the instability of the joint from the previous separation contributed/caused the labral tear.
    The procedure I had is what was described in the first post – as a non medical professional, but an educated patient, I believe this is the best. Stay away from the variant that uses ‘buttons’ rather than screws for fixation as there are instances of broken clavicles due to the ‘voids’ left in the clavicle. I also had my labrum cleaned up and biceps attachment moved to my humerus.
    I was prescribed an ‘ice man’ for post op…I elected to use the Game Ready system. It uses cold water and compression. It’s programmable so you can safely sleep with it on. 30 mins on/30 mins off. I think this really helps in pain mgmt. and getting off the meds quickly. My doc had never had a shldr patient use the system (just knees) but was impressed with my rate of initial recovery. It’s expensive but I was able to get insurance to cover it. I used this for 4 weeks post-op.
    First motion check (dr’s office) – He says everything is healing great but unfortunately my ROM is on the lower end. Not a problem or concerning he says, just more work to do in PT.
    I was totally/partially immobilized for 7 weeks – they told me 6-8 weeks pre-op. I only removed the sling to shower (0-4 weeks)…I slept in a chair (0-7)…at about week 4-5 I was allowed to remove the sling and raise my arm using my non-surgical arm. I could do that to the horizontal position at first. Slowly I could raise it further (not using the muscles in that arm).
    Work – I had surgery on a Tuesday and returned to work the following Monday. In hindsight, that was too soon. I should have taken a bit more time. I was taking 1 pain med before I ‘slept’ (Can’t say I ever got good, consistent sleep) so I could drive. I work inside but was challenged with typing, etc.
    PT – Find a good PT and stick with it. Make it a game and WIN. It’s going to hurt…know your body and if its ‘good pain’ suffer through it.
    4 months post op (almost) – I have a doc appt next week. They promised that they will clear me for ‘outdoor activity’. My PT suggests I discuss the need to continue formal PT – she thinks I can stop. They told me pre-op that there was 4-6 months of recovery. I challenged him on the 4-6 months as I had heard people say 12-18 months before they felt they could truly perform unrestricted activity. His response: ’18 months is kinda long…’ My takeaway is that I am ‘recovered’ (or soon to be) to the point that I don’t need additional medical supervision, but total recovery may take more time. I’m OK with that and appreciate the professionalism of Doc #2 (first opted non-surgical rehab in 2012 and my PT…I still have 40 +/- PT visits that would be covered…true professionals).
    For those that have endured, I have to tell you that I am VERY happy that I waited to have surgery and VERY happy with the results at this stage. That said, I tell people of a conversation I had with my doc pre-op: Doc: I am not going to sugar coat this…this is one of the nastier shoulder surgeries you can have…I tell some patients they are going to be ‘uncomfortable’…not with this…it is going to hurt…’ All I heard was ‘This is going to suck’. I do have to say that I underestimated the suckiness a bit.
    This was my first real surgery. I think my biggest shock was the PT. I thought I would have soreness at first but then that would stop and I would just focus on rebuilding strength. Well, I was wrong…I am sore…a lot…PT says that is 80% normal and 20% due to me (I do extra reps when she’s not looking).
    I actually found this site because I was trying to get info on when I can expect the constant soreness to end…it seemed like some great info, so I decided to tell my story. Hope it helps. Cheers

  82. I had a stage 4 separation while body surfing in Hawaii. I was taken very high by a wave and when the wave crashed down…the weight of the water slammed me down onto the sand upside down on my shoulder. I heard the tendons snap and was barely able to make it out of the water because i wasnt feeling up to swimming much anymore. Hawaii doctors wouldnt give me a referral to a surgeon, which is understood because I only had 3 days left of my vacation. After my return to Oklahoma I had the surgery and have a cadaver thigh tendon in my shoulder now. Its much much better. I still have a little pain, but the only time it ever gets really bad is when my muscles in my neck tighten up from over use and tension. It can give me some insanely bad headaches. Massaging it helps, but is only temporary. Im not sure what I can do to fix this or if there is even any fix at all, but hey…at least I didnt fall on my head and break my neck! Id love any advice on an exercise or something to help prevent this pain. I am 35. It has been six years since surgery and the headaches related to my shoulder are only getting worse. Goodluck out there. Thanks for reading.

  83. Im in Los Angeles. I had a wakeboard yank to my right arm 7.5 yrs ago. The whiplash then lasted a month and I never saw a doctor because I couldn’t afford it.

    Now I have terrible arm/shoulder and neck pain everyday, lots of crunching and cracking in neck as right shoulder is slumping down, and painfully left shoulder is tightening up. My neck is crushed/strained. My whole rifht sode of body is strained. I had plantar facitas on left foot and last year had the bone spur removed. Is it smart for me to see a sports doctor? I’ve been to an orthopedic dr and he said my bones are fine. All the pain is me pretending. Also i have nerve damage in shoulder according to MRI. No one is diagnosing me. What is my smartest move to get help for 1. Pain 2. Normal functioning (i have trouble brushing hair/doing laundry)?

  84. Why do you now believe conservative treatment (aka do nothing) is the best course of action? Is it relative to what the medical community USED to do? It seems to me you guys aren’t sure how to treat separated shoulders. There’s disagreement, conflicting evidence, and rather vague definitions of “doing well” I repeatedly hear. From what I’ve read, ligaments, like bones, stand the best chance of healing with immediate intervention. They require contact to heal, a pathway. Kind of hard for ligaments to heal when they can’t bridge a full thickness tear. Sitting around and hoping the ligaments magically line up is rolling the dice. That “cosmetic” deformity of the distal clavicle wreaks havoc on the rotator cuff arthritically due to altered shoulder mechanics. That AC joint is more important than orthopedists once thought, THAT’S what research says. When patients report clicking, cracking, catching, it’s NOT normal. You’re hearing induced arthritis in action. Interventional surgery may have it’s drawbacks due to imperfect techniques and poor rehab, but is walking around with a deformity of the shoulder girdle the better alternative? My guess is: no.

  85. The medical community is shifting away from Mumford procedures for shoulder separations. It doesn’t make senses to “correct” a deformity by adding another deformity. In fact a Mumford makes the shoulder even more unstable and accelerates subacromial arthritis. But hey, at least you can’t develop an osteoarthritic AC joint which was a symptom of the root of the problem, not the cause. What is that sin, treating the symptoms and not the cause or something.

  86. I’ve had a separated ACJ for 17 yrs since I was 22 and chose no surgery. now I’m nearly forty and I’m starting feel pain when I play guitar or piano extending out and flat I experience cramping and once in a while I experience significant pain from work. I’m a chef and I do nothing but pick up pans all day and night​. It’s not been a huge burden but I still worry ab reinjuring it if I take a fall off my longboard or just arthritis. Is it too late to have surgery and is it recommendable?

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