Surgery for a shoulder separation

What is a shoulder separation, and what are the treatment options? When do you need surgery for a shoulder separation. Learn more about AC injury of the shoulder in this Ask Dr. Geier column.

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. What surgical technique do you use?

Thank you very much for your time and expertise. Terry

Treatment options for a shoulder separation

Surgery for shoulder separations (acromioclavicular joint separations, or AC separations) is actually not that common. 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.

Do you need surgery for a shoulder separation?
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.

Surgery for a shoulder separation

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.

Also read:
AC injury: Mechanism of injury, diagnosis and treatment of this shoulder injury
Shoulder separation (AC injury)

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.

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