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Right shoulder X-Ray showing acromioclavicular (AC) separation (blue arrow)


3. This is a grade 1 AC separation, where the AC ligament is mildly sprained.


4. This is a grade 2 AC Separation. In a grade 2 separation, the AC but not CC ligament is torn.

AC Separation

What is AC Separation? And how does it happen?

What is the AC joint. 

Also known as the acromioclavicular joint, he only bony/joint connecting the shoulder to the thorax.  This joint consists of the acromion (part of the scapula, or shoulder blade) and clavicle (collarbone), and is stabilized by the ligamentous capsule of the joint, as well as through ligaments that connects the clavicle to the coracoid-another bony process off of the scapula.

Function of the AC joint.
The AC joint is one of multiple mechanisms that allows for the shoulder to have a large range of motion.  It is the only joint physically connecting the entire shoulder and shoulder girdle to the axial skeleton.  It does so through very small joints at either end of the clavicle.

Typical injury.

Typically, injury of the acromioclavicular joint occurs as an acute traumatic Impact or excessive motion.  It is possible for the capsular ligaments and/or the coracoclavicular ligaments to stretch or tear.  The degree of separation is related to how much and how many of these structures have been injured.

Who gets this injury?

AC separation commonly occurs in athletes who participate in contact sports such as football, rugby, and soccer.  Sports with high velocity or risk of fall from heights, such as downhill skiing or gymnastics also pose a risk of AC joint injury.  Males are more likely affected by this condition than females.

What are the symptoms? And how can my doctor tell if I have this condition?

The symptoms of an AC separation include pain, weakness, bruising, swelling, limited range of motion, and a prominence at the top of the shoulder. This bump, which is more obvious in more serious injuries, can help diagnose a separation. X-rays can also help diagnose this injury.

Grading of AC separation injuries

AC separations are graded into severity from I-VI.  Generally the treatment follows the great, and your doctor will help you to both grade the injury as well as develop a treatment plan.

How do I treat AC Separation? And how long does it take to recover?

The initial treatment for this injury involves taking care of inflammation and pain with rest, over the counter pain medications like Tylenol and Ibuprofen, icing, immobilization via a sling, and physical therapy.

X-ray should be taken, and clinical examination by a qualified medical practitioner should be performed in order to make sure that related issues or not missed, and to ensure the appropriate grade classification is assessed.

Recovery for AC separation depends largely on the classification of injury, and if the ligaments of the AC joint are intact. It also depends on the age and activity level of the patient, as surgery is more likely to be considered for younger, more active patients and for those with higher grade injuries.


Nonsurgical treatment is typically considered for grade 1 or 2 fractures, but ample discourse exists regarding the treatment of other classifications of injuries. Overall, the AC joint is a complex joint that can be injured in many different ways and severities, and there are a variety of treatments to account for this.

When AC injuries only need conservative treatment, patients typically regain functional mobility by approximately six weeks and return to normal activity by 12 weeks.

Sometimes surgical treatment is required however, and surgery can be quite different for acute injuries then for chronic injuries which can even require reconstruction.


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