Grade 3 Shoulder Separation: Treatment Options and Recovery Insights

Acromioclavicular joint dislocation

Hello Doctor: I have a grade 3 acromioclavicular joint dislocation that has not been surgically treated for three weeks.
1.
The injury occurred due to a motorcycle collision, where my left shoulder hit the ground.
2.
At the emergency room immediately after the accident, the physician indicated that everything was fine and it was just a contusion, so no specific treatment was provided for the shoulder injury; only ice packs and pain medication were administered.
Is it possible that the dislocation had not occurred at that moment? 3.
Two weeks later, I continued to experience persistent shoulder pain and noticed a hard lump near the shoulder joint.
An X-ray revealed a grade 3 acromioclavicular joint dislocation.
Could this be due to the lack of shoulder immobilization after the injury? 4.
The outpatient physician mentioned that a grade 3 dislocation can be treated surgically or non-surgically, but if reduction is required, surgery is necessary.
After surgery, rehabilitation will be needed, and there may be an impact on joint mobility.
5.
If I choose not to have surgery, will the dislocation worsen due to joint use and heavy lifting? 6.
If I do not have surgery for reduction, will the pain gradually improve? Will this affect my future quality of life, and are there potential long-term consequences? Will joint mobility also be affected? I am truly feeling anxious.
Thank you, Doctor, for patiently reading my questions.
Thank you!

JANE, 40~49 year old female. Ask Date: 2020/06/21

Dr. Shi Guozheng reply Orthopedics

Dislocation of the acromioclavicular joint may not be clearly visible on X-rays due to potential imaging limitations, and it is usually necessary to take the X-ray while standing.
If the injured arm is carrying a heavy object, the dislocation may become more apparent.
Both surgical and non-surgical options are available; if surgery is not performed and the individual does not engage in heavy labor, there may be minimal impact on function.
The advantage of surgery is the ability to achieve complete reduction, although surgical procedures also carry their own risks of complications.
Both approaches do not significantly affect joint mobility.

Reply Date: 2020/06/21

More Info

Grade 3 shoulder separation, also known as acromioclavicular (AC) joint separation, is a significant injury that occurs when the ligaments connecting the collarbone (clavicle) to the shoulder blade (scapula) are completely torn. This type of injury is often the result of a fall or direct impact, such as in your case with a motorcycle accident.
1. Initial Injury and Diagnosis: It is possible that the separation was not immediately apparent at the time of the accident. Sometimes, the symptoms of a Grade 3 separation can be mistaken for a simple contusion or strain, especially if there is no visible deformity. The presence of pain and swelling can mask the severity of the injury. The hard lump you felt two weeks later is likely the result of the separation, where the end of the clavicle becomes prominent due to the loss of support from the torn ligaments.

2. Delayed Diagnosis: The fact that the injury was not diagnosed immediately could have contributed to the worsening of your condition. Without proper immobilization or treatment, the joint may have shifted further, leading to the development of the hard lump and persistent pain.
3. Treatment Options: In terms of treatment, Grade 3 separations can be managed conservatively or surgically. Conservative management typically involves rest, ice, pain management, and physical therapy. Surgery may be recommended if the joint is significantly displaced or if conservative treatment does not alleviate symptoms. If surgery is performed, rehabilitation will be necessary to restore function and strength to the shoulder.

4. Long-term Effects: If you choose not to have surgery, there is a risk that the joint may remain unstable, especially with activities that involve lifting or heavy use of the arm. Over time, this could potentially lead to further separation or chronic pain. However, many individuals with Grade 3 separations do experience improvement with conservative treatment, and pain may gradually decrease as the body heals.
5. Rehabilitation: Regardless of whether you opt for surgery, physical therapy will be crucial in your recovery. A rehabilitation program will help strengthen the muscles around the shoulder, improve range of motion, and stabilize the joint.
6. Future Considerations: It is important to be aware that even with successful treatment, some individuals may experience lingering effects, such as reduced range of motion or chronic discomfort. Engaging in activities that place excessive strain on the shoulder joint, such as heavy lifting, should be approached with caution.
7. Psychological Impact: It's understandable to feel anxious or depressed about your injury and its implications for your future. Seeking support from healthcare professionals, including physical therapists and mental health counselors, can be beneficial as you navigate your recovery.

In conclusion, while Grade 3 shoulder separations can be serious, many individuals recover well with appropriate treatment. It is essential to follow up with your healthcare provider to discuss your options and develop a tailored rehabilitation plan. Your active participation in your recovery will play a significant role in your overall outcome.

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