A first degree separation is merely a sprain without serious ligament damage. The joint is tender and swollen, but there is no separation. Treatment consists of ice applications and use of a sling for 3-7 days. Athletics can later be resumed when the pain subsides, and full shoulder motion is restored. Little rehabilitation is necessary, and the prognosis is excellent.
In the second degree separation, the injury is greater, and there is complete disruption of the ligaments which surround the A-C joint. However, the ligaments holding the collarbone to the shoulder blade are not torn, and consequently there is only minor displacement of the collarbone. The A-C “bump” is more prominent, and the separation can be felt. This injury is also treated with a sling, but immobilization is required for two to three weeks to allow the joint to heal. During this period, gentle motion exercises are allowed to prevent shoulder stiffness. Later, shoulder strengthening exercises are recommended. The athlete can return to sports in four to six weeks if the pain has subsided, and if there is clinical evidence of healing.
A third degree A-C separation represents a complete dislocation of the joint and rupture of all ligaments. The collarbone displacement produces a large painful deformity. The treatment of this injury is controversial. Some orthopaedists believe that no treatment is necessary, and therefore no attempt is made to reduce the separation. The rationale of this treatment is based on the belief that the separation does not really cause any permanent disability of the shoulder after the initial pain has subsided. The patient rests with a sling for one to two weeks and later resumes activity when there is no longer any pain, often after 12 weeks or longer. There is merit to this approach, as many patients regain useful function of their shoulder even with a permanent deformity. However, often surgery is required, which consists of returning the collarbone to its normal position and holding it in place with a screw, pin, or wire. The ruptured ligaments are also repaired. The athlete will miss competition for approximately 12 weeks.
