Shoulder Separation versus Shoulder Dislocation

If you play or watch sports, odds are you’ve heard these phrases tossed around a lot. People tend to use them interchangeably, but they are actually quite different.

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Shoulder Dislocation
This is when the “ball comes out of the socket”. The shoulder is inherently unstable. It’s a golf ball sitting (slightly off centered) on a golf tee. There’s the labrum (a ring of fibrocartilage) that goes around the edge of the fossa (socket), to deepen it in an effort to improve stability. Then, there’s layers of capsule, ligaments, and muscle, that all blend together to hold everything in, and allow movement and strength at the joint.

In some cases, there is some general laxity to the structures that surround the joint (some young females, people who have had multiple injuries, or those who have connective tissue conditions such as Ehlers-Danlos Syndrome, among others), that make it prone to dislocate. Other times, and commonly, this injury happens from trauma. A fall with the arm out-stretched, a collision in sport, a slip down the stairs while you hang on to the railing, etc.

The term dislocation means the ball has come out of the socket (usually forward and down). Usually this means you’re going to be sent to an urgent care center for x-rays to be taken, and for manual relocation. There’s a chance of nerve or blood vessel injury, as well as fracture, which is why we don’t get to “pop it back in” ourselves (sidenote - this was literally one of the things I was super fascinated by and thought I’d get to do as an AT).

Either way, after some time in a sling to let the ligaments and capsule start to heal, we then head into some long term progressive stability and strength training.

@codexanatomicus

@codexanatomicus

Shoulder Separation
This injury is actually happening at the AC or acromioclavicular joint. This is the joint that attaches the arm to the trunk, through multiple ligament attachments of the bones. Commonly, in mild sprains of the AC, it’s the strong ligament directly attaching the collar bone to the scapula at the tip of the shoulder that gets injured. There are a few other ligaments that attach these bones as well, and if you’ve heard this injury given a grade, the higher the grade, the more ligaments are affected.

This injury is usually the result of direct contact to the tip of the shoulder. A fall where your arm is tucked in, a collision into the boards or the ground. In more severe cases, it can be quite obvious to see what’s called a “step deformity” in which the collar point is projecting upwards from the tip of the shoulder. These may or may not require an x-ray or sling, depending on the severity. But no matter the grade, all will benefit from therapy to facilitate healing, improve mechanics, and strengthen the shoulder again.

Final note…
With both these injuries, the prognosis is quite good! It can take time, but rehab can facilitate the stability and strength you need to return to pre-injury activities…maybe just with some adjustments to exercise form or equipment modifications (like to your shoulder pads).