Shoulder Separation

Shoulder separations, also known as an acromio-clavicular (or A/C) separation, usually results from a direct blow to the shoulder, a fall on an outstretched hand, or a direct blow that pushes the shoulder forward. It is a sprain or rupture of the ligaments connecting the clavicle and the acromion process. There are three grades of shoulder separations:

  • Grade 1 involves only a slight sprain of the acromioclavicular ligaments.
  • Grade 2 involves some ruptured and torn ligaments.
  • Grade 3 is a complete tearing of all ligaments (with obvious deformity). A severe sprain may cause nerve and artery damage.

Signs and Symptoms

  • Immediate pain.
  • Tenderness and possible deformity at the attachment of the clavicle to the scapula.

On-Site Management

P.R.I.C.E. PROTECT the area from further injury (i.e. put arm in sling). REST the area up to 12 weeks (depending on the grade) to promote healing. ICE the area to reduce inflammation. COMPRESSION is NOT recommended. ELEVATION is NOT necessary.

Referral. Refer to a physician for further assessment and treatment.

Rehabilitation. After the approval of a physicial, see a physiotherapist for the appropriate exercises to increase range of motion and strength.

Return to Activity

  • Athletes with a grade 1 sprain usually are able to begin shoulder strengthening exercises as soon as they no longer have pain at rest (2 – 7 days).
  • A moderate injury usually requires 10 – 14 days of rest before strengthening exercises can begin.
  • A severe shoulder separation usually requires surgery and prolonged therapy.


  • The athlete should be wearing proper protective equipment.
  • Instruction on the proper way to fall should be given to try and reduce the risk of falling on an outstretched arm.
  • Caution should be taken when performing overhead activities in training (i.e. snatch olympic lifting).

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