The most common shoulder injury that occurs in high school soccer – the “shoulder separation.”
This painful injury can lead to future shoulder disability if not diagnosed properly and treated appropriately.
What exactly is a “shoulder separation”?
The shoulder is connected to the rest of the body via the clavicle (collarbone). This bone acts like a support strut in a racing car suspension, providing stability while allowing movement of the shoulder blade.
The acromio-clavicular (AC) joint is the joint where the collarbone meets the shoulder blade (on top of your shoulder at the end of your collarbone. If you grabbed your sternum (breastbone), go to the “other end” of the collar bone!).The AC joint is the area injured in what is commonly called a “shoulder separation”. For a closer look at the anatomy of this area, just type in “AC joint” on your favorite search engine to look at the images on the web.
High school soccer players usually injure this joint in three common ways: a fall directly on the side of the shoulder, a fall on an outstretched hand or, less commonly, a collision with another player. There are three common grades (and three uncommon) of injury to the AC joint.
Grade 1 – This is the mildest grade of injury and most common injury to the AC joint. Typically the AC ligaments are stretched or partially torn and there is a mild displacement of the joint. The clavicle may appear displaced upward, so a mild bump may be noticeable on top of the shoulder. The joint will be painful to the touch, and motion across the body is painful and mildly limited. Typically an athlete may be able to get back to sports in two weeks with proper treatment in the high school training room.
Grade 2 – This is a moderately severe injury to the AC joint. Typically the AC ligaments are completely ruptured, but other ligaments remain intact. There is a mild to moderate bump on the shoulder with bruising present. The joint is definitely painful to the touch, and motions across the body and overhead are moderately limited to pain. A sling is sometimes used for 3-7 days to manage pain. Typically an athlete may be able to get back to sports in six weeks with proper treatment in the high school training room and physical therapy rehab.
Grade 3 – This is a severe injury to the AC joint. Typically, all of the ligaments connecting the clavicle to the shoulder blade are completely ruptured, causing the shoulder blade to essentially “fall off” its support from the collar bone. There is swelling and bruising around the joint and a moderate to severe “bump” noticeable on top of the shoulder. The joint is extremely painful to the touch, and the athlete exhibits marked disability on attempts to move the shoulder. Typically an athlete will be immobilized in a special sling for 3-6 weeks, and will be out of sports up to 12-16 weeks with appropriate treatment by the athletic trainer and physical therapist. This injury can require surgical intervention if moderate to severe disability remains after a trial of immobilization and rehab.
Grades 4-6 – These injuries are usually high velocity in nature (snowboarding, motocross, etc.) and not commonly seen in high school soccer athletes. Due to the nature of the severe ligament rupture and clavicle displacement in these injuries, immediate medical attention along with surgical intervention is required.
It is always prudent to get X-rays to make sure the clavicle (collarbone) is not fractured in these types of injuries. The results of the x-rays can also show the “separation” of the joint to confirm the grade of injury. Here is a great website to elucidate x-ray findings in AC joint injuries: http://www.learningradiology.com/archives05/COW%20138-AC%20Separation/acseparationcorrect.htm
The pain from any AC joint injury can be initially disabling, even in a low grade injury. The presence of a “bump” on top of the shoulder can remain even after successful non-operative rehab. Grade 2 and Grade 3 injuries are likely to increase the risk of future arthritis due to excess motion in the joint even after healing occurs. Shoulder blade dysfunction (difficulty controlling motion) can become a chronic residual problem.
A special type of tape and taping technique are quite helpful in managing the pain and shoulder blade control issues following AC joint injury. Here is the web link that shows the specific tape and taping technique used by athletic trainers and physical therapists for AC joint injury: http://www.youtube.com/watch?v=oc1w9se3wSM
Read more: http://www.metrosportsreport.com/index.php?option=com_content&view=article&id=2605:soccers-most-common-injury-to-the-shoulder&catid=184:about-msr