I Dislocated my Shoulder and have Ongoing Shoulder Instability. Why?

Dr. Millett,

I fell and hurt my shoulder skiing a couple of years ago (in Vail of all places!) and since then it has caused me problems. I have a bump on the top of the shoulder and was told I have a shoulder separation. What does this mean?

It sounds like you may be suffering from an injury to the acromioclavicular joint (AC joint). This is also known as a separated shoulder. A fall directly onto the shoulder which causes a large, prominent deformity (bump) and pain are typical findings in a separation of the AC joint. This type of fall usually causes injury to the ligaments that surround and stabilize the AC Joint.

There are different degrees of injury (types 1 through 6) depending on which ligaments are torn and to what extent. Types 3-6 usually result in some deformity of the shoulder. For types 4 through 6, surgery is recommended. For type 3, AC joint surgery is sometimes recommended. These injuries range in pain, severity, and physical deformity. The greater the deformity, the greater the severity, and thus the pain and the amount of time it may take to return to pain-free function of the shoulder.

Type 1 and 2 injuries usually respond better and more quickly to conservative, non-surgical treatments that include: rest, cold compression, injections, and oral anti-inflammatory medicines.

Type 3 injuries may require surgery to repair or rebuild the damaged ligaments which hold the clavicle in place. This surgery is performed via arthroscopic or open surgery. In acute cases, the clavicle can be held in position with sutures while the ligaments heal, while in most cases, the torn ligaments need to be completely rebuilt with new tissues (either from one’s own body – autograft – or from a cadaver – allograft). This is a common repair and often yields really good results. I prefer to perform this arthroscopically as it leads to smaller scars and less disruption of the surrounding muscles. When one suffers this type of injury, typically x-rays and/or an MRI are needed so your doctor can determine the severity of your injury and make a decision on how to best treat your AC injury.

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