AC joint sprain (separated shoulder)
I fell on my shoulder and now have a bump on top. What is it?
A sprain of the joint at the top of the shoulder, common in hockey, cycling and contact sports. Most are managed without surgery.
What it feels like
Pain on the top of the shoulder after a fall onto the point of the shoulder or a hit in contact sport, sometimes with a visible bump where the collarbone meets the shoulder blade, and pain lifting the arm or reaching across the body.
What is actually happening
The acromioclavicular (AC) joint connects the collarbone to the shoulder blade. A fall or hit can sprain or tear its ligaments. Injuries are graded from mild sprains to complete separations, and the grade guides management.
When to see a doctor
See a doctor promptly after the injury if the bump is large, the skin over it is tented, you have severe pain or numbness in the arm, or you cannot move the arm, so that the injury can be graded and a fracture ruled out.
How it is assessed
Assessment includes the injury history, tenderness and any step at the AC joint, range of motion, strength, and specific tests that load the joint, alongside any grading from your doctor.
How it is treated
A Cochrane review comparing surgery with conservative treatment for AC joint dislocation found no clear evidence that surgery gives better results for most people, and conservative treatment avoids surgical risks. Conservative care usually includes a short period in a sling for comfort, early range-of-motion exercise, progressive shoulder and shoulder blade strengthening, and a graded return to sport. Higher-grade injuries are discussed with an orthopaedic surgeon.
What to do first
Use a sling for comfort in the first days if needed, keep the elbow and hand moving, and have it assessed and graded.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
References
This page is based on the following clinical practice guidelines and research.