Coming Back From: Shoulder Separation

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points: 

  • A “shoulder separation” is a different injury than a shoulder dislocation
  • The shoulder separation involves a sprain to the ligaments of a joint at the point of the shoulder near the end of the collarbone
  • We will often see these injuries when a player is tackled or falls to the ground on the point of the shoulder, with the arm at the player’s side
  • Most shoulder separations from sports injuries can successfully be treated without surgery

This week I’ll offer up some pre-World Cup injury recovery info, inspired by Egypt/Liverpool brilliant playmaker Mo Salah. There’s been much speculation about the nature of Salah’s recent shoulder injury, and I haven’t been able to find a clear diagnosis in publicly available sources. But if I had to guess (and this is a pure guess), given the way the injury occurred and the evaluation from the physician in the accompanying photo, I’d say he likely sustained a shoulder separation.

First, let’s look at some confusing terminology.

I’ve written previously about shoulder dislocation, a serious condition in which the ball portion of the shoulder (humerus) becomes completely dislodged from the socket. This week we’ll discuss a shoulder separation, another common shoulder injury.

A separated shoulder refers to an injury to the ligaments of the acromioclavicular joint (commonly known as the AC joint), which is the joint between the end of your collarbone and the upper part of your shoulder blade. It’s located near the point of the shoulder.

Most shoulder separations occur during some type of hard fall or contact, such as a player being tackled on to his shoulder, or a cyclist falling and landing on his shoulder. When I see a hard fall to the ground I’ll be suspicious for either a shoulder separation or a broken collarbone if the athlete fell with the arm tucked in to the side, and I’m suspicious for a shoulder dislocation if the athlete fell on to the outstretched hand.

There are six types of shoulder separations. Types 1 and 2 are the most common ones we see in sports injuries and are treated without surgery. Type 3 injuries are also reasonably common, and most of these are treated without surgery (although there is some debate about early repair for the throwing shoulder of an elite athlete…).  Types 4-6 are not seen very often in sports injuries and these will require surgery. I refer to these as “types” although some surgeons will call these “grades”.

  • Type 1 – The ligaments have a mild sprain without a tear.
  • Type 2 – The AC ligament tears, leading to a partial separation.
  • Type 3 – The AC ligament and other associated ligaments tear, leading to a complete separation.
  • Types 4-6 – These are complete separations, serious injuries often requiring urgent surgery. I have seen one type 4 separation in a D1 quarterback during my 23-year career.

Here are typical return to play times for the common types:

  • Type 1:You can usually return to play 2-3 weeks after the injury, depending on your sport and position. You should be comfortable, with full motion, normal strength, and ability to do sport specific motions. Treatment includes rest and anti-inflammatory medication.
  • Types 2 and 3:A Type 2 injury takes about 3-4 weeks to fully heal, and a type 3 injury takes about six to eight weeks to heal. We’ll almost always treat these without surgery, and we’ll use the same return to play criteria as indicated above for the Type 1 injury. If you’re in a collision sport (such as football) I’ll usually recommend you return to play with an AC joint pad to minimize the chance of another injury.Logo

Whether Salah will play is still speculative but most media reports indicate him as “probable”. When it comes time to lacing up the cleats for a possibly once-in-a-lifetime event with the eyes of the country on him, my guess is that he’ll find a way to work his magic from game 1.

Staying Healthy in the NBA vs NFL

Mark Bartelstein from Priority Sports & Entertainment, Dr. Brian Cole (@BrianColeMD) and Steve Kashul discuss Bartelstein’s client Micheal Porter Jr. and protecting his best interest, his rehab and evaluating his long-term prognosis. Bartelstein discusses the difference between staying healthy in the NBA and the NFL.

PRIORITY SPORTS is a full service management firm, with over 25 years of experience, comprised of honest, ethical, hard-working, passionate and productive professionals who make it a point to build long lasting and meaningful relationships with our athletes.

In the NFL

  • PRIORITY SPORTS has been named one of the top football agencies by ESPN in each of their last five rankings.
  • PRIORITY SPORTS has the experience of representing more than 30 First Round Draft Picks.

In the NBA

  • PRIORITY SPORTS has the experience of representing more than 20 First Round Draft Picks.
  • PRIORITY SPORTS has negotiated over a BILLION dollars in contracts in the last 3 years alone.

Sports Medicine Weekly on 670 The Score

For Hockey Players, Downtime Means Lacrosse Training Time

Dr. Brian Cole, @SteveKashul & Jason DeMaria owner of JD Strength Performance discuss training routine w/ hockey players during the off season and the growing popularity of #lacrosse training techniques.

Jason (Jay) De Maria attended Western Michigan University. While in college, Jay played ice hockey and volleyball.  As a student, he earned a Bachelor of Science Degree in the field of Exercise Science. Quickly looking to further his education, Jason became a Certified Strength and Conditioning Specialist from the National Strength and Conditioning Association and a Performance Enhancement Specialist through the National Academy of Sports Medicine.

With more than 10 years of experience behind him, Jason has successfully coached athletes in multiple sports.  Athletes of all levels have succeeded under Jason’s coaching, ranging from youth athletes all the way through the Collegiate and Professional ranks.  His dedication has earned him time working alongside strength and conditioning staffs in the USHL and the NHL.

More on Notable Athletes trained by Jason DeMaria

Sports Medicine Weekly on 670 The Score

Beyond The Body: How Sports And Exercise Can Improve Mental Clarity

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Being physically active has long been associated with numerous benefits for the body. But did you know that the benefits extend to the brain as well? Just as proper nutrition contributes to a healthy state of mind, playing sports and exercising on a regular basis, significantly benefits mental clarity in both direct and indirect ways.

Thinking skills and memory

Recent research led by Harvard Medical School suggests that participating in sports and being physically active changes the way our brains work by not only improving thinking skills, but by protecting memory as well. As soon as your heart rate is up and you begin to sweat, there is a notable size increase of the hippocampus, which is associated with learning abilities and verbal memory. While you can choose many different types of physical activity for these benefits, the important thing is to remain consistent.

Eliminating brain fog

Partaking in sports and aerobic exercise also improves mental clarity in a different way. We all know that dreaded feeling of ‘brain fog’, often associated with general confusion, a lack of motivation and even inspiration. Breaking a sweat significantly affects our cognitive functions by increasing blood flow to the brain, resulting in higher levels of both energy and oxygen. It also releases hormones such as adrenaline and dopamine that not only make you feel good and energized, but also enable you to concentrate and think clearly. What does this mean for your mental state? Better performance and a clear head. In other words, say goodbye to brain fog.

Indirect benefits

While physical activity directly impacts our mental health, it also affects us indirectly, but again in positive ways. When we exercise, we are naturally reducing both stress and anxiety, which can negatively impact our moods and mental state. Playing sports is a particularly good option as your mind will be focused on working with your team or towards a goal, rather than stressing out about things you cannot control. Consistent physical activity also results in a deeper sleep, and feeling rested is crucial to mental clarity and mood.

While playing sports and exercising has long been associated with benefits for the body, it also greatly impacts our minds. By strengthening cognitive function, providing clarity, improving mood and promoting sound sleep, joining your local sports team or incorporating exercise into your daily routine is a move both your body and mind will thank you for in the long run.

By Jess Walter