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.

The Power of the Placebo

Dr. Cole and Steve discuss the psychological and physiological effects of using a placebo for recovery. Dr. Cole also explains the powerful effect the mind has on assisting the body in recovery.

Sports Medicine Weekly on 670 The Score

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