As the most mobile joint in the body, the shoulder joint is also the least stable and therefore the most prone to separation or dislocation. Shoulder separation usually refers to an AC separation, which is a separation of the acromio-clavicular joint (located at the end of the collar bone, where it attaches near the shoulder joint). A shoulder dislocation refers to a complete dislocation of the ball (humerus) from the socket (glenoid fossa) at the shoulder joint (gleno-humeral Jt.). A subluxation is a partial dislocation.
Shoulder separation at the AC joint most commonly occurs after a fall or a direct blow to the shoulder. The subsequent separation can range from mild to severe, and with increased severity the collar bone elevates or becomes more prominent. Rarely, surgery is indicated.
Shoulder dislocation occurs most commonly when the arm is overhead and the humerus (arm bone) is forced in a forward direction (this occurs in about 95% of dislocations), dislocating the ball from the socket. That commonly occurs during contact sports, but also can occur from a fall.
Symptoms include pain, muscle spasm, limited motion (inability or apprehension in raising the arm overhead), as well as a loss of function.
Most AC separations and shoulder dislocations/subluxations can be treated conservatively with a thorough rehabilitation program with an emphasis on preventing re-injury.
If left untreated, these injuries can eventually lead to an unstable shoulder, and increase the future risk of injury from repeated separation, dislocation or subluxation.
What to expect from therapy
Initially rest, immobilization (the use of a sling) and ice is advocated for both injuries, including the use of anti-inflammatory medication. After about 7-10 days, graded mobilization and manual therapy (hands on) techniques employed by a physical or occupational therapist provide relief of symptoms and promote realignment of tissues and structures that have been affected by the injury.
Modalities may be employed if needed to reduce muscle spasm and to accelerate a healing response. It is important for any person who has a separated or dislocated shoulder to have an exercise program prescribed by a therapist who understands the unique phases to properly rehab these injuries, as well as to address your individual health concerns.
Proper technique and follow through in skilled therapy is the key to reducing pain, increasing mobility and stability of the joint as well as building strength to restore normal shoulder mechanics and a return to full function, including sports. Most patients respond well to skilled therapeutic care and only in rare cases do these conditions require surgical intervention.