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Shoulder and/or clavicle injuries are some of the most common sports ailments, regardless of the time of year. Cyclists, mountain bikers, football players, hockey players, wrestlers, skiers and snowboarders all frequently fall victim to separated shoulders or broken clavicles.
The clavicle, or collarbone, is particularly vulnerable because it’s close to the surface and easily broken by a direct impact as well as shock transfer, meaning falling hard onto an outstretched hand can send enough force up the arm to break the clavicle.
The clavicle meets the shoulder blade at the acromioclavicular – or “AC” – joint. The same type of impact that can fracture the clavicle can also sprain the ligament that holds that joint together, resulting in a AC sprain, or what’s colloquially called a “separated shoulder.”
“Typically, the athlete knows right away that something happened in the shoulder,” says Coordinated Health Orthopedic Surgeon Nicholas Slenker, MD. “They very often have difficulties elevating their arm, difficulties moving the arm, so we’ll see them pretty soon after the injury, because … they’re in a fair amount of pain.”
Although doctors will almost always x-ray the shoulder and clavicle, it’s often possible to make a preliminary diagnosis with just a physical exam.
“Sometimes feeling over the clavicle bone, you can feel when there’s a fracture. And for an AC separation or shoulder sprain there’s a very obvious deformity where you see the elevation of the end of the clavicle,” says Dr. Slenker.
An AC sprain has varying degrees of severity. A lower-grade sprain may be nothing more than a strained ligament and have only minor pain.
“Often times I’ll put them in a sling for a few days for comfort, we’ll work on physical therapy and they can be back to their sport as soon as a week or two afterward,” says Dr. Slenker.
But more severe sprains may require more time in sling or possibly even reconstructive surgery.
If the clavicle itself is broken, either in combination with an AC sprain, or as an injury by itself, surgery is becoming more common than in years past. While many people can heal properly when the arm is placed in a sling, there are newer techniques for more complicated breaks.
“There’s more and more research that shows us that for a displaced clavicle fracture, higher level athletes do better to have that fixed up, rather than just allowed to heal in a poor position,” says Dr. Slenker.
In that case, a contoured titanium plate is screwed in place over the bones to ensure proper alignment.
“Those athletes are moving a lot quicker than they used to be,” says Dr. Slenker, and getting back to their sports a lot faster.
Prevention isn’t always possible, but for activities like cycling, hockey, or snow sports, Slenker advises wearing a helmet and being cautious and aware of your surroundings.