Pain in your shoulder is making you search for an answer.  Most likely you either fell and landed on your outstretched arm to break your fall or someone told you that you separated your shoulder (sometimes called a sprain.)  Either way, let’s see why you have shoulder pain and what it means to have a separated shoulder.

First, you should become familiar with the basics, if you haven’t already, by reading our ‘shoulder 101’ article.  The shoulder blade (scapula) rests on the back of the rib cage and is only held there and moved by many muscles.  It does have a small, direct bony attachment to the body through its connection to the collar bone (clavicle) called the acromio-clavicular (A-C) joint (where the acromion process of the scapula attaches to the clavicle.)  The clavicle then attaches at its other end directly to the breast bone (sternum.)  The term ‘separated shoulder’ refers to the A-C joint and it is usually graded in severity as a 1^st, 2^nd or 3^rd degree separation. 

With a 1^st degree separation (sometimes called a sprain) there is minimal tearing in the ligaments holding this joint together so the joint itself remains stable but there is some pain and swelling.  Pain is usually present with raising your arm over your head or holding your arm straight out in front of you and reaching across your body.  Typically, a 1^st degree sprain will get better within a few days to a week and you should be able to resume pain-free activity at the same level as before the injury.  If other damage occurred along with the separation, such as tearing in the rotator cuff, then those areas will need to be addressed as well.

A 2^nd degree sprain will cause more fibers of the ligaments to be torn, resulting in more pain, swelling and instability.  The pain and inflammation should subside within a week or so, assuming you have been careful to rest and not aggravate the injury.  The instability, however, will most likely not go away.  Many people with this degree of injury will experience ‘movement,’ ‘shifting’ or ‘clicking’ symptoms.  This is normal and is due to the ligaments being stretched and the joint, therefore, being looser. 

Experiencing a 3^rd degree sprain means you have significant pain, swelling and instability.  This degree likely will require you to keep your arm in a sling (immobilized) for several days and then beginning easy, active range of movement and strengthening exercises.  Strengthening typically occurs initially through a shortened range of movement to get the muscles working while protecting the joint from further damage.  The ligaments are stretched significantly at this level and you will need to either alter your activity level and put up with the extra movement and clicking or discuss the options with an orthopedic surgeon for repairing the joint stability.  Due to the location of this joint and the extreme demands placed upon it, while the repair might be considered successful, often times the functional outcome (that is whether the ‘patient’ is happy they made the decision to have surgery) is not a sure bet.

Exercises for a shoulder separation are generally aimed at strengthening muscles that surround the A-C joint as there are no muscles that provide any significant stability directly across the A-C joint.