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Shoulder Sprains

(Shoulder Separation; AC Separation)

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Shoulder sprains are tears in the ligaments that hold the shoulder joint in place.

  • Ligaments may be partially or complete torn.

  • Shoulder sprains are common, especially among athletes, such as football and rugby players and wrestlers.

  • The joint is painful and tender.

  • Doctors take x-rays to determine how severe the sprain is.

  • Joints are usually immobilized with a sling if a sprain is not severe, but severe sprains may require surgery.

The shoulder joint is held together by ligaments that connect the collarbone (clavicle) to two knobs of bone on the shoulder blade—one on the front (called the acromion) and one on the back (called the coracoid process). Sprains most commonly affect the ligament on the front (called acromioclavicular sprains). But one or more ligaments can be torn.

Anatomy of a Shoulder Joint

Ligaments may be partially or completely torn. If the ligaments that connect the collarbone to the coracoid process are completely torn or nearly so, the collarbone separates from the shoulder blade—called a shoulder separation.

Shoulder sprains are common, especially among athletes who participate in high-velocity or contact sports such as alpine skiing, jet skiing, football, rugby, and wrestling. These sprains result from a fall usually on the shoulder or, less often, on an outstretched arm.


The shoulder joint is painful and tender.


  • X-rays

X-rays of the collarbone are taken on both sides of the body. X-rays help doctors determine how severe the sprain is by showing how far apart the bones of the joint are.

Based on these findings, doctors classify the joints into types:

  • Type I: The sprain is minor, and bones of the joint (collarbone and shoulder blade) remain in place. This type is the least severe.

  • Type II: The bones in the joint are partly out of position (called subluxation).

  • Types III through VI: The bones of the joint are completely separated. These types are shoulder separations.


  • For less severe sprains, a sling and early range-of-motion exercises

  • For severe sprains, surgery

Treatment of shoulder sprains depends on how severe the sprain is and what type it is.

For less severe sprains, such as types I and II, the joint is usually immobilized, typically with a sling, and exercises to maintain the joint's range of motion are begun early.

For some severe sprains, such as shoulder separations, surgery is required.

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