My shoulder looks worse than it is but it is still a level 2/3 AC tear
This summarizes the injury and the choices for treatment:
Mechanism of injury
The most common cause for a separation of the AC joint is from a fall directly onto the shoulder. The fall injures the ligaments that surround and stabilize the AC joint.
If the force is severe enough, the ligaments attaching to the underside of the clavicle are torn. This causes the "separation" of the collarbone and wingbone. The wingbone actually moves downward from the weight of the arm. This creates a "bump" or bulge above the shoulder.
This figure shows the intact ligaments around the acromioclavicular
joint. The red arrow points to the ligaments that are around the joint
itself. The gray arrow points out the important stabilizing ligaments underneath
the collarbone.
- A mild shoulder separation involves a sprain of the AC ligament that does not move the collarbone and looks normal on X-rays.
- A more serious injury tears the AC ligament and sprains or slightly tears the coracoclavicular (CC) ligament, putting the collarbone out of alignment to some extent.
- The most severe shoulder separation completely tears both the AC and CC ligaments and puts the AC joint noticeably out of position.
Nonsurgical Treatment
Nonsurgical treatments, such as a sling, cold packs, and medications
can often help manage the pain. Sometimes, a doctor may use more complicated
supports to help lessen AC joint motion and lessen pain.
Most people return to near full function with this injury, even if
there is a persistent, significant deformity. Some people have continued
pain in the area of the AC joint, even with only a mild deformity. This
may be due to:
- Abnormal contact between the bone ends when the joint is in motion
- Development of arthritis
- Injury to a disk-like piece of cushioning cartilage that is often found between the bone ends of this joint
Surgical Treatment
Surgery can be considered if pain persists or the deformity is severe.
A surgeon might recommend trimming back the end of the collarbone so that
it does not rub against the acromion.
Where there is significant deformity, reconstructing the ligaments
that attach to the underside of the collarbone is helpful. This type of
surgery works well even if it is done long after the problem started.
Whether treated conservatively or with surgery, the shoulder will require rehabilitation to restore and rebuild motion, strength, and flexibility.
At the moment I have chosen to wait and see method as the injury is causing not so much pain as mild discomfort and awkwardness in moving the left shoulder girdle.
