Shoulder injuries can lead to pain, instability, and limited movement, but shoulder dislocations and shoulder separations affect different parts of the shoulder. While both can result from falls, direct impact, or sports injuries, they involve different joints, bones, and ligaments. Recognising these differences helps with identifying symptoms and choosing the right treatment approach.
This article explains the differences between shoulder dislocations and shoulder separations, including their causes, symptoms, treatment options, and long-term effects.
Shoulder Dislocation vs Shoulder Separation
Although both injuries affect the shoulder, they involve different joints and structures. Their causes, symptoms, and treatment approaches vary, affecting movement, recovery, and the choice of management.
Location of the Injury
Shoulder Dislocation: A shoulder dislocation occurs when the humerus (upper arm bone) moves out of the glenoid (shoulder socket), disrupting the connection between the arm and the shoulder blade. This affects the glenohumeral joint, the main ball-and-socket joint responsible for arm movement.
Shoulder Separation: A shoulder separation does not involve the ball-and-socket joint. Instead, it affects the acromioclavicular (AC) joint, which connects the clavicle (collarbone) to the acromion (top of the shoulder blade). This injury results from ligament damage, affecting joint stability rather than bone displacement.
Causes of the Injury
Both shoulder dislocations and shoulder separations can result from falls, trauma, or sports injuries, but they occur through different mechanisms.
Shoulder Dislocation: A shoulder dislocation is usually caused by a forceful pull, twist, or direct impact, forcing the humerus out of the socket. This often happens when falling onto an outstretched arm, especially when trying to break a fall. High-contact sports such as rugby, football, or wrestling increase the risk due to sudden tackles or collisions.
Dislocations can also occur from forceful overhead movements, such as in volleyball or weightlifting, placing excessive stress on the joint. Accidents involving sudden pulling or twisting of the shoulder may also lead to the joint slipping out of place.
Shoulder Separation: A shoulder separation is typically caused by direct impact to the shoulder, leading to ligament damage at the acromioclavicular (AC) joint. A common cause is falling from a bicycle or motorbike and landing directly on the side of the shoulder.
Collisions in ice hockey, rugby, or similar sports can generate enough force to disrupt the AC joint. Hard impacts with the ground, such as those experienced in skateboarding, can also lead to a separation. In some cases, repetitive overhead movements gradually weaken the AC joint ligaments, making them more susceptible to injury over time.
Symptoms and Physical Appearance
Both injuries cause pain, swelling, and limited movement, but their appearance and specific symptoms differ.
Shoulder Dislocation Symptoms: A shoulder dislocation typically causes immediate pain following the injury, which may worsen with movement. The shoulder may appear sunken or out of place, creating a noticeable deformity. Movement is often severely limited, with difficulty lifting or rotating the arm. Swelling and bruising usually develop around the shoulder joint as inflammation increases. In some cases, a dislocation can affect nearby nerves, leading to numbness or tingling in the arm.
Shoulder Separation Symptoms: A shoulder separation often causes pain at the top of the shoulder, particularly when pressing on the acromioclavicular (AC) joint. In more severe cases, a visible bump may form over the collarbone due to ligament stretching or tearing. Movement can be restricted, especially when attempting to lift the arm above shoulder height. Swelling and bruising may develop around the AC joint, adding to discomfort. Some individuals may also notice shoulder instability, especially when lifting objects or applying pressure to the affected side.
Treatment Approaches
Although both injuries may require rest and rehabilitation, treatment varies depending on severity.
Treatment for Shoulder Dislocations
Closed Reduction: A doctor manually moves the humerus back into the socket, restoring proper alignment and relieving discomfort. This procedure is typically performed as soon as possible to prevent further complications.
Pain Management: Ice, medication, and activity modification help reduce pain and swelling while protecting the injured shoulder from further strain. Pain relief strategies may also include anti-inflammatory medications and temporary movement restrictions.
Immobilisation: A sling or brace is used to stabilise the shoulder, preventing unnecessary movement while allowing damaged tissues, ligaments, and muscles to heal properly. The duration of immobilisation depends on the severity of the dislocation.
Physiotherapy: Rehabilitation exercises help restore movement, strengthen the surrounding muscles, and improve joint stability. Physiotherapy helps reduce the risk of future dislocations, especially for individuals involved in sports or activities that require repetitive shoulder movement.
Surgical Stabilisation: If dislocations happen repeatedly or if the ligaments and soft tissues surrounding the joint are significantly damaged, surgical intervention may be required to stabilise the shoulder. Surgery typically involves repairing or tightening stretched ligaments to prevent ongoing instability and improve long-term function.
Treatment for Shoulder Separation
Rest and Ice: Mild cases are usually managed with rest, ice, and a sling to control pain and swelling while allowing the ligaments to heal naturally. Anti-inflammatory medication may also be recommended for additional pain relief.
Immobilisation and Rehabilitation: Moderate cases may require a longer period of immobilisation with a sling or brace to support the joint while healing. Once pain and swelling decrease, rehabilitation exercises help restore movement, strengthen the shoulder, and prevent stiffness.
Surgical Repair: Severe cases, where the collarbone has significantly shifted, may require surgical intervention to repair torn ligaments and realign the AC joint. Surgery is typically considered if the displacement affects shoulder function or causes ongoing discomfort.
Recovery and Strengthening: Most people recover without surgery, and rehabilitation focuses on improving shoulder stability, rebuilding strength, and restoring function. Gradual return to activities helps prevent further strain on the AC joint and minimises long-term discomfort.
Long-Term Effects and Recovery
Both injuries can lead to long-term instability or weakness if not managed properly.
Shoulder Dislocation: May weaken the joint over time, making future dislocations more likely. People who experience recurrent dislocations may develop chronic instability, requiring surgical intervention to repair damaged ligaments.
Shoulder separation: Severe cases may cause persistent discomfort or deformity, especially if the ligaments heal in a stretched position. Some individuals may notice a permanent bump on the shoulder where the collarbone remains elevated. However, this does not always affect shoulder function.
When to Seek Medical Attention
Medical evaluation is recommended if you experience severe pain, swelling, or difficulty moving the shoulder after an injury. Symptoms that may indicate a more serious issue include a visible deformity or bump, inability to move the arm without pain, or numbness, tingling, or weakness in the arm or hand.
Individuals with a history of recurrent shoulder dislocations or ongoing pain that does not improve with rest should also consider medical evaluation. A doctor may perform a physical examination and imaging tests, such as X-ray or MRI, to determine whether the injury is a dislocation, separation, or another shoulder condition, guiding the appropriate treatment approach.
Conclusion
Shoulder dislocations and separations both result from trauma but affect different parts of the shoulder. A dislocation occurs when the humerus moves out of the socket, while a separation involves ligament damage at the AC joint. Identifying the injury early and receiving appropriate treatment can help restore shoulder function and prevent long-term instability.
If you are experiencing shoulder pain, instability, or limited movement, book a consultation today for a comprehensive assessment, diagnosis, and personalised treatment plan.
