By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I was checked into the boards by another player and injured my shoulder. There is now a bump at the top of my shoulder and I was told I have a Grade II shoulder separation. What is it and what can I do to get back to playing hockey?

Answer: A shoulder separation, as opposed to a shoulder dislocation, is an injury between the collarbone (clavicle) and the shoulder blade (scapula). In medical terms, this is the acromioclavicular joint, commonly called the AC joint.

Shoulder separations are different from shoulder dislocations because dislocations occur between the ball of the upper end of the arm (humerus) and the socket of the shoulder blade (scapula) and are more serious injuries than shoulder separations.

The main types (or grades) of shoulder separations that we see in hockey are grades I, II and III. They are graded according to the amount of tearing of the ligaments which hold the AC joint together.

Type I shoulder separations occur when there is pain at the joint, but there is no major tearing of the ligaments and no visible deformity of the shoulder is present. In type II separations, there is enough tearing of the ligaments which hold the AC joint together that a bump can be seen at the joint between the end of the collarbone and the shoulder blade. For a complete tear of the ligaments (type III), the arm pulls the shoulder blade away from the end of the clavicle and there can be a rather prominent bump present at this joint.

The treatment and prognosis for returning back to play after shoulder separations depends upon the grade of the injury. Almost always, you can multiply two by the grade of the shoulder separation to determine the amount of time in weeks that it will take to get back to full competition. Thus, grade I separations usually take up to two weeks, grade II separations take four weeks, and grade III separations usually take six weeks to return back to on-ice competition. In rare cases, surgery may be indicated for grade III separations.

In most cases, the initial treatment of shoulder separations is to place ice on the separation immediately to minimize swelling and bleeding. Icing should then be performed for 20 minutes of every hour for 48 hours. We also use a shoulder sling for comfort to support the arm for the first few days after a separation.

Our athletes are encouraged to use the shoulder for motion activities as much as possible to prevent shoulder stiffness from developing. Once they get their full motion back, they work in the training room on rebuilding their muscle strength for their rotator cuff and other shoulder muscles. Athletes are allowed to return back to on-ice activities once they have full motion and full strength of the shoulder.

In most instances, we will place a special protective pad over the AC joint under their shoulder pads to minimize pain and the chance of recurrent injury through the end of the season. The pad helps both to provide comfort over the injured joint and also to dissipate the contact force over a wider area of the AC joint to minimize re-injury.

Shoulder separations are the most common shoulder injury in hockey players. Proper evaluation and treatment can set the guidelines for an expected return to play and can minimize down time.

In general, we recommend that almost all shoulder separations have x-rays to make sure that there is not a fracture of the joint, especially in young athletes, who may have a growth plate injury which can look like a shoulder separation. The most important thing to remember is to make sure that athletes have full strength and full motion before returning to play so that they do not injure themselves further due to any residual shoulder stiffness or weakness.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .