Question 1

What is the difference between a shoulder separation (AC joint) and a shoulder dislocation?

Accepted Answer

SHOULDER SEPARATION (AC joint injury): Injury to the joint at TOP of shoulder where collarbone meets shoulder blade (AC joint = acromioclavicular joint). Ligaments connecting these two bones tear. Results in collarbone prominence or bump at top of shoulder. SHOULDER DISLOCATION: Injury to main shoulder ball-and-socket joint (glenohumeral joint) where upper arm bone (humeral head) comes completely out of shoulder socket (glenoid). Results in arm hanging in abnormal position, severe pain, inability to move arm. Entirely different injury, different joint, different treatment. Common confusion - both involve shoulder but completely different structures and mechanisms. AC joint separation does NOT mean the main shoulder joint is dislocated.

Question 2

Do I need surgery for my Type III AC joint separation?

Accepted Answer

Type III AC joint injury is THE MOST CONTROVERSIAL in shoulder sports medicine - NO DEFINITIVE EVIDENCE that surgery produces better long-term outcomes than physiotherapy alone. DECISION FACTORS: (1) SPORT TYPE: Overhead athletes (volleyball, tennis, swimming, cricket bowlers) may benefit from surgery (better overhead strength and endurance). Contact athletes (rugby, AFL) - mixed evidence (some studies show faster return and lower re-injury with surgery, others show no difference). Non-overhead athletes (runners, cyclists, footballers in non-throwing positions) - conservative often sufficient. (2) HAND DOMINANCE: Dominant arm injury in throwing athlete - stronger indication for surgery. (3) AGE AND ACTIVITY LEVEL: Young elite athletes - surgery often recommended. Older recreational athletes (over 40) - conservative usually first-line. (4) COSMETIC CONCERNS: Conservative treatment always leaves visible bump (collarbone prominence). Surgery reduces but doesn't always eliminate bump. If cosmetic deformity major concern, surgery may be preferred. (5) PATIENT PREFERENCE: Some athletes prefer to try conservative first, can always have delayed surgery if not satisfied (delayed reconstruction more complex but feasible). Others prefer definitive surgical treatment upfront. AUSTRALIAN CONTEXT: Public system - conservative Type III treatment standard (surgical waitlists long). Private system - more likely to offer surgery to motivated athletes. GENERAL RECOMMENDATION: Type III injuries in recreational athletes - trial conservative treatment 3-6 months before considering surgery. Type III injuries in elite/professional athletes in overhead or contact sports - early surgery (within 3 weeks) often recommended.

Question 3

Why does the hook plate need to be removed and when?

Accepted Answer

Hook plate is a TEMPORARY implant designed for short-term use (8-12 weeks) while AC joint ligaments heal, NOT designed to stay permanently. REASONS FOR REMOVAL: (1) SUBACROMIAL IMPINGEMENT: Hook sits under acromion bone in subacromial space (same space rotator cuff tendons glide through). Hook causes mechanical impingement - painful arc with overhead movement in 40-60% of patients while plate in place. (2) ACROMIAL EROSION: Hook rubs against underside of acromion. Over time (greater than 12-16 weeks), hook erodes through acromion bone, can cause acromial stress fracture or complete erosion. (3) PLATE DESIGNED FOR REMOVAL: Hook plate serves as internal scaffold holding collarbone in correct position while scar tissue forms. Once scar tissue healed (8-12 weeks), plate no longer needed biomechanically. (4) INFECTION RISK: Any retained hardware carries ongoing low infection risk (1-2% lifetime risk). WHEN TO REMOVE: Optimal timing 8-12 weeks after insertion. Earlier than 8 weeks - insufficient healing, bump may return. Later than 16 weeks - increased erosion risk. REMOVAL PROCEDURE: Day surgery under general anesthetic. Same incision. Remove screws, remove plate. 30-40 minutes. Overnight observation sometimes. Return to normal activities 2-4 weeks. DISADVANTAGES OF REMOVAL REQUIREMENT: (1) Second surgery, second anesthetic (additional risks, time off work). (2) Second recovery period (delays return to sport). (3) Additional cost ($2,000-4,000 for plate removal surgery in private system). (4) Risk of bump returning after removal (10-30% lose some reduction). These disadvantages are why CC ligament reconstruction (single operation, no removal) increasingly popular in athletes despite higher complexity and cost.

Question 4

When can I return to contact sport after AC joint injury?

Accepted Answer

RETURN TO SPORT HIGHLY VARIABLE based on injury grade and treatment: TYPE I (AC sprain): Non-contact sport 2-3 weeks, contact sport 4-6 weeks. Some professional athletes return as early as 1-2 weeks with bracing and pain tolerance (not recommended for amateur athletes - re-injury risk high). TYPE II (AC torn, CC intact): Non-contact sport 6-8 weeks, contact sport 8-12 weeks. TYPE III CONSERVATIVE (non-surgical): Non-contact 12-16 weeks, contact sport 16-24 weeks (longer than surgical in many cases because relies on scar tissue for stability). TYPE III-V SURGICAL - Hook plate: Cannot return to contact sport until after plate removal (8-12 weeks) plus rehabilitation (additional 8-12 weeks) = 16-24 weeks total. TYPE III-V SURGICAL - CC reconstruction: 16-24 weeks return to contact sport (similar timeline to hook plate but only one surgery). TYPE IV/V/VI (all surgical): 20-28 weeks minimum for contact sport return. RETURN TO SPORT CRITERIA (must meet ALL before contact clearance): (1) Full pain-free range of motion compared to other side. (2) Strength 90%+ of uninjured side (isokinetic testing for scapular, rotator cuff, deltoid strength). (3) Passed functional tests (press-up, dip, bench press without pain). (4) Sport-specific drills at 100% intensity without pain or apprehension. (5) Surgeon and physiotherapist clearance. GRADUATED RETURN PROTOCOL: (1) Non-contact training (individual skills, running, conditioning). (2) Light contact drills (50% intensity). (3) Full training (100% intensity). (4) Game clearance. Each phase 1-2 weeks minimum. NO SHORTCUTS in contact sport return - premature return increases re-injury risk 3-5 fold. AC joint re-injuries usually higher grade than original injury. PROTECTIVE BRACING: AC joint braces or shoulder harness may allow slightly earlier return in some athletes (reduces direct impact forces on AC joint) but does NOT eliminate re-injury risk.

Question 5

Will I have a permanent bump on my shoulder?

Accepted Answer

DEPENDS ON INJURY GRADE AND TREATMENT: TYPE I and II (conservative): No permanent bump. AC joint alignment restored. TYPE III CONSERVATIVE (non-surgical): YES - permanent visible bump (collarbone prominence) in 90-100% of cases. Bump is where collarbone sits higher than normal because CC ligaments torn and healed in elongated position. Bump size variable (some subtle, some very prominent). Bump is COSMETIC ONLY in most cases - does NOT predict pain or dysfunction. Many athletes perform at elite level with visible Type III bump. Bump may partially reduce over 6-12 months as scar tissue contracts but never completely disappears with conservative treatment. TYPE III-V SURGICAL: PARTIAL improvement in bump. Surgery aims to restore CC distance to normal and hold reduction while ligaments heal. Even with surgery, 30-50% have residual subtle bump (less prominent than conservative but not completely flat). Complete anatomic restoration unusual even with best surgical techniques. Bump may increase slightly after hook plate removal (10-30% lose some reduction). Why does bump persist after surgery? Ligaments heal with scar tissue (longer and less stiff than original ligaments). Gradual stretching of scar over time allows some collarbone migration upward. Drill holes in bone may elongate. DOES BUMP MATTER? For most people, NO. Functional outcomes (strength, range of motion, return to sport) do NOT correlate with bump size. Bump is cosmetic concern for some (particularly women with visible décolletage, athletes in singlets/swimwear). Overhead athletes sometimes report fatigue or endurance issues with persistent AC joint instability (bump) but this is minority. AUSTRALIAN CULTURAL CONTEXT: Many rugby and AFL players wear their AC joint bumps as 'badges of honor' - visible evidence of tough contact sport participation. Social acceptance of sports injury scars relatively high in Australian athletic culture.

Medical Disclaimer

AC Joint Injuries in Athletes

📖What is AC Joint Injuries in Athletes?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention