Shouldering AC joint separations commonly seen in football

New York Daily News—October 25, 2009

Dr. Josh Dines of the Sports Medicine Service at Hospital for Special Surgery offers the following insights on shoulder injuries:

Sports medicine became a part of last weekend's college football game between the Oklahoma Sooners and Texas Longhorns when star quarterback Sam Bradford aggravated his shoulder injury. He absorbed a big hit from defensive back Aaron Williams on the same shoulder he injured in the first game of the season against BYU. Bradford had suffered a "shoulder separation," or injury to his AC ("acromio-clavicular") joint - a relatively common occurrence in football and hockey players. NFL quarterback Eli Manning and Michigan's star freshman quarterback Tate Forcier have also recently dealt with similar injuries.

With "shoulder" or AC separations, the joint between the collarbone ("clavicle") and shoulder blade ("scapula") is injured. The ligaments and capsule connecting the bones can be injured to varying degrees depending upon the severity of the injury. It is commonly caused by a fall directly on the "point" of the shoulder, or a direct blow, such as a quarterback sack or check into the boards in hockey. Disruption of the AC joint results in significant pain and tenderness at the front of the shoulder joint.

The pain is most severe when an athlete attempts overhead or throwing movements, and is even sensitive to the pressure of protective padding. As the AC joint is relatively superficial, separation injuries are usually accompanied by a "bump" from the prominence of the collarbone at this location. Point tenderness to this location usually confirms the diagnosis clinically. Radiographs are helpful in ruling out associated fractures and in grading the severity of the separation.

The severity of an AC joint injury depends on how severely the ligaments and capsule that stabilize this joint are damaged.

This story originally appeared at nydailynews.com.

Rock Positano, DPM, and Josh Dines, MD, practice sports medicine at the Joe DiMaggio Sports Medicine Center at Hospital for Special Surgery.