Q: Last week, my son was playing basketball and fell on his left shoulder. He had severe pain and difficulty lifting it. He went to the emergency room and was told he had a separated shoulder and was given a sling. He was sent to an orthopedic surgeon who said he needed surgery. We got a second opinion and my son was told he would have a "bump" but would not need surgery and could go back to play basketball sooner. What is the difference between a separated and a dislocated shoulder and which doctor is right?
A: The shoulder is comprised of two joints. The ball and socket joint known as the glenohumeral joint is responsible for the majority of shoulder rotation. If an injury to the glenohumeral joint occurs where it pops out of place, this is known as a dislocation. This usually results in an injury to the stabilizing bumper known as the labrum and in a young patient will usually require surgery to prevent recurrent dislocations.
The second joint in the shoulder is above the glenohumeral joint where the collar bone (clavicle) attaches to the acromion. This is known as the AC or acromioclavicular joint and is stabilized by two pairs of ligaments. When the AC joint is injured, this is known as a separated shoulder.
Minor injuries to the AC joint are treated with a sling followed by a rehab program. Severe separations where both pairs of ligaments are torn and the clavicle comes out of place, may or may not require surgery depending upon the age of the patient, the sports that the athlete plays, the degree of the deformity, and the degree of instability of the clavicle.
Some of these injuries can do well with or without surgery and you trade a bump for a scar. Therefore, both of the doctors may be correct. You and your son should return to the specialists for further discussion to determine what is the best treatment option for your son's future.