by Thomas Jensen, P.T.
Hockey is a very physical and demanding sport with a lot of contact. As the amount of contact increases, the chance of injury also increases. One area commonly injured in hockey is the shoulder—specifically the area just above the ball and socket of the shoulder. This is called the acromioclavicular joint (or AC joint, a bump on the top of the shoulder). The small joint is formed where the collarbone (clavicle) and shoulder blade (acromion and scapula) come together. The joint is usually hurt when an athlete falls directly on the shoulders or when the shoulders bang into the boards or another person. The force of the fall or hit causes separation of these two bones (commonly referred to as shoulder separation).
There are different severities of separations ranging from mild (grade 1) to severe (grade 3). Grade 1 and grade 2 are usually treated conservatively and the athlete is returned to activity as rapidly as possible based on their signs and symptoms. Grade 3 separations usually require surgery and rehab.
After a blow to the shoulder, tenderness and possible gaping in this area are signs of an AC injury. Initial treatment for the AC separation is ice application, immobilization, and medical evaluation as soon as possible. To be sure of the severity, an x-ray should be taken to get an idea of how much, if any, separation there is. The degree of separation can then be determined based on the x-ray and physical exam. With mild to moderate AC separations, continued icing and protection is usually all that is needed. When the pain is tolerable for the athlete, they are able to return to participation.
Protecting the shoulder after a separation is extremely important. Orthoplast or other types of material can be used to make a bubble of pad wrapped around the AC joint. There are some places that will actually fabricate a bubble type of protection into the athletes hockey pads so all they have to do is to put the pads on and not worry about the pad moving or the placement of the pad. Either way, it is recommended that the bubble type of protection be done to avoid more contact to the joints and possible worsening of the separation with another blow to the area.
Often with AC separations, the rotator cuff (which sits just underneath the AC joint) becomes bruised. Athletes may have difficulty moving the arm and experience pain over the bump of the AC joint. With time, ice, and rest, movement is restored over the next week or so. Specific cuff exercises should then be initiated when able based on pain and signs and symptoms.
If AC separations are untreated or mistreated, it can lead to a permanent deformity and/or possible early arthritic changes. When an AC separation is thought to have occurred, evaluation should be done, so that it can be graded properly and then a treatment plan set up according to what the specific diagnosis is.
Our shoulder specialists provide quick and careful treatment for every type of shoulder separation to help athletes return to their game. If you our your student athlete experience any type of injury to your shoulder, contact us to schedule an appointment with our board-certified orthopedic specialists.
