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Five years ago, I fell while taking the garbage out. I landed right on my left side and separated my shoulder. I opted for conservative care and turned down the surgery. The surgeon said it was a mild-to-moderate shoulder separation so avoiding surgery was an okay option. Well, after all this time, I still have daily pain and clicking in that shoulder. Did I make a mistake by not having the surgery?

The AC joint is part of the shoulder complex. The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone). The connection between the scapula and the clavicle is the AC joint. To be a little more specific, the part of the scapula that makes up the top of the shoulder is called the acromion. The AC joint is where the acromion and the clavicle meet. Ligaments hold these two bones together. AC joint separations are graded from mild to severe, depending on which ligaments are sprained or torn. The mildest type of injury is a simple sprain of the AC ligaments. Doctors call this a grade I injury. A grade II AC separation involves a tear of the AC ligaments and a sprain of the coracoclavicular ligaments. A complete tear of the AC ligaments and the coracoclavicular ligaments is a grade III AC separation. This injury results in the obvious bump on the shoulder. Conservative care usually includes resting the arm in a sling, using ice, taking oral antiinflammatory drugs, and exercising. A specific rehab program under the direction of a physical therapist is often prescribed. A recently published study looked at the long-term (10 year) results of conservative care for Type I and II AC joint separations. The authors report that what seem like minor shoulder injuries may not be as innocent as they first appear. The incidence of residual symptoms is fairly high. More than one-third of the patients with a Type I injury had ongoing symptoms years later. And patients with type II AC separation were twice as likely to have long-term symptoms as those with type I injuries. Should patients with mild shoulder separations continue to skip the surgery and stick with conservative care? Why do half the patients end up with residual symptoms and the other half don't? Researchers will be able to answer your question and these additional questions in the coming years. It may be possible to find subgroups of patients who respond better than others to conservative care. Likewise, there may be patients with milder types of AC joint separation who would have a better result with surgery than with nonoperative care.

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