I was out skiing with my family when my ski tip hit a chunk of ice. Before I knew it, I was flying through the air. I landed on my head and on my shoulder. Fortunately, I was wearing a helmet. But it looks like I have a shoulder separation. The emergency room doctor said something about surgery as a possible treatment. How do I know if that’s what I need?

You’ll need to make a follow-up visit with an orthopedic surgeon. Surgery is usually done on the more severe acute acromioclavicular (AC) joint injuries (also known as shoulder separations). AC joint injuries are graded from I through V based on the severity of the separation.

Grade I is a mild sprain of the ligaments holding the joint together. Grade II is a more severe sprain. Grades III through V are varying degrees of separation of the two ends of the bones as they meet to form the AC joint. The joint is located along the front of the shoulder where the clavicle (collar bone) meets the acromion (the bone that comes across the top of the shoulder from off the shoulder blade).

A series of X-rays will be taken designed specifically to look for this problem. An MRI may be ordered. But even the best MRI (with a contrast dye injected) won’t give as good of results as an arthroscopic exam. If the separation is severe enough to need surgery, the surgeon will be repairing or reconstructing the joint using an arthroscope anyway. At the same time, the rest of the joint can be assessed for any additional injuries.

Grade III separations are usually only repaired surgically when the patient is a manual laborer or active athlete. Otherwise, a rehab program is advised for all Grade III injuries. Grades I and II are more likely to heal on their own with rest and limited activity. But Grades IV and V require surgical repair or the patient will end up with a chronically dislocated AC joint and possibly injury to the soft tissues around the area.