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Everything You Always Wanted to Know About Separated Shoulders, But Were Afraid to Ask*

Ryan Wilson CRUSHES Taylor Hall [HD] (via NHLArchive)

(* - Okay, probably not.)

Derek emailed me last night and asked me to say a few words about Taylor Hall and Teemu Hartikainen's current injury, an acromioclavicular sprain. Usual Disclaimer: I am neither a doctor nor an athletic therapist. I only play one on the Internet sometimes.

First, the basics. The acromioclavicular joint is one of the major joints in the shoulder, between the scapula (shoulder blade) and clavicle (collar bone). It's held together by the acromioclavicular (AC), coracoacromial (CA), and coracoclavicular (CC) ligaments. Injury to this joint is broadly described as shoulder separation, because injury to any of those ligaments will cause the clavicle and scapula to separate to varying degrees. This is not to be confused with a shoulder dislocation, which involves damage to the ligaments of the glenohumeral joint, between the scapula and the humerus (upper arm bone).

Gray326_medium
Slide 326 of Gray's Anatomy, via upload.wikimedia.org

Grade I separations typically involve a partial rupture (sprain) of the AC ligament, resulting in slight, if any, displacement of the collarbone, slight tenderness, and reduction in range of motion (ROM). Grade II separations involve complete tearing of the AC ligament and some degree of damage to the CC ligament, with a much more noticeable step deformity and significant reduction in ROM and strength, as well as some degree of swelling. Grade III separations involve the complete tearing of multiple ligaments, resulting in severe deformity, pain, loss of ROM/strength, etc. Newer sources also include Grades IV-VI (the Rockwood classifications), which are increasingly graphic, and thankfully not relevant to the discussion here.

Given how Hall went into the boards - his arm crumpled forward, instead of being pulled back, which would be more akin to the traditional "fall on outstretched hand" mechanism - it doesn't look like he'd have done much damage to anything other than the AC ligament (though I admit to wondering at first if it might not have been a dislocation). Combine that with the fact that he's only expected to miss 2-4 weeks, and I'm assuming he's been diagnosed with a Grade I separation, which is usually just called a sprain to keep everyone from getting unnecessarily alarmed. For more minor injuries - Grades I & II - surgery is generally avoided in favour of stabilization, immobilization, and modalities (e.g., ice and medication) for the inflammation and pain. After a period of healing, the athlete would begin rehabilitating the joint in preparation for an eventual return to play.

I know there was some controversy about why he was sent back out in the first place. I suspect this happened in part because Grade I injuries come with comparatively little pain: he wouldn't necessarily know if it was actually sprained or just really sore until he tested it some, and the AT can only take Hall at his word on the pain/tenderness at a certain point. Furthermore, an AT doesn't want to alienate his players by being overly cautious: see Brooks Laich's comments on concussions from a few weeks ago. If you let a player try to walk off something minor, instead of being a "helicopter parent" about it, you're not only more likely to get him to listen to you about more serious stuff down the road, but he's also more likely to trust you with other minor, nagging injuries that you'd want to keep an eye on.

As for recurrence, I couldn't really find any information on it one way or the other, in my notes or in the literature. My understanding, confirmed by a former AT, is that while ligaments never quite heal to 100%, the AC joint is pretty stable compared to sites noted for recurrent injury like the knee, ankle, and glenohumeral joint. This ultimately means that if he does have another shoulder separation, even a more severe one, it's unlikely to be due to inherent joint destabilization (which appears to be Ales Hemsky's problem), and more likely due to his style of play.

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