For those watching the UEFA Champions League Final soccer game, you undoubtedly saw Real Madrid defender Sergio Ramos taking down Liverpool star Mo Salah, with Salah injuring his left shoulder on the play and leaving the field in tears. With the World Cup beginning in a few weeks, Salah’s presence for Egypt may be in doubt. The official word regarding the injury is not yet available, however, to me, it looked like a shoulder separation.
A shoulder separation is different than a shoulder dislocation, which often gets confused. The former describes an injury to the AC (acromioclavicular) joint – the small joint between the collarbone and shoulder blade. A shoulder dislocation is an injury to the larger glenohumeral joint; the ball-and-socket articulation.
The AC joint is comprised of a number of ligaments (acromioclavicular and coracoclavicular) that hold the clavicle to the scapula. An injury to the AC joint is caused by a fall directly onto the side of the shoulder. The forces going through the shoulder will either cause a sprain to the ligaments of the AC joint, or a fracture of the clavicle. There are varying degrees of severity (grade 1-6), dependent on the number of ligaments torn.
Mild injuries (grade 1-2) cause no obvious deformity and are usually treated conservatively, with a sling, physical therapy, and anti-inflammatories. Return to an activity usually only takes a few weeks. More severe injuries (grade 3-6) will cause deformity and gross instability of the AC joint, and usually require more aggressive treatment including possible surgery.
Surgery to stabilize the AC joint is determined based on a number of factors, including the severity of the injury, hand dominance, and patient’s activity level. Grade 4-6 injuries are rare but are almost always treated surgically. More common grade 3 injuries can also benefit from surgery, especially in active patients.
There are a number of surgical options, including open and minimally-invasive arthroscopic techniques. Full recovery from surgery will take 4-6 months.
Mo Salah is in the unfortunate predicament of injuring his shoulder only weeks before the World Cup, the likely pinnacle of his career. If he has a grade 1-2 AC injury, he will certainly play after a course of conservative treatment. However, if he has a more severe injury, he may require surgery and a prolonged recovery away from soccer. Fortunately, the team physicians may be able to get him on the field for the World Cup with temporizing pain management measures consisting of anesthetic AC joint injections.