Shoulder · Jacksonville Beach, FL

AC Joint Separation &
Clavicle Fracture in Jacksonville, FL

A fall onto the shoulder that produces a visible step-off at the top of the shoulder — that's an AC joint separation. A clavicle fracture from the same mechanism looks similar but requires a different treatment decision. Dr. R. David Graham at JOI classifies both precisely: AC separations by Rockwood type, clavicle fractures by displacement and Neer type for distal injuries.

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Dr. Graham's Decision Framework

AC Type I–II: Non-operative — sling and PT
AC Type III: Patient choice — non-op vs reconstruction, both discussed
AC Type IV+: Surgery — Arthrex suture button reconstruction
Clavicle: >100% displacement → ORIF; mild → sling
Distal clavicle: Neer Type II → surgery; Type I/III → non-op

Most AC joint separations — even complete (Type III) — can be treated non-operatively with good outcomes. Surgery is reserved for Types IV and above, and for Type III patients who are overhead athletes or heavy laborers who prefer reconstruction.

Two Distinct Conditions

AC Joint Separation vs Clavicle Fracture

The acromioclavicular joint and the clavicle shaft are adjacent but distinct structures with different injury patterns and different surgical decision frameworks.

AC Joint Separation

Separation of the acromioclavicular joint — where the clavicle meets the acromion of the scapula. Caused by a fall onto the shoulder or a direct blow. Graded by the Rockwood classification (Type I–VI) based on the degree of ligament disruption and the direction of clavicle displacement. Type I–II: sprains, managed non-operatively. Type III: complete AC joint disruption — patient choice. Type IV and above: surgical reconstruction with Arthrex suture button.

Clavicle Fracture

Fracture of the clavicle shaft (most common), proximal, or distal third. Midshaft clavicle fractures are the most common. Most are managed non-operatively. Surgical fixation considered for fractures displaced more than 100% of the shaft width, shortening beyond threshold, or open fractures. Distal clavicle fractures use the Neer classification to guide operative vs. non-operative decision. Most Neer Type I and III heal without surgery; Neer Type II (disrupted coracoclavicular ligaments) has high non-union risk and is typically fixed.

Treatment Decision Framework

Dr. Graham's Approach by Type

Classification	Pattern	Treatment
AC Type I	AC ligament sprain, CC ligaments intact. Mild tenderness, no deformity.	Non-operative. Sling for comfort, PT for periscapular strengthening. Full recovery expected.
AC Type II	AC ligament torn, CC ligaments sprained. Mild step-off at AC joint.	Non-operative. Sling, PT. Minor cosmetic asymmetry may persist; rarely functionally significant.
AC Type III	Both AC and CC ligaments torn. Complete AC joint displacement. Full step-off deformity.	Patient choice. Most Type III separations do well non-operatively — especially sedentary or older patients. Overhead athletes and laborers may prefer surgical reconstruction. Both outcomes discussed before deciding.
AC Type IV+	Type IV: clavicle displaced posteriorly into trapezius. Type V: severe superior displacement (>100% shaft width). Type VI: inferior displacement (rare).	Surgery — Arthrex suture button reconstruction. A suture button construct through the coracoid and clavicle restores CC ligament function. Allows early motion and avoids long-term hardware concerns of hook plate.
Clavicle Midshaft	Displaced fracture — shaft width displacement >100%, shortening, or comminution.	ORIF with plate and screws when displacement thresholds met. Non-displaced or minimally displaced fractures managed with sling and figure-of-8 brace.
Distal Clavicle (Neer II)	Fracture through the coracoclavicular ligament attachment — CC ligaments disrupted, high non-union risk.	Surgery — hook plate or suture button construct to maintain reduction and prevent non-union. Neer Type I and III typically heal without surgery.

Recovery

Return to Overhead Activity

Weeks 0–3

Sling Protection

Sling for both non-operative and post-op patients. Pendulum exercises. No overhead reaching. For suture button: protect the construct while early healing occurs.

Weeks 3–8

Progressive Motion

Sling discontinued at 3–4 weeks for non-op; 4–6 weeks post-op. Forward flexion and abduction advanced progressively through formal therapy.

Months 2–4

Strengthening

Rotator cuff and periscapular strengthening. Return to light overhead activity. Athletes advance sport-specific training.

4–6 Months

Full Return

Full overhead sport and heavy labor at 4–6 months. Suture button hardware does not typically require removal. AC joint cosmetic step-off may persist in Type III — this is normal and does not affect function.

FAQs

Frequently Asked Questions

Not necessarily — and most do not. The majority of Type III AC joint separations do well with non-operative management: sling for 2–4 weeks, physical therapy, and return to activity as pain allows. Most patients achieve good or excellent functional outcomes without surgery, even with a persistent cosmetic step-off at the AC joint. Surgery becomes a genuine option for overhead-demand athletes, heavy laborers, or patients who fail non-operative management. Dr. Graham presents both options honestly and lets the patient choose based on their goals and activity level.

Hook plate reconstruction holds the clavicle down with a hook that loops under the acromion — effective but requires a second surgery to remove the plate after healing, and can cause subacromial impingement while in place. The Arthrex suture button construct — placed through the coracoid and clavicle — reproduces the coracoclavicular ligament function without metallic hook contact with the acromion, allows earlier motion, and does not routinely require removal. In Dr. Graham's experience, it provides reliable stabilization for Type IV and above separations with a simpler recovery.

The Neer classification divides distal clavicle fractures into three types based on their relationship to the coracoclavicular (CC) ligaments. Neer Type I: fracture lateral to the CC ligaments — ligaments intact, stable, heals well non-operatively. Neer Type II: fracture through or medial to the CC ligament attachment — CC ligaments detached from the proximal fragment, highly unstable, high non-union rate, typically treated surgically. Neer Type III: fracture into the AC joint — ligaments intact, usually managed non-operatively but may develop AC joint arthritis.

Next Steps

Shoulder separation or clavicle fracture —
classification determines treatment.

AC joint separations and clavicle fractures are common injuries with widely variable treatment depending on the type. Dr. Graham classifies, explains the options, and involves the patient in the decision — particularly for Type III separations where the evidence supports both operative and non-operative management.

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Contact & Location

(904) 241-1204

1577 Roberts Drive, Suite 225
Jacksonville Beach, FL 32250

Clinic: Tue · Wed · Fri | Surgery: Mon · Thu

Walk-ins welcome via JOI Now for acute shoulder injuries.

AC Joint Separation &Clavicle Fracture in Jacksonville, FL