Why is it that a year, even two years after a grade 2 AC separation, an athlete can still have pain and struggle through weightlifting sets?

“If the patient is still symptomatic it may either have not been a grade 2 injury or it may need a reconstruction,” says Jonathan Oheb, MD, North Valley Orthopedic Institute, Chief of Orthopedic Hand and Upper Extremity Surgery.

“I would advise seeing an orthopedic surgeon.”

Does this mean that a grade 3 AC separation was misdiagnosed as a 2?

Dr. Oheb says, “Not necessarily.  You can have a grade 2 injury which is persistently symptomatic.  I cannot give you a simple answer to this question.

“Some things require a thorough evaluation of the patient and the X-rays to determine the root cause of a patient’s pain.  There is no range of motion test that strongly points to a grade 3.

What Is a Grade 2 AC Separation?

The joint is partially dislocated including a completely torn acromioclavicular ligament (which attaches to bone.

The other ligaments of the AC joint (coracoclavicular) remain intact.


  • The pain ranges from medium to severe.
  • Swelling may be present.
  • Movement of the arm induces pain.
  • There may be a small bump where the clavicle bone ends, at the top of the shoulder.
  • Pushing the clavicle with a hand may move it. Do not experiment with this. It’s not necessary for you to evaluate the injury this way. Only a doctor should do this.
  • There may be pain when touching the area.

With proper diagnosis and treatment, a patient should not experience pain during strength training, weightlifting or other physical activities long after treatment and rehab end.

If you have recently injured your shoulder, and it’s so painful that lifting your arm straight out in front of you (frontal raise) is impossible due to pain — see a doctor as soon as you can.

If your injury does not involve the AC joint, it may be a clavicle fracture.

In addition to hand, elbow and shoulder care, Dr. Oheb provides comprehensive surgical and nonsurgical treatment for all orthopedic conditions of the hip, knee and ankle, including broken bones and injuries. jonathanohebmd.com
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health. 


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