Separated vs. dislocated shoulder: Which is worse?

Actor Channing Tatum recently had surgery for a separated shoulder, and the news has highlighted a common source of orthopedic confusion: Is there a difference between a separated shoulder and a dislocated shoulder?

While many people confuse the two injuries, they are actually quite different since they have different causes, require different treatments and follow different physical therapy regimens.

A separated shoulder involves damage to the ligaments that hold the collarbone to the shoulder blade, while a dislocated shoulder happens when the upper arm bone pops out of its socket.

“A shoulder separation is almost always caused by a direct fall onto the side of the shoulder, like falling off a bike or onto the turf of a sports field,” says Dr. Zachary Domont, an orthopedic surgeon at Advocate Health Care. “Dislocations usually happen when the arm is up and forced backward.”

Treatment for a dislocated or separated shoulder

Fortunately, surgery is rarely the first-line treatment for these injuries. Initial treatment focuses on physical therapy, which often leads to a full recovery. You may eventually need surgery if the injury is severe or persists despite rehab.

“Most people are feeling really good after six weeks of physical therapy,” Dr. Domont says. “Once you have full range of motion without pain and have full strength, then you can go back to full activity. If you need more than three months of physical therapy and still have significant issues, there could be more going on that needs to be fixed.”

Unsuccessful rehab isn’t the only reason surgery is considered, though. While uncommon, severe separations – such as grades IV, V and VI – can also require surgery. Repeated dislocations can also require surgical repair, which is common because the injury tears the labrum, a cartilage rim that stabilizes the shoulder.

Shoulder separation and dislocation recurrence

“Teenagers have a nearly 90% chance of recurrent shoulder dislocations,” Dr. Domont adds. “Usually every decade you get older, the risk of recurrence drops by about 10%.”

Many people also assume the injury is healed once the pain goes away, but that’s rarely the case with separations and never the case with dislocations. Both require medical evaluation and treatment to ensure the shoulder heals properly and returns to previous strength.

You should always seek urgent or emergency care immediately after either injury.

“It’s critical to be evaluated and get a proper MRI so that we can make sure that there’s nothing else damaged in your shoulder that can cause long-term issues,” Dr. Domont says.

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