Non-surgical Treatment:
In most people, a separated shoulder doesn't usually require surgery, but treatment is based on the grade of your injury. For types I, 2 and type 3 in most people, a brief period in a sling 2-4 weeks, ice, NSAIDs, physiotherapy and a gradual return to normal activity is usually all that is required. One can expect a return to full function by 2-3 months after the injury.
Surgical treatment:
For type 3 injuries in laborers or elite athletes, for example, surgery can be performed. Also for types 4, 5 and 6. Historically it was thought acute injuries were treated with ORIF (fixation) and chronic injuries were treated with ligament reconstruction however, recent studies have shown no difference in outcomes in types III injuries treated surgically after 6 weeks non-op treatment versus immediate surgery. A period of nonoperative treatment with a view to surgery if symptoms don’t settle seems reasonable for type 3 injuries. I would recommend acute surgical stabilisation for types 4-6.
A traditional technique has been the Weaver-Dunn procedure which involves distal clavicle excision with transfer of coracoacromial ligament to the distal clavicle to recreate a new ligament. However, with the advent of easily available synthetic ligaments, such intricate surgery is now rarely performed.
The technique I use is open (not key-hole) and passes a synthetic graft (Lockdown tape) under the coracoid process and then over the top of the clavicle and then is secured to the clavicle with a single screw. The tape doesn’t dissolve with time but rather acts as a scaffold for your new natural ligament to grow along. In time, perhaps 2 or 3 years, if one were to re-explore the area surgically, the tape would be indistinct from your own tissue. You can watch the surgical technique here https://lockdownmedical.com/
The surgery takes about an hour and it’s often feasible for you to go home the same day. You will have a sling on which is usually recommended for a period of 4 weeks. This should be worn day and night but can be safely removed for short periods for washing and dressing. You should also do some gentle exercises every day for the hand, wrist and elbow. In the shower, you must keep your wound dry for 2 weeks to help prevent infection. So, remove your sling and keep your arm in the position as if it were still in the sling and then hold the shower head in the other hand. Shower low down but do not get your dressing wet. You can use a wet flannel around the shoulder and under the arm. At 2 weeks you will see a member of the team who will check your wound and trim or remove your stitches.
At 4 weeks you can start to move your shoulder out of the sling for light daily activity and progress more with the physiotherapists. At this point, restricting movement to below the level of the shoulder is preferred. At 6 weeks most people are comfortable enough to drive and start to lift the arm above the shoulder level. By 8-12 weeks strength will be building in the shoulder and by 12 weeks most people are fully recovered. Contact sport and heavy manual labour is usually feasible at 12 weeks post-op.