Breaking Down AC Joint Separation: The Shoulder Injury Impacting Quarterbacks

Fall in New England is a magical time filled with crisp nights, colorful leaves, county fairs, and of course, football! With football season in full swing, we sat down with Dr. Erik Carlson, a shoulder and upper extremity specialist at Active Orthopaedics in Middlebury, CT, to discuss the unique challenges football presents to student-athletes across Connecticut and how orthopaedic specialists can help keep players safe and strong.

Q: Dr. Carlson, thank you for taking the time to talk with us! As a shoulder and upper extremity specialist, what kinds of injuries do you most often see during football season?

A:Thank you, Christina, happy to be here! Football can certainly place our student-athletes at risk of injury. In fact, studies indicate shoulder injuries account for about 15-20% of all football injuries. The most common serious injuries reported are AC joint separations – aka shoulder separation, shoulder dislocation or subluxation with or without labral injury, and rotator cuff tears. Clavicle or collarbone fractures are also common. I have seen and cared for all of these types of injuries in football players here in the Greater Waterbury community.

Q: How are these football-related shoulder injuries treated?

A: The treatment of each shoulder injury is individualized to the student-athlete’s particular injury pattern and goals for recovery. Some injuries can be treated with time off from sport and a structured rehabilitation protocol, while others require surgery with an extended recovery. Unfortunately, many serious shoulder injuries lead to the athlete missing playing time.

Q: A former standout Connecticut student-athlete was recently featured in the news because of a shoulder injury. It has been reported that Tennessee Titans quarterback, Will Levis, will miss the upcoming season with a shoulder injury requiring surgery. Can you tell us more about Levis’ situation?

A: Unfortunately, Mr. Levis reportedly sustained an AC joint injury last September when diving for a first down against the Miami Dolphins. He even posted a picture of the injury on his social media before surgery! AC joint injuries are one of the more common injuries we seen in quarterbacks. There are different degrees of injury to the joint—some of which respond well to rehabilitation and others that require surgery to repair torn ligaments. Recently, it has been reported that quarterbacks Anthony Richardson, Derek Carr, and Trevor Lawrence have all sustained some type of AC joint injury—so it’s something we see often at the highest level of play.

Q: Why are AC joint injuries so common in football players?

A: The AC joint is usually injured when a player falls directly onto the affected shoulder. This places a direct force on the AC joint and can cause any degree of tearing or rupture of the strong ligaments that usually hold together the clavicle or collarbone to the rest of the shoulder bone (the acromial process of the scapula). Full tears with dislocation of the AC joint often require surgery to stabilize the joint—especially in quarterbacks, throwers, and contact athletes who need maximum shoulder strength and steadiness.

Q: What does recovery from an AC joint injury look like? Can patients return to football?

A: Recovery from an AC joint injury, whether it requires surgery or not, is a stepwise process, initially focusing on controlling pain and inflammation from the injury (or surgery) with medications and gentle range of motion exercises, like shoulder rotations. The second phase involves progressive stretching and strengthening of rotator cuff, scapular stabilizers, and core muscles. Finally, a physical therapist and/or athletic trainer will work on mechanics retraining for athletes returning to overhead sports.

Full recovery can take six to nine months, depending on the demands of the sport. More severe injuries may result in a full year of recovery. In fact, most football players are able to return to their previous level of play. Most studies show a return to play rate of over 90% after an AC joint injury.

Q: How can injuries to the shoulder, like AC joint injuries, be prevented?

A: The best way to prevent shoulder injuries, including AC joint injuries in football, is to utilize properly fitted protective gear, use correct tackling and blocking techniques, and maintain a strong rotator cuff and stabilizer muscles. Coaches and athletic trainers should prioritize proper rest and recovery days, using correct throwing mechanics to avoid muscle overuse, and paying attention to early warning signs, such as shoulder pain, stiffness, or loss of throwing power.

Final thoughts:

Football will always carry a risk of injury, and shoulder injuries like AC joint separations are among the most common challenges athletes face on the field. The good news is that with advances in sports medicine, individualized treatment plans, and a structured rehabilitation process, most athletes can successfully return to play—often at the same level they were before injury.

Will Levis’ season-ending surgery shines a spotlight on just how impactful these injuries can be, even at the professional level. For student-athletes, coaches, and parents, it’s a reminder that injury prevention, proper technique, and early recognition of symptoms are key to protecting players. With the right approach, athletes can recover, rebuild, and continue competing in the sport they love!

Dr. Erik J. Carlson is a board-certified orthopedic surgeon specializing in hand, wrist, shoulder, and upper extremity surgery. At Active Orthopaedics, P.C. in Middlebury, he provides expert, patient-focused care for rotator cuff tears, arthritis, tendon injuries, nerve damage, fractures, and sports-related conditions. You can call his office to schedule an appointment at (203) 758-1272.