What looks like a shoulder separation but isn't .... !?

[felix913]

I have been to the doctor for what i believed to be a separated shoulder. The acromion process on my leftside is raised and hard, and it never used to be like that which is obvious from photos. It was also very tender a few weeks back but no longer is now. My doctor was adamant however that I did not have a separated shoulder and instead diagnosed me with tendonitis of the long head of the bicep on the basis of performing some range of motion tests and seeing where I had a painful arc. He then offered me a cortisone shot, which I refused because I was unconvinced by the diagnosis because I don't understand if/how LHB tendonitis would explain a lump on my left acromion process. Could tendonitis of the biceps long head cause a bursitis under the acromion process which would explain the bump (seems difficult because I didn't think the LH tendon went under acromion process ...)? I want an explanation for the bump and I want the bump gone because my left shoulder has become incredibly noisey now due to grinding because of what feels like a lack of space in the joint, which i attribute to the bump. Any input on what the bump might be would be greatly appreciated. If you are wondering what the bump looks like .... it looks like Grade 1/2 separated shoulder.

[Will Morris]

It was also very tender a few weeks back but no longer is now......I want an explanation for the bump and I want the bump gone because my left shoulder has become incredibly noisey now due to grinding

Here is a very important question: does it really matter if your physician diagnosed you with the "correct" diagnosis if your symptoms resolved?

You may be absolutely right. You may have suffered a separated shoulder, but guess what? These are treated conservatively in all but a few cases. Even for grade III AC Joint separations, surgery is not recommended unless there is bony disruption that causes the AC joint to be unstable. The bump / deformity on your shoulder means absolutely nothing, nor would any surgeon I have worked with operate on you to improve the aesthetic look of the shoulder. I hate the be the bearer of bad news, but surgeons don't operate on patients on the whim of the patient. They operate on someone when the indications are there that surgery is the best treatment option, or, in cases where the surgical indication is less clear, they may operate when all conservative measures have failed. You may not like the answer, or the explanation, but this is likely something you just have to live with. In the case of AC joint separations, there just isn't any clear evidence that surgery is needed, helpful compared to conservative treatment, and you take on all the risks of orthopaedic surgery for something that has been shown to be more effectively managed with conservative treatment.