4 years ago i was in an accident that caused an ac joint separation (type ii or iii). never treated, still painful. any options other than surgery?

Injection: If still painful after 4 years, surgery may very well be required. Physical therapy and possibly a cortisone injection could be tried first. See an orthopedic surgeon.

AC SEPARATION: Typically an AC JOINT separation can be treated conservatively when it is only a type 2 or 3. Treatment consists of therapy to regain motion after a short period in a sling. If pain persists or you have pain with activities then sometimes surgical intervention is warranted. Sometimes a steroid injection can decrease pain also. Hope this information is helpful. Take care. Wilsonshoulder.com