It’s been three weeks or so since the AC joint and supporting ligaments in my left shoulder were completely torn apart.
My recent visit to the orthopedics doc left me kind of annoyed. I waited for about an hour and when the doc finally came in, the first thing he asked me was what I did for a living. I replied with my typical “I’m an IT guy”, to which he replied “Well, you can have surgery, but you’ll be fine without it.”
At that point he was ready to wrap up the visit only 60 seconds in. I asked if the ligaments would ever grow back, and was told they wouldn’t unless I got the surgery. He went on to explain that the muscles in the shoulder would grow to compensate for the lack of support, and unless I was a pro tennis player or something like that, then I shouldn’t worry about it. I asked him if there were any limitations or loss of structural integrity and was told “nothing significant.”
Well I’m sorry, but it seemed to me that a proper shoulder should be supported by the very ligaments I tore. Yes, being an IT guy, the likelihood of me taking up a pro tennis career is practically nil. However, I still felt that any loss of structural support like that couldn’t be good, especially when I get older. After getting my hands on some orthopedics texts while visiting a doctor friend of mine today, I found that indeed a 5% to 10% loss of strength can be expected with a type III separation. What bothers me most isn’t the permanent bump on my left shoulder, or the fact that the ortho doc I saw was basically saying “you’re a fat IT guy, you won’t miss what you don’t use”… what really bothers me is the thought of being broken, especially when I have the option to fix it.
As of today, amazingly I can move my left arm around pretty good and I’m gaining some strength back. I still can’t lift my arm up to raise my hand or anything, and I have no hope of doing things like reaching around to scratch my back. The pain in the AC joint itself is still very real, and it lets me know when I go too far, but all in all I’m impressed with my body’s ability to cope. All the muscles around my scapula still cramp up like nobody’s business, and I have to take frequent rests to help calm those puppies down… but things are progressing.
So with all this progress and not much in the way of lost function to look forward to, why am I considering surgery? Aside from the fixer in me that is bothered as hell that one thing that is supposed to be connected to another just isn’t, and will never be without surgery… the fact is I have an opportunity to take a small risk to fix the problem while I’m young enough to recover as quickly and as thoroughly as possible. No amount of muscle building or physical therapy can get my body to a state as structurally sound as how I’m naturally supposed to be put together.
Still, the argument for just letting it recover without surgery and live with the separated shoulder is a good one, particularly when my physical activity level is currently so low and the foreseeable future doesn’t assume any increase. The real bottom line is; I want my limitations to be entirely of my choosing. I know that sounds kind of funny, but let me explain it this way; When I was a kid growing up, I liked keys. I began collecting them because I knew they would let me into something or somewhere. Eventually that collection became known as “the forbidden key chain”, and held such gems as the mater key to all the doors in my high school, the key to a mountain top communications relay station, and several others. I never used any of these keys… well, ok rarely did I ever use only a couple keys from the forbidden key chain a couple times, but my point is I had the option to use them, but chose not to. The important thing was that I had the choice… and really that’s all anyone wants. I see it all the time.
Let’s say a someone is looking over a clearance table in a local store. They stand and look over the items with other people. As they look over the various things, they are making judgments about usefulness, value, etc. but ultimately nothing from the table interests them. Then this casual browser overhears a couple standing on the other side of the table talking about an item sitting next to the casual browser. Immediately the mind races… the browser instantly becomes an aggressive shopper, rechecking the table, reassessing the item in question. The browser may even be prodded into action by pretending they didn’t hear the couple talking as they pick the item up… staking a claim to it by simply holding it, and at the same time reserving the option, the choice, to purchase it. Whether or not the casual browser decides to buy the item or not is irrelevant. Action was taken because of the pressure generated by the knowledge that soon, if they didn’t act fast, the choice to buy it would be gone. The knowledge that the item itself would be gone is not the affecting issue, the browser had already determined that it was of no interest. Action was taken due to the potential loss of choice.
So here I sit with my broken shoulder. No matter what the doc told me, I know there will be limitations. For example, with my shoulder the way it is I don’t have the choice to take up professional tennis. I know I’ve had and will have a lot more situations come up in my life where I have no choices at all, but in this case I do have one. I can choose to get the surgery.
I’ll give it a month, let things settle down with my shoulder and my day job projects, then I will revisit this decision. Luckily, the doc told me this is a choice that can wait.
Tags: health, psychology
Thanks for posting! If you do decide to get surgery, please do keep us all informed!
Hi everyone. I have been away enjoying my summer break over here in Aussie land. I am happy to report than I am doing really well. Most days I don’t even think about my injury. I am back riding motorcycles, swimming and hiking and doing all the out door things I love. I never thought I would have gotten to this stage, as when it happens you just feel life will never be the same. My head is still not there yet. I am very careful with riding and have not gone back to enduro yet. I was really anxious when I got on my bike the first time and still feel sick at the thought of crashing.
A friend of mine races motorcycles and he had his done laproscopically. He is doing great now but said he would reconsider having surgery if it happened again only because of the down time. The recovery period is very prolonged. I have 100% range of motion but still exercising to get all my strenght back.
So guys the body does heal, if slowly, but the mind, I dunno I think I have a way to go yet.
Nice! Thanks for checking in and updating us 🙂 It turns out I’ll be in Australia in June giving a keynote at Wollongong University. Too bad it will be winter there 🙁 Can you suggest any sites to check out that aren’t in the guide books?
It’s been about a month since I posted, and about six weeks since my separation injury. I have met with FOUR orthopedists (i know it seems like overkill), and each one of course has a little different take. First said “No surgery period.” Second was a bit of a prick, and I think he just wanted my money. Third was terrific, but couldn’t repair it arthroscopically, but referred me to one who could. I met with the fourth, Dr. Cox, yesterday. I am very excited about this. Dr Cox uses the GraftRope to do the repair. I researched it (obviously I am thorough researcher, seeing as I went to four doctors), watch animation on the web, and watched the actual arthroscopic repair on the web. This clearly is the best option for surgical repair, in my opinion.
I do plan on getting the surgery. My shoulder is MUCH better. I went rock climbing this weekend even. I still feel pain on certain moves, but it’s not debilitating. And I feel a slight dull pain all the time, whenever I move. I’d say I’m over 90% strength and 90% mobility.
I’m considering waiting till this coming winter…say December 2010…for the surgery, to have my time in a sling and healing to be during winter months. Part of me says do it now, and be ready for summer climbing. But my shoulder just gets better each week. So I’m not sure.
I will be getting surgical repair, arthroscopically, at some point though. Just when.
Interesting! If/when you do end up getting surgery, please keep us all informed as to how it went and how you recover!
hey there! being a x trapeze catcher and a current gymnastics coach 6 days a week. here i am a little over a mont ago after my bike accident and suffered a type 3 AC seperation and now ive got full range of motion with no weight in my hands. all i did was move my shoulder every day to the point where i feel pain and then ice for 20 min twice a day every day and im allmost all good!
the body is amazing!
ill just have a bump on my shoulder for life… we will live
Hello, I have an AC joint seperation level III, injured on Jan 15th.
Same story as most, doc, ortho, physical therapy…..
But, i was feeling good, up untill about a week ago. I started to increase my workout, on advice from my physical therapist.
And, my arm is starting to hust worse then before, almost feels weaker, not stable, bones rubbing when walking or driving in a car I feel the bumps of the road. (almost a clicking sound/ feeling in my arm.)
I also toof a small fall this week, walking my dog, sliped on ice….dont think I put presure on my bad arm….just a scary fall that left me thinking if I damaged it more…..dont think so, was kind of a slow mo fall.
Any advice, because I feel physical therapy was going well, untill this week.
Thank you, Bill
Hi Bill,
I’d chill out on the physio. You can do absolutely no physio with this kind of injury and you won’t be any worse off after it scars over, so there’s no point in pushing it to the point of pain. I’d tell your physio guy about the pain and ask him to scale it way back. After you’ve had a while to scar up, then start pushing it again. The only thing you’ll gain with physio is better strength and range of motion, but you can build both those up later and not be any worse off.
To: Billy O.
Amal is correct again (to chill out). I got a type III on March 14, 2009 while snowboarding and have been checking this post on and off since then; it provides very good info.
It has almost been a year and I’m about 90% fully recovered. I have been skiing and snowboarding this whole winter season and only occasionally feel a clicking in my shoulder but it really doesn’t bother me. I had started lifting weights two months after the injury but strained it and stopped. Within the last four months, I have been lifting weights again, and have strained it to the point of real pain (for a few days) only once. It doesn’t bother me at all to do normal everyday activites.
What I’m trying to say here is, you will slowly recover but don’t over do it. Unless you are a professional athlete, I don’t see any reason to put pressure on yourself to recuperate quickly. I think the problem is, most people who get this type of injury are sports nuts (including myself) and don’t know when to quit!
Hey Amal, I live in Brisbane but I will check with a friend who lives in Wollongong. What things are you interested in , will you have transport and how much time do you have?
Yes winter in Australia. Well you guys who come from places that get really cold would laugh at what we call winter. I saw snow for the first time last year when I went to Tasmania. Anything below 21 I consider freezing. That’s in Celcius.
Yeah the physio thing. It really is for strength. I find it helpful for the pain I was getting in my back muscles. I also find my TENS machine invaluable. The weather is a little colder now, about 24 and I am finding my shoulder is aching a little so it will be interesting to see how I go through winter.
I’m going to be in Wollongong the first week of June, then I’m splitting the following two weeks between exploring Sydney and trudging around New Zealand. Should be fun times 😉
Yeah the muscle cramping takes a while to work through, and physio does help… but I would focus more on stretching than strength to help with cramps. The muscles are cramping because they are now doing the job of the torn ligaments. They are under stress as it is, so they will get stronger all on their own during the “healing” phase. Once they calm down and stop cramping up, then I’d say slowly start working on strength. I didn’t do any strength training at all… like none… but last week I started doing moderate weight lifting and I was able to work both arms and shoulders equally, so that says to me that the body will eventually be able to compensate very well for the lack of support… no need to add additional stress in the first few months following the separation when everything is already working overtime just to catch up.
I’ve heard of the TENS being used to cause muscles to relax. How it does that by causing them to fire and compress through shocking them is beyond me 😉 But I have heard it working miracles for people with muscle spasms and cramping. I wonder if any women use it to relieve “lady cramping”?
I’m a martial artist who ended up having a level III AC separation around Nov 08. The orthopaedist said that at the time he didn’t recommend surgery either. I recently had a check up (Mar 10) with a different MD because I still experience pain and he recommended surgery for me at this point. He did say that only about 30% of people who get this type of injury require surgery at all. I have full range of motion and excellent strength despite the injury (and the pain). You might just want to wait it out, see if you function without pain, and decide from then whether you want surgery or not. You’d be surprised how well your shoulder will work without it.
howdy,
I suffered a type III AC-separation in July of 2007 and have been considering surgery ever since. I am a highly active 22 year old outdoorsman. What bothers me the most about this injury is, as amal stated, just the feeling of being broken! I have great ROM, little pain, and great strength. However, the nagging feeling of instability and visual deformity makes me tentative and self conscious, and has made me quite depressed.
Another thing that bothers me is that my trapezius muscles on the affected side seem underdeveloped. Does anyone else have this problem?? I don’t know if it is because muscle attachments have been torn or just because there i not the downward pull on my clavicle anymore. Maybe these muscle would fill out a little more if I had surgery.. but who knows. Doctors are always in a hurry so you can never really get your questions answered.
Thanks for reading. PLEASE respond with some input if you have any.
Bill,
I have been reading this post for a year (since my snowboarding Type III accident in March 2009) and don’t remember anyone actually getting the surgery. All the doctors recommend waiting and see how it feels a few months down the road, mine included. There have been a few people who said they were going to get the surgery but I don’t remember them sending in a post afterward.
I would like to hear a surgery story if any one has one. Personally, my shoulder is 95% healed and I don’t think I will ever get the surgery.
Bill,
I think the trapezius muscle will naturally get weaker as people tend to consciously or subconsciously do less with that side of their upper body, and favor the unaffected side. Targeted exercise to work that muscle without putting unnecessary stress on the torn joint and ligaments would undoubtedly increase the size and strength of that muscle. Talk to a physical therapist about it, I’m sure they have all kinds of fancy work out tricks to isolate that muscle.
One thing I would like to clarify though is that on a type III separation, there is no actual muscles that have torn, only the AC joint and ligaments that suspend the scapula from the clavicle. Your muscles are now taking over that job, and that’s why we’ve all got small bumps on our shoulders instead of slumpy hunchbacks 😉
Eric,
I know what you mean about nobody posting about having surgery. Sandy62 mentions her friend that had it done laproscopically, but said he would reconsider having surgery if it happened again because of the down time. If anyone has had the surgery, please fill us in!
Thanks for the responses!
Eric. I’m sure if we had more “high level throwing athletes” and “overhead laborers” on this forum we might get to hear from someone who has actually had the surgery. Unfortunately for the rest of us, however nagging our injury, we are advised to just live with it. Which is completely understandable but, If I knew the surgery would fix this unstable feeling I’d get it in a heartbeat, even though I am not quite a high level throwing athlete (close though) haha. As for the down time, at 22, I feel 6-8 months or so of being laid up is worth it if the surgery actually works. Maybe if we made an ac-joint injury facebook page we could hear from more ppl who have had surgery on it lol. I’ll leave that up to someone else. Cheers.
Vea,
What kind of martial artist are you? What standard? Competative?
I’ve just had a separation due to being suplexed (rammed shoulder first in to the ground, with not only my weight, but also my opponents weight on it, in a pick up and dive like motion)… in a no gi grappling competition that had “no slamming” as rule number2!
Happened 11/4/10.
Been told on visit to clinic 16/4/10 it is type 2, but the bump on my shoulder matches type 3 internet descriptions much more accurately.
Recovery time is more like the internet descriptions of type 2. I took the thing out of a sling pretty quickly as the sling caused more pain than carrying it with my other hand did. When I’ve had ice on it (currently 1 week after injury) I forget about the injuy and can handle light objects as long as I lift no higher than shoulder hight. Though, without ice or ibroprofen I’m still feeling the pain and acting injured.
Anyway, just wondering if I’d be able to return to BJJ/no gi grappling? …and if so when?
How is it likely to stand up to fighting the strength of someone elses arm in various directions? Getting twisted in Americana and Kimura – like will I have the same opportunity/time to submit, before it gets twisted too far, as I did before? What is it going to be like at taking medium sized knocks when falling to the ground from regular (rule obeying) throws/takedowns?
Hi Thunder, welcome to the frey 🙂
I would think your injury and your physical activity would suggest you are a prime candidate for surgery. However, if the clinic is saying it’s only a type II separation, your doctor may not offer that as an option. If you really do have a type III and you wish to return to BBJ/no gi, then I would guess you are going to be out of the ring for at least 3-6 months. The first month, I wouldn’t do anything… just let things settle down. There is a lot of torn tissue and a lot of inflammation. Once the body deals with those things, you might be able to start doing light range-of-motion work and light exercise. You may notice the muscles in your back on the injured side start to cramp up… this is normal as they are taking over the job of the ligaments that are now torn and unable to support your scapula. Work with a physio therapist to identify an exercise timeline and regimen.
Beyond that, I would imagine it would be difficult at best to return to what you were doing without some loss of strength. As you know, in grappling, leverage is everything, and without those ligaments in place your bones have lost a lot of leverage… which means your muscles will be working hard at not letting your body get torn apart, instead of putting a hold on your opponent. I would see if you could get a second opinion from another clinic, and talk to an orthopedic surgeon.
Hi Amal,
Thanks for your reply.
On Sunday 11/4/10, when I did it the hospital gave me the impression that everthing would be fine and would go back to normal. Friday 16/4/10 ‘specialist’ in fracture clinic says type 2 and bump won’t go away, hence I start looking on the internet! Recent stuff I’ve seen on you tube shows a guy with a type3 – and he had less of a bump than me!
I’m really worried that the delay in identifying the injury correctly is costing me to lose opportunities cosmetically and/or strength and/or recovery. The bump is already more difficult to push down by hand, Making me think it is too late for to tape up and force to settle lower (assuming that stuff shown on you tube does anything for a type whatever it is that I have!)
NHS in the UK is crap. My brother had an AC problem (not a separation though) and ended up having to diagnose it himself and tell doctor how it should be treated, after seeing four specialists that had different wrong opinions on what was wrong.
Anyway, I have booked in to see a private physio today Wednesday 21/4/10. I’m also seeing a private ostiopath Friday 23/4/10. Unfortunately I don’t have private medical cover in my new job,so will have to pay for this stuff myself 🙁
Also seeing NHS specialist on Friday 30/4/10. At least that will be for free, so worth another NHS visit/opinion.
Recovery wise I managed to use my arm a bit washing my hair last night, waved round a full 1L bottle of water (though not did not try above my head!), changing gear OK in the car now (gear stick on left in UK), tried a press up but failed last night – not too far off though. It seems better than most people on her after 10 days, so I just dont get why the lump is so big!?!
Hi Thunder,
Don’t worry about the bump, it will settle down in time. Mine started out huge and after the inflammation went away it’s rather small in comparison. Also don’t worry about losing out on opportunity for lack of a proper diagnosis. The surgery can’t be done now anyway, things have to settle down… and every orthopedic doc I’ve talked to (and books I’ve referenced and docs others have talked to on this post) say that you can get the surgery now or years later and it won’t make a difference.
Take it easy for at least a few weeks and don’t push it into further injury. Let things settle a bit before pushing to where pain stops you… just keep up with your range motion tests but don’t push past where it starts hurting… there’s no need to stretch things out or do further damage at this point.
Talk to the physio and the ortho/ostio docs and get their opinions, but above all you can rest assured that just doing what you’re doing now is the best thing you could be doing.
Hi everybody,
I am new ar this, just had my biking injury 2 days ago April 30 2010 – I was crashing into asphalt at 35km/h – my left shoulder took the impact. The paper from the emergency room says a type III AC-separation.
I am still in a great pain, every body movement, bending down, etc.
My arm is suspended and attached to my stomach.
I need all the good advice how to progress on that. I was Kayaking /biking/tracking until 2 days ago.
Thanks
Hi Doron,
Sorry to hear about your crash landing. All the advice anyone could ever give you is already listed in the comment thread. Just read through it all and if you still have questions, post away and someone will respond.
Thanks Amal,
Let me in brief update the situation and progress. Its now the 6’th day past the accident. Intense pain and filling really crippled in the first 3-4 days, I have called up a physiotherapist for a consultation, He recommended starting a treatment right away. His session combines of electric , ultrasound and laser and some minor shoulder movements , it felt so much better right after. We have scheduled
a daily session for the next days. He seems to know what he is up to .
He also recommended taking Arcocsia 90mg daily – I am already taking it, and so for the next 5 days. The “bump” over the shoulder is not pronounced (yet ?) – maybe because the whole shoulder is still swollen.
In all – he made me optimistic about the recovery .
during the past days I have consulted with many over the phone, I have come to the conclusion that any Energy/Resources of mine invested in a diagnostics and further estimate of the damage IS NOT CONTRIBUTING TO THE REHABILITATION PROCESS . those can wait for later (if/when needed) . So, I do not ask to be driven to see any Doctors/MRI now.
Electricity, ultrasound, and lasers… oh my! That sounds very interesting. Is the point of that treatment simply to minimize pain, or is there some impact on healing time as well?
Also, where are you from? I don’t know of any physiotherapists in my area doing that kind of treatment.
Hello Amal, I am from ISRAEL, Western Galili region. The purpose of the treatment is to enable a swift recovery of damaged tissues and the prevention of further damage to already partially damaged tissues. Those treatments stimulate blood circulation in the trauma area and accelerates local metabolism .
Relief of pain I am told is also important because it allows you to start moving the arm, therefore preserve the normal angular motion range, and further stimulate the exchange of trauma waists materials ( liquids, blood clouts remains etc.) you know – my chest and back skin all around the trauma area turned yellow – indication to the massive tissues trauma .
Its surprising how I have regained most of the arm movement range( no load though ! ) .
Don’t be mistaken – it is still painful and feels swollen but I could even prepare my own meal and eat with both hands. That physiotherapist is taking me tomorrow morning to the 1’st session of Hydrotherapy ( a therapeutic water pool ) .
I will keep you posted as for any progress/regress of my case.
Thanks
Interesting. Very cool stuff. I was curious where you were from because Arcocsia is not approved for use in the US yet (like a lot of other great things).
Hey I’m 16 and just suffered a type 3 AC separation yesterday at my lacrosse practice, I saw my local doctor today and they classified it as a type 3 and are transferring me to a bigger hospital with orthopedic specialists. My appointment is on Friday and I’m pretty nervous. I was reading through these posts and this doesn’t sound good. I have the feeling the doctors going to give me the option to get surgery or not and I’m not sure what I should go with.
Is this a re-occurring injury? Do you lose strength/ movement in the shoulder?
pros/cons to surgery? Any and all help would be appreciated!
Thanks.
Thought I’d come back with an update…
Physio and Oestio both independently diagnosed me as having a something that could best be described as a “type 3 minus a 1” i.e. the coraco-clavicular have been completely torn, but there still appears to be something holding at the (more vulnarable) acromio-clavicular end!
Orthopedic surgeon 30/4/10 just said “type 3” (and I could not be bothered to argue with him just yet, as it makes little difference at this stage), which means NHS doctors have now diagnosed a 1,2, and 3 respectively on each visit! He is prepared to do keyhole surgery if I want it (before which I would make sure I’d had a scan, to see who is right about the A-C ligaments). I’ll see him again in two months. Until them he said to do any exercise beneath head height, stop when it hurts, no excercise over head (i.e. shoulder pressess and lat pull-downs), and no grapppling.
Recovery wise:
In the first two weeks after the accident I made huge progress.
Before injury I’d knock ot 60-80+ press-ups depending on fitness.
For the first seven days after the accident it was too painful to do any.
14 days after accident I did 20 (but I was leaning a lot to my good arm, and probably on ibroprofen).
…But, in the two weeks since them I have not really got any better, managed 25 one day, but only 7 another. With/without ibroprofen seems to have been the determining factor.
Lump has not gone down at all. Possibly even got a little bigger.
Bone/lump has become more difficult to move/remove.
Pain levels etc have not changed at all during the second fortnight.
I can lie on the shoulder at any angle when awake, but I’m in pain when I wake up each moring!
I don’t feel pain when doing any of the basic single direction strength , flexibility, fuctionality tests that a doctor does; but when my arm moves in a number of directions in sequence I get pain – so no chance of grappling like this.
Pain often seems to arrive at odd times for no reason.
If it continues along this platto till July then I’ll be asking for surgery, especially as a need to study over the next year or so makes now the best time in my life to have it done. If it gets better then I’ll delay the decision, since the op can be performed just as effectively in the future.
AWESOME post. I just suffered type 3 ac joint seperation 7 days ago playing hockey. I came across your website trying to do some research to weigh the pros and cons of surgery vs non-surgery.
Thanks for the post and comments – it’s good to know other people have experienced the same injury and decision!
yo great read here… sounds like i fit in… ha
about 1.5/2mnths ago i was righting my dirt bike wiped out and a gave myself a sweet type 3…it looks like a golf ball on my shoulder.. no fun.. thankfully its on my left side and im not affected with the everyday.. ive broken many bones and healed just fine no problem… but for some reason this thing stresses me out.. the fact that its tend and ligaments worries me… i feel broke constantly.. im back to running now without any pain when my feet hit the ground.. thats def a good feeling.. as far as rock climbers and pull up people out there… is everyone able to do that again at the same level before? also people those who hike and use heavy packs does the shoulder straps on that bone bother you? thanks for the input everyone its good to be able to relate hahah
Hi guys, Same deal here with a crash whilst training on BMX track about 3 days or so before Doron. Initial diagnosis by physio was grade 1-2, but as others note, the bump became more pronounced as swelling of the whole area settled. I raced at National BMX titles 2 weeks after with plenty of taping and Ibuprofen. It was painful, but knocked out a decent lap or two…
It’s now 4 weeks and movement is good and pain minimal at times. I manage a health club and have good contacts in rehab, but they all have pointed me towards a orthopedic surgeon for diagnosis and assessment. I get the feeling that no-one really wants to risk INCORRECT diagnosis, and leave this up to a medical specialist. I think it’s a grade III, but I will see this doc (who incidentally repaired my torn bicep tendon – another whole story – with a 100% great result. I have great faith in his ability).
Deformity I can live with.. Instability and advancing arthritis I can’t.
I will be watching this string closely. Thanks.
Hi Speedtrip,
Thanks for posting! If you end up getting surgery please consider posting frequent updates! We’re all very curious!
Hey Amal,
I feel you on that fear of choice and limitations, I also broke my shoulder snowboarding and had a type 3 AC separation, about a month ago. I was thinking on the cheap alternative of not paying anything and letting it heal by itself, but 2 weeks down the line i decided to get surgery on it, currently its been roughly 2 weeks since I had surgery . The surgery took less than an hour, i didn’t feel anything, and the pain from surgery isn’t that bad, i didn’t even take my vicodin, unless i have a strong thresh hold on pain. The only thing I’m concerned on is that i have 2 metal points on my shoulder (on my coracoid of my scapula and on my acromian end of my clavicle) used to keep my ligament in place, because of going into the airport and the metal detector, and not being able to enjoy steam rooms or saunas =P. Doc said that i will be out for maybe 6 months for full recovery there for, i can’t work (vacation =D), and I’m getting disability. Currently my arm is on a high-tech looking sling and will have it there till 2 more weeks, till i begin therapy. I strongly suggest on that surgery, My arm feels better in 2 weeks after surgery than 2 weeks after I injured my arm.
Thanks for posting! I’m sure we’re all very interested to hear more from you as things progress.
Hello every1 ,
its now 4 weeks and 3 days since the Bike Crash, during the past few weeks I was having Physiotherapy and Hydrotherapy sessions.
I am already swimming: breast/cowl/back strokes – not full power yet, but 1000 meter each time. I do shoulder warm up before. Today I took my bike for a ride – not in a rough terrain yet.
My Physiotherapist seems very pleased. My goal for the few next week is to return to Ocean Kayaking.
There are still days when I over stress my shoulder – I get some pain that is passing away after a day or two. I hope to be able to do ~100% of what I used to before and not to consider surgery, The surgery is a process that keeps you out of activity for 6 months or so. Not all injuries are to be treated with the minimal 2 holes technique .
I will keep you updated in a few weeks.
Be good.
My son has recently had an ac joint op with plates put in his right shoulder. He had a stage 3 dislocation from a rugby injury. Doctors said looking at his xray that he definately needed an op. Has been sleeping on the sofa since and is on lots of painkillers. Will keep you posted
I received a level 3 seperation on May 7th in a grappling class. First thing I realized is that I’m just too old for this…44 years. Nevertheless working out is part of my life, and I need to be able to get back to my weight – interval training.
I’ve been recovering…I can go for my runs, do curls & work the tricepts with some exercized, doing lots of squats and crunches. Been back to bicicyling and motorcycling. But I still can’t do a push-up.
Saw the surgeon last week and he said surgery was up to me, with no clear benefit to getting it. However he said that if I do get it, it would be a bit better to get it immediately while the initial injury is still healing. Otherwise, surgery down the road will require taking tissue from my hamstrings. But he said the only reason to get surgery down the road would be if the clavicle becomes unstable while working out…something I won’t know until months down the road! It’s a catch 22 situation.
Then I checked with a relative in Europe who’s a doctor, and he checked with a surgeon. The response was that without surgery, the shoulder will always remain less than 100 % stable. Surgery can re-establish stability though it’s not guaranteed to do so. This lack of stability may impede certain sport activities.
Like the original post here, it seems to me intuitive to get the surgery. I’m really at a loss as to what to do, but am leaning towards surgery.
Well, on the one hand the ortho surgeon I consulted with sent me this:
“I would estimate about three quarters of patients are happy with both operative and nonoperative management. The planned second surgery that some patients get is to remove the coracoclavicular screw as we discussedOne of our vascular surgeons had this injury and after initial enthusiasm to have it fixed, he opted for nonoperative management and he says it feels great with no disability. Your clavicle won’t ‘become’ unstable rather it’s unstable now due to the acute injury. Over time, it will often scar down and stabilize.”
While, on the other hand, this article seems to indicate that the most recent view is that surgery for level 3 ac seperations is recommended:
http://www.hss.edu/conditions_shoulder-separation-dislocation-overview.asp
Very difficult to make a decision….
Hi Guys
It looks as if I have just joined the AC club, had a fall with my horse on 12th June 2010 and following a visit to the fracture clinic was told type 3 or maybe 4 AC separation, am now off to see a shoulder surgeon in the next couple of weeks.
Def not keen for surgery as I work as a contractor and no work means no pay!
I still have loads of swelling a huge lump on my right hand and I am right handed, and some pain although I am amazed at the range of movement I have regained.
My concern is falling off again, is the injury more likely to occur again if you don’t have the surgery, unfortunately falling off horses is something I am quite good at although I have never managed to damage myself quite this badly before! But when I go back to riding, if I am concerned about falling off and constantly worrying about it it will affect my performance, upset the horse as well and make a fall nore likely! Not going back to riding is not an option for me.
Can anyone help?
Hey vickyb, as I understand it, if you do not get the surgery, you cannot tear the ligaments again because they do not reattach to the clavicle by themselves.
Without surgery scar tissue forms and muscle compensation occurs to help provide stability to the shoulder and clavicle.
I’m no doctor but it seems to me that you could still damage yourself again, just not in the same way…especially with your shoulder not as supported as pre-injury or with surgery.
I’m at 6 weeks post injury. Have regained most range of motion, but only partial strength. Still can’t do pushups because of pain that comes when I try. I feel uncomfortable most of the time with back aches in the area of my shoulder blade (injury side).
I went crazy for the past week trying to make a decison on surgery…the surgeon said it’s up to me. Unfortunately there was a delay before I saw him. Read lots of web sites, and spoke with 2 guys at work who had the same injury. One had the surgery from the same surgeon I saw and is very happy he got it.
The other did not get surgery. His accident was 8 years ago, and he’s quite happy.
I also spoke with 2 different physiotherapists. At the end of the day, surgery is up to the patient, and I think we have to go on instinct. This morning I left a message with the surgeon’s office asking to go ahead with the procedure if it’s not too late. Guess I’ll find out next week one way or another. Personally, the totality of the deformity and my body parts remaining unconnected and not fully supported doesn’t sit right with me. I’m willing to take the initial pain, risk and aggro of surgery to get my body reconnected properly. Either way as one physiotherapist told me, it’s a major injury and we are all in for artheritis with or without surgery.
Luckily I have a hot tub and a fridge with cold beer.
Hi Dan
Thanks for your advice, I really appreciate your views.
My x-rays have now been reviewed by a shoulder surgeon and he has already booked me in for surgery on 3rd July even though I haven’t seen him yet, my appointment with him is on the 29th June.
My concern is much the same as yours, it is the feeling of being broken and not structurally the same as I was before that bothers me and at the moment I am inclined to err on the side of surgery and endure the longer recupration time to enable me to be returned as closely as possible to my pre accident state.
Long term it seems we are all in for arthirits etc but like you I have cold wine and a hot bath to sort out those issues!
I will keep you posted on the surgery vs non surgery route and look forward to hearing about your choices.
Take care
Hey Vicky,
If the surgeon is booking you in for surgery, I’m thinking that would indicate that it’s probably more of a level 4 separation. In which case, they apparently do go with surgery. At least the choice is made for you.
Good luck & keep us posted!
Thanks Dan
Will let you know how I get on!
Hi all!
I am another who really had no choice but to go the surgery route, and as a result, have learned alot about why surgery is a good thing. I am a 39 yo male, triathlete, with a strong emphasis on road cycling and racing. A crash on May 22nd of 2010 left me with a distal clavicle break, and torn Conoid and Trapezoid ligaments. The clavicle break was too close to the AC joint to use screws/plates, and the remainder of the clavicle was impaled in my trapezius muscle… there was also a space of about an inch and a quarter between the broken bones. I saw three surgeons the following week, evaluating and learning from each. If I opted for no surgery, the clavicle break would almost certainly be a non-union, and left untreated, the ligaments would not reattach. Given my activity level, all three docs recommended surgery, as soon as possible, to give me the optimal opportunity at full recovery. All agreed, I really tore things up. I chose to have the surgery on 6/1, performed by a surgeon from Manhattan, who is also the doctor for a regional sports team. He drilled holes in my coracoid process and in my clavicle, through which he laced cadaver tissue and restored alignment of the shoulder… this is acting as a scaffold to allow MY OWN ligaments to reattach and return to normal function. Once that was done, the clavicle fracture was perfectly aligned, and he was able to ‘wrap’ the pieces and keep them from shifting. This is not as secure as a plate or screws, but it does mean that I have absolutely no metal in my shoulder, bone on bone healing, my own ligaments, and a great prognosis! The surgery took three hours, and the doc warned me there would be significant pain after all the poking that was done. The following 48-72 hours were unreal, and I could not sleep at all. Still, its several weeks out, my shoulder looks awesome, and feels pretty good too. I start PT work in another week, and I miss bike riding more than anything. So, if you want to give your own ligaments the chance to do what they were intended to do, you have to have surgery very soon after the trauma. The literature says that if you wait four weeks, the likelihood that your own ligaments will reattach is low.
Thanks for posting your comment Hector. The part about the ligaments not joining together if you wait for surgery, is that true for simple type III separations? All the input from ortho docs I’ve heard is that you can have the surgery any time, and they cinch your bones together with a screw, perhaps deal with some scar tissue if it’s been awhile since the separation, and just stitch your own ligaments back together.
Amal, I just got a call from the surgeon’s office telling me it’s not too late for surgery (I’m just past 6 weeks post injury) and they are going to book me for either the end of this week or next week.
I think the surgeon’s going to go with screws that willbe removed down the road. I’ll update once I now more.
I know that past a certain point, he would take some of my hamstrings to help secure my clavicle & scapula – I hope it’s not too late to avoid that!
Well I’m going in for surgery next Wednesday, June 30th. Will update post surgery.
Hey guys, great thread. Would like to share my experience thus far.
I did my AC playing hockey. Diagnosed as a type three, the surgeon had actually had the surgery done himself and said he wouldn’t do it again given the choice. I was having impingment problems when raising my arm so the surgeon booked me in.
I had the operation 2 days ago, 17 days after the injury. The procedure I had was the “hook plate” one. Reports from the surgeon were it was a type 4 anyway so I am glad I had it done sooner rather than later.
Pain was quite bad when I came out, but once I got the medication sorted it is all tolerable. Sleeping is still a drama but I am realistic as it is only day three.
Will pop back in to let you guys know how I go. More than keen to answer questions. I did a huge amount of research before going under the knife. And I did my homework on the surgeon and had nothing but glowing reports. All I can stress is see a surgeon immediately as this increases your options to what procedures are available.
Yours in AC decisions
Snappa
Hi Amal,
As I understand it, by going in quick, the surgeon doesn’t have to ‘repair’ or ‘reconstruct’ the ligaments… Your own ligaments heal, as nature intended. After four weeks, the likely hood of that happening drops very fast. If you wait, then the surgeon performs some kind of ligament reconstruction… there are several techniques to do that.
Hector
Hi guys
Wish i came across this thread a few weeks ago. I did my AC joint in my right shoulder (being right handed not helpful) 6 weeks ago after a nasty cycling accident. I was diagnoised with a grade 5 AC joint dislocation. I had a significant lump approx 1 inch high and a shoulder that just dropped away. Tshirts or jumpers wouldnt stay on my shoulder (well at least the ones i was able to get on). It was suggested that I undergo surgery as cosmetically it would never get any better and having a physical job it would have more stability after surgery. It was 3 weeks after the injury before i under went surgery via the Lars procedure. So i was starting to get quite good at doing things again by this stage. I now have 2 screws in my collar bone and a synthetic ligament.
I am now 3 weeks out from surgery my shoulder looks great i have a scar that is about 2 inches long that will fade over time. My shoulder is still tender to the touch but i have more movement each day, dont really require anything more than panadol for what i would describe as a constant ache more than anything.
Still early days but i am at the same stage after surgery as i was after the injury before surgery and my shoulder is definitely more stable the bones dont move and crunch and i am positive i made the right decision.