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You can live with Type III AC joint separation, but I want more

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.

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457 Responses to “You can live with Type III AC joint separation, but I want more”

  1. JREC says:

    Vickyb, Good luck with your surgery. I fell off a horse I had in training a year and three days ago. I fell square on my right shoulder and it resulted in a Grade III separation. I train horses as a full time job and I wish I would have done surgery! The pain after a day of lifting saddles, having young horses jerk on the reins and lead ropes is overkill on that shoulder. I would certainly go with the surgery if I could do it again. The doctors told me that it really didn’t matter either way, however, since then I’ve learned that it is controversial and actually quite a few recommend doing the surgery.

  2. vickyb says:

    Hi Dan

    Good luck tomorrow, I hope it goes well, keep us posted on your post op progress.

    Mine is scheduled for Saturday 3rd July

    Take care

  3. vickyb says:

    Hi JREC

    Well I went to my surgeon yesterday and he has now said that I don’t need to have the surgery as I have full range of movement and lowgrade pain. He advised that the surgery was only really carried out for patients that were in a lot of pain and I would have a nasty scar and be in a sling for 6 weeks, if I had the surgery.
    I am booked back in to see him on the 13th July to decide if I go ahead, he told me there is only a small window of opportunity to carry out the surgery really successfully as after a while the body creates scar tissue which makes it much more difficult.
    I am so confused as some people are happy without the surgery and some are happy with and there does not seem to be a consensus of opinion one way or the other.
    This is a contraversial injury and we put ourselves in the hands of the experts who all seem to have varying opinions!

    Thank you for telling me about your situation as I have 2 horses, one is a youngster that I will be starting groundwork with soon, luckily I do have a sedentary job but look after my horses around work and therefoere need to be fit.

    Juat out of interest have you fallen onto that side since your original accident?

    Take care

    Vickyb

  4. Peter says:

    I too have a grade 3/4 separation of my left AC joint. However, I am both a handyman and a personal trainer. When I saw my shoulder specialist they told me that it isn’t really all that important to get it operated on for the reasons already mentioned above. It has now been 6 months and it limits me in my work and has completely stopped me being able to do gym. I am pissed off about it and am really considering very seriously getting it operated on (or at least getting the operation more in focus!).
    It was good to see this article as I too feel exactly the same way. If they can fix it, why don’t they? It will never be perfect but, damn it, it will be better than it is.

  5. Dan says:

    Got surgery yesterday. 2 screws in clavicle. Ouchie.

  6. Dan says:

    2nd day post op. Worst part about the srgery for me is the anesthetic – makes me sick. I was nautious for 24 hours.

    Pain in shoulder is getting intense but is controlled effectively with Tylenol 3’s. I have some oxycodone but am trying to avoid them if possible.

    Could be psychological, but I have the impression that things are back where they should be as far as my shoulder goes. The awkward feeling I had before – that my collarbone was sticking out and my shoulder was not where it shoud be – is gone.

    Am feeling confidant so far. Have to see the surgeon in 2 weeks to get sutures removed. Will have a better assessment at that point.

    In 3 months I have to get 2nd surgery to remove the screws.

  7. Snappa says:

    Well I am up to two weeks tomorrow. I have an appointment with the surgeon to have the stitches out.
    The range of movement is slowly getting better. But if I lean over with my arm hanging down it feels like something is falling loose and it bloody hurts, it kind of clunks back into place. Not sure if I should be moving it that much.

    I haven’t tried moving my arm above my head. Will find out if I am allowed tomorrow.

    Dan what are the 2 screws doing exactly in you shoulder? I had the hook plate procedure to hold down my clavicle. The scarring is meant to hold it in place with the plate out as I don’t think anything was done with the ligaments

  8. Dan says:

    Hey Snappa,

    The screws go through the clavicle and into the scapula, holding them together. Once scarring forms to hold the bones together, the screws are removed.

    Let us know how it goes when u get the stitches removed. I have to do the same in 2 weeks.

  9. Snappa says:

    Hey AC 3 gang,
    well I got the stitches out today and had a good chat with the surgeon. Two weeks after surgery tomorrow.
    The wound has healed well, almost completely. The stitches came out today Dan but there was a little bit of “gunk” on one piece that stung a bit when it got pulled out.

    Right, to the nitty gritty. I was concerned about how much movement I should be doing with my shoulder without affecting the healing. Well today with the surgeons help I got my arm up at about 30 degrees from level. It clicked on the way down. The 2nd time, less of a click. 3rd time smooth. 🙂
    He removed the back strap for the sling and encouraged me to do minor stretching, with rotation up on my back and also rotation out.
    He said to take it easy, I can understand why as after stretching with him and weighted arm xrays today I am sore as buggery.
    I just received a phone call to say the xrays look good.

    The range of movement is the next thing to work on. I am pretty sure the stiffness is causing the pain in my neck.
    I have to be patient, only week 2.
    Dan make sure you stay on top of you pain relief, very important mate. Ice packs are great even after the 2nd day. Also get specific range of movement stuff with your week 2 meeting as your hardware is secured differently to mine 🙂

  10. vickyb says:

    Hi Guys

    Had my surgery on saturday, one small screw , half an inch off bone and wrapped with synthetic fibre.

    The anesthetic made me really ill and the pain is intense and I am still numb over the wound site, I am hoping it isn’t nerve damage.

    Apart from that I feel great, it feels as if I am structurally sound again.

    I have been told by my surgeon to stay in my sling for 6 weeks, no lateral movement for the six weeks, I have dissovable stitches and am booked in to my Doctors in two weeks to get them checked.

    I hope you guys keep feeling better and we are now all on the road to recovery

    Take care

    Vic xx

  11. Dan says:

    vicky & snappa, thanks for the updates. Glad to hear that things seem to be working out for all.

    Snappa, I also have a pain in my neck on the injured side. Feels really tense. Pain wise in the shoulder, things are getting better each day.

    Taking off my dressing later today.

    Vicky, do you need to get your screw removed down the road with a 2nd surgery? That’s something I’m not looking forward to only because of the nausea I get from the anasthetic, but oh well. Still feel good with the decision to get the procedure.

  12. vickyb says:

    Hi Dan & Snappa

    As far as I understand it my screw stays in, the surgeon said it is really small and I won’t feel it. I am with you Dan I don’t want another op as I felt so sick after the surgery. They also put a nerve block in so my right arm was paralysed for nearly 24 hours which was really disconcerting.
    I am seeing the surgeon in six weeks so I will ask him about the screw then.

    My pain is already better from this morning, it feels really stiff and it is really pulling, I guess that must be the stitches!

    Well guys keep us posted on your post op progress.

    Here’s to being pain free, very soon!

    Take care xx

  13. Dan says:

    Hey Vicky,

    My surgeon told me that removing the screws is not mandatory, but they will probably break if I leave them in. I’ll follow his advice and have them removed.

    Weird about the nerve block, I hadn’t heard of that before.

    I removed the dressing today. It wasn’t stitches, it was staples they used. Whatever, doesn’t matter to me. The protrusion from my collar bone is COMPLETELY gone – awesome! I’ll take the scar over that anytime. My wife’s happy about it too.

    Stapled area seems fine – no excessive redness, no swelling, no leakage.

    Did some crunches and sit-ups today as well – my 1st exercise since surgery (other than slow walks around the block, which I’ve done the past 2 days). Felt better.

    Will nevertheless absolutely keep my arm slinged as long as they tell me. Will go to physiotherapy once I’m at that point and do what I’m told. I am determined to regain strength & range of motion, but in a cautious manner – don’t want to re-injur myself in any way.

  14. vickyb says:

    Hey Dan

    Thanks for the heads up, I will ask my surgeon if my screw is likely to break if it stays in, I don’t fancy that.

    I changed my dressing today and ditto, no more lump, the wound looks fine and I am not bothered about the scar, but I hated the lump.

    Glad to hear you are getting some exercise in but you are right to take it easy as it would be a nightmare if you re injured it, I am already going stir crazy but determined to follow doctors orders as I couldn’t bear to have to go through it again.

    Take care

    Vic xx

  15. Darlene says:

    Hi AC guys

    Sounds like every one is doing good after there surgery. Just as Vicky suggests follow the drs orders (who would want to go through the injury and the surgery again. Not me thats for sure).

    I am now 4 weeks post surgery with great range of movement. Have the pain in neck and muscles across shoulder which is quite intense. This increases the more i do but stir crazy by now. I think maybe in Australia they do surgery different my grade 5 dislocation was fixed via the LARS method. 2 screws and lars synthetic ligament, dissolving stitches arm in sling for 2 weeks then no restrictions of movement. Also the screws dont come out unless they are causing problems.

    Can get arm 90 degrees but 180 straight up just doesnt want to do at this stage. But a week ago couldnt do that. Each week brings new things that i can do again, so take each step with excitement that nearly back to how i was before the accident. The scar is definitely better than the deformity of a collar bone sticking out of your shoulder and everything feeling as though it was in the wrong place. But in saying that the surgeon did such a good job you basically cant see the scar already. Should be back a work in a couple of weeks hoping will be without discomfort by then.

    Take care
    Darlene

  16. Darlene says:

    Hi guys

    sorry im just presuming because everyone seems to be having different surgery to myself that you must be in America or some other country. Where abouts is everyone. Are you all in Australia also.

    Darlene.

  17. vickyb says:

    Hi Darlene

    I am in the UK, my surgery does sound similar to your though, only one screw and synthetic fibre, dissovable stitches, but six weeks in a sling and my surgeon was very insistent, no lateral movement and stay in the sling! Although I am already going mad, I am following his orders to the letter.

    Glad to hear you are making good progress, it seems that the decision to have the surgery was the right one, I guess in your case with a type 5 you had no choice anyway.

    Sadly I am back to work next week so hoping that the pin is better by then!

    Take care

    Vic xx

  18. Dan says:

    Hey Darlene,

    Glad to hear things get better with each week.

    I’m in Ontario, Canada. Someone I know in radiology looked at my x-ray, apparently I only have one screw in my clavicle. My clavicle & scapula are, I’ve been told, now perfectly alligned. I’ll find out more next week when I get my follow-up with the surgeon & more x-rays.

    I think that one key thing with this surgery is having a competent & experienced orthopaedic surgeon, and I’m very confident with mine.

    Sounds like you & Vicky also got good surgeons.

    The impairment to our ability to excercise is frustrating as hell for us – you don’t get this injury from falling off the sofa watching TV. Patience & some creativity is needed. Change to activities you CAN do…walks, maybe some abdominal exercises if you can avoid stress on the shoulder, squats…and enjoy the excuse to take it easy as well… I’m doing a lot of reading now!

    I’m actually back to work on Monday. Most of my work is at a desk, and I can still operate the computer & use the phone. And with my arm in a sling, I have a great excuse to not wear a tie…just in time for the hot weather.

  19. Snappa says:

    Hey Gang,

    I am in Australia, sounds like we have quite an eclectic mix of people. It really is interesting hearing the different procedures for pretty much the same thing. Time after injury and type of ac does vary the type of corrective surgery available.
    Vicky did you have some bone removed in your procedure am I reading that right? That would probably explain the block they gave you because that is traumatic for the body.
    Also you are right about the nerve damage it is exactly that. You have to remember to get to your shoulder they slice and seperate the different layers to get to the bone. The surgeon then reconstructs the muscle, layers of tissue, layers of skin over the top. You will be numb in the area for a long time. Nerves grow back eventually, once they start to repair it SLOW, from memory 0.2 of a mm a week i think.(must google it now) I had ankle surgery a year ago and a little bit is still numb. It does get better!!

    Also for those that have hardware to be removed at a later date, relax 🙂 This was stressing me out too.

    My girlfriend is a nurse, working having worked both as a surgical nurse and recovery nurse. She has said they do removals of hardware all the time, very much a straight forward procedure, much less pain. They don’t open up the shoulder anywhere near as much. And if you ask you will get to keep the metal as a trophey 😀

  20. Darlene says:

    Hi guys
    Well we are a mixed bunch from England, Australia and Canada.

    Like you say Dan we didnt get these injuries from sitting watching the TV but i have to say im not to keen getting back on my bike yet so i am just watching TV the tour de france to be exact. Not sure if this is a good idea though they have a lot of crashes.

    Your tougher than me Vicky if your going back to work already and you only had your surgery on the 3rd July. I had mine on the 4th June and not back at work till the 18th July. We must be a bit soft here in Australia. Like you I have had a couple of accidents on my bike so a little nervous about doing the same again.

    Hope all goes well with your return to work guys. Seems like ive been off forever i had to wait 3 weeks for surgery then 5 weeks off post surgery. I didnt realize how high maintenance i was till i couldnt even put mascara on or wash my hair. Well at least those days are over. My poor husband must of wondered who the hobo was he was living with. And my kids driving me places it has been quite a journey and a bit of a laugh i must way now i can look back on the worst part of it.

    Take care
    Darlene

  21. vickyb says:

    Hi Guys

    Glad to hear everyone is still making progress, even if we are all frustrated at the lack of activity.

    I know exactly where you are coming from Darlene, i have now mastered eyeliner, but still can’t do mascara, I had to have my hair cut, as my husband was about to throw himself out of the window trying to deal with my long hair and me whingeing at him and telling him no that’s wrong, I can’t go out looking like that!

    I am like Dan, I mainly fly a desk in my job and so can easily do my job, I am also a contractor, so if I don’t go in I don’t get paid, and I am hoping, it will keep my mind occupied as not sure how much more daytime TV I can handle!
    I really feel for you having to have so much time off when you can’t really do much.

    Hi Snappa thanks for the heads up re the nerve damage, hopefully the feeling will eventually come back, but at least I know why I am numb. I did have about 1/4 of an inch taken off the bone and that is exactly what the pain feels like, as if someone is sawing at my bone, glad to say though I am pretty much off the pain killers now and managing to get though most of the night without waking up.

    Good luck going back to work Dan and take care guys and as per Dan’s great advice, a bit of patience is a must now even though I am sure we are all itching to get back out there and play our respective crazy sports!

    Vic xx

  22. John Ryker says:

    I’m 51 and consider myself an amateur athlete, but really I’m a dad and general manager. I suffered a Grade 3 shoulder separation on June 3rd riding a skate-board. I’ve experienced the same feedback for 3 different surgeons about not fixing my shoulder. After some deep thought and depression I decided I would not be happy unless I did all I could do to fix this shoulder. After-all I plan on running, biking, swimming and lifting weights until I’m 100 years old,, So I’m choosing to fix my separation, which is scheduled on Thursday, July 15,2010.

    My surgeon is doing something called a modified Weaver-Dunn procedure, sounds allot like all of you surgeries. However I’ve heard of another procedure that uses cadaver ligaments/tendons to fix this problem.. Anyone go that route?

    Glad I found this group..

    John Ryker
    jshryker58@yahoo.com

  23. Dan says:

    Hey John,

    I went through the same torment in trying to make a decision as you (which after all is how this forum began). In the end we have to go with our instincts on this one (for those of us who had to make a choice on surgery), and I feel the same way you do. While to some extent my shoulder was getting better after the injury, it also continued to feel awkward, and I had a very unpleasant sensation involving both my collarbone and the shoulder – everything felt out of place.

    Like you, I also want to keep working out for decades, and after speaking with a couple of physiotherapists and other people, I had a sense that I’d be better off with the surgery when it came to support of the shoulder for weight lifting.

    Even right after surgery my shoulder felt more “normal”. To me, unless you have a strong aversion to surgery (not that I like it!) it’s worth doing. At least, so far…it’s still early days for me. Man, I can’t wait to start physiotherapy…at least I’ll be doing something!

    Keep us posted. What country are you in?

    Hey, Snappa, good call on asking for the screw when they remove it…I definitely want that as a trophy. Just a reminder of how I was…well, screwed! (Sorry, couldn’t help myself.)

  24. Dan says:

    Hey Amal,

    How is your situation at this point? Are you feeling like you’re getting back to your pre-injury condition?

  25. Amal says:

    Hi Dan,

    I’m pretty happy with my situation. I’ve recovered basically 100%… there is still a bump, which I don’t mind because it actually looks more like I’ve bulked out some shoulder muscle than it does a disfigurement at this point. I do notice from time to time some clicking/grinding noises coming from my torn left AC joint when sleeping on my left side, but absolutely no pain. I just completed a very technical hike yesterday with lots of scrambling while carrying a pack and the only thing I notice today is that my left side back muscles are slightly more sore than my right side back muscles… the same muscles that tend to painfully cramp up in the days immediately following the initial injury.

    The only thing I’m really annoyed with is the Orthopedic doc’s comment to me that “I could have the surgery now or 10 years from now and it won’t make any difference”, but the truth is it does make a difference. That difference has to do with the type of surgery you can get. If done within the first few weeks of the injury, you can have your own ligaments reconnected. If done later, after scar tissue has formed, more grotesque methods are necessary, including using cadaver ligaments. This really angers me because I really feel I was duped into not going with surgery, even though I don’t feel I’m at any significant detriment for not having it done.

    What I’m curious about now is what are the different outcomes later in life between the three groups; 1) those not having any surgery, 2) those having surgery early enough to have their own tissues repaired and reconnected, and 3) those having surgery later using cadaver bits and such. What will the effects of old age be on each group? What types of arthritis might each of these groups expect later in life? If these things had been explained to me by the doctor, I would not be so miffed at the medical profession, and perhaps the need for this make-shift forum wouldn’t exist either.

  26. Dan says:

    Yeah…one of the reasons I decided on getting surgery is that the surgeon told me that getting it later on (which he also said would be no problem) would involve taking a hamstring from my leg. That didn’t seem too cool to me.

    This injury is infuriating because there is no simple obvious answer on treatment. You’re absolutely right, there is a lack of long term studies involving various surgeries, & physical activities that benefit or suffer from surgery in the long run.

    Glad to hear you’re able to get back to your physical activities.

    2 guys at work had this same injury, several years ago. One had surgery, the other did not. They’re both happy with their outcomes. 2 different surgeons I checked with had similar answers: most of those who don’t get surgery end up satisfied with their outcome. Most of those who DO get surgery also end up satisfied.

    So at the end of the day, it really ends up being a personal choice. It’s difficult because we’re just not used to making to make such choices.

  27. Darlene says:

    Hi Guys

    Just like you Vicky i got my husband to try and do my hair washing, blow dry etc gave up in the end and went elnatural. Bless their little cotton socks they do try and after 22 years of marriage its the first time he as ever had to do such a thing. Just not his forte. Like you im not getting paid whilst im off, dont have any sick leave until February next year now used it all up about 4 -5 weeks ago. Unfortunately i need to get clearance to go back to work because im a nurse in a busy medical ward and im not able to go back on light duties because its not a work place injury so the hospital wont take responsiblity for any issues that could be caused moving patients etc. Like you i had a nerve block and definitely knew when it had worn off. Had discomfort and strange feelings down to my fingers from it. Re: unpaid leave I have since taken out insurance for bike riding which is like car insurance covers personal injury, property and loss of income wasnt expensive $105 australian for family cover. The rider that cleaned me up on my bike has it so i should be able to recover loss of income from it. Has a large excess though $1000 per claim. Useful though if you ride into a porsche or the like.

    Like you John im no spring chicken im 43 years old and wanting to keep fit for many years to come. It was 3 weeks after my accident before i had my surgery so was defintely starting to use my arm again and be able to do things but aways had a strange sensation that things were just not right and they clunked and grinded. Not sure i was comforble with the inch lump on my shoulder either, also from the back just looked strange. I personally was told with a grade 5 ac joint dislocation i could leave it but im glad ive gone for the surgery it defintely feels stronger and more comfortable than before.

    Been able to vacuum, iron, carry firewood in the house, mop floors etc ache afterwards but doing this before surgery shoulder clunked and seriously was painful doing it rather than afterwards. Must admit cant hang washing on line yet but just dont have over the head movement or strength yet.

    Not sure about the cadaver/tendons/ligaments etc but the lars procedure that they did with mine is a synthetic ligament. Good luck with your surgery on Thursday im sure either way you’ve made the right decision, seems as though professional athletes have surgery straight away without having to make a decision its just the ameteurs that have these dilemas.

    Also agree good call on getting your screws my husband had a spinal fusion years ago and they had to take the bolts out he has them in a jar for old time sake.

    Darlene

  28. vickyb says:

    Hi Guys

    John I had the same, do I don’t I decision to make with the surgery, first my surgeon booked me in for surgery from seeing my x-ray but not me and then when he saw me he said, well you have good range of movement you could wait a bit and see how you get on, I spoke to a physio and he advised me that if I wanted to get back to the level of activity I was doing before the accident to get surgery.
    I have 2 horses and one is a youngster that basically stands up on her
    back legs if something doesn’t go her way, you need a great deal of strength to be able to deal with naughty horses and I have 2 of them and there is a lot of lifting, carrying etc, plus i was worried about falling again and what might happen to the collar bone if I did, would it come through the skin on my shoulder?
    I felt disconnecterd after the fall, my shoulder blade didn’t sit right and I had the same feeling that Dan and Darlene have spoken about that nothing felt connected
    I am really pleased I had the surgery, it may be purely in my head but the shoulder felt better immediately, although the surgery was painful, I am now one week on, feeling better than I did one week after the injury.

    This has been a very frustrating injury as there does not appear to be one approach or a right answer but Dan is right it is intuiative and individual to each person, I guess we will probably all get athritis, but I guess we will probably all ignore it as much as possible as most people in this group will have had multiple falls and injuries as a by product of the sports we do.

    Darlene I am planning to get a similar type of insurance as protection, as my current employer has been really understanding, but there are other organisations who would have said no to me coming back as I am a liability to a degree.
    When will you be able to go back to your job?

    Good luck John, I hope all goes well with the surgery.

    Take care

    Vicky

  29. Snappa says:

    I am really keen to hear how people get on with above shoulder movement. I know most of us are still making the slow painfull gains, where every centimetre is a triumph, but I keep racking up the triumphs bit by bit.
    I hope everyone gets as much fun out of finding a hidden centimetre here and there. Little things I guess.. haha

    My main concern, above head weights for strength. Chin ups and how the shoulder holds up with straight arm lifts ie deadlifts.

    Although these are gym terms, they have very important applications to everyday life, more importantly sport 🙂

    Amal this is a great thread. Any extra bit of info that can help people recover is a good thing.

  30. John Ryker says:

    Wow, thanks for all your feed-back and encouragement. Dan, I’m in the USA (Oklahoma)..

    To everyone participating in this conversation string, for the past 6 weeks I’ve been looking doing research on AC Joint Injuries, there is allot of information about the injury and all the information is like copied from site to site. This is the first string of conversation I found with real people and real experience of going through the process.

    Thanks everyone for sharing, I will post my experience through the recovery. I will also be glad to email, chat, or talk to anyone who curious as I’m sure there will be more people facing our same injury and dilemma.

    Thanks for sharing,,

    John Ryker
    jshryker58@yahoo.com

  31. Amal says:

    Hi Snappa,

    With regard to the “hidden centimeter” comment, I was able to get back to full range of motion somewhere between 3-6 months, but did not have much overhead strength until 9-12 months. Now at over a year I can do straight arm lifts and deadlifts no problem. I’ve moved from overhead lifting 35lb weights to lifting 50lb weights up over my head with both arms and not noticing a difference. The only thing I do notice is endurance… I usually have to quit lifting on my left side not because my arm muscles are exhausted, but because I can start feeling my back muscles on my left side begin to waiver, and I don’t want to pull anything back there so I step down to 20lb weights to round out my set.

  32. Darlene says:

    Hi guys

    On a encouraging note the first couple of weeks the “hidden centimetres” of movement are so exciting and good for moral. Also being able to lift something more than a cup of tea is exciting also. I would have to say though that once your over about the 2nd to 3rd week mark the range of movement returning is considerably more so you will be excited by probably “hidden 10cm” rather than 1 or 2. Also being able to use a knife and cut something was a big thing for me i did my right shoulder and im right handed so being able to cut a steak etc was almost party time for me.

    I get a bit down sometimes thinking im not getting any better for a week then all of a sudden i wake up the next day and its like i’ve suddenly made a remarkable recovery overnight.

    Just curious is it shoulder pain or pain in the upper arm and forearm that everyone struggles with the most. Mine is mostly the upper and forearm. To start with a few weeks ago it was like severe cramp in my upper arm and constant ache in forearm. Now its like ive worked out to much and all the muscles just ache. My shoulder is basically pain free, it just tingles if its touched or your clothes move over it.

    Vicky have ortho surgeon appointment on 23rd July expecting him to clear me so back to work after that hopefully.

    Darlene

  33. vickyb says:

    Hi Guys

    Could you tell me how long each of you has been told they must stay in the sling, it seems some people are out of it much sooner than others. My surgeon has advised me I must stay in the sling for 6 weeks and it is the full Lancaster sling with the strap that goes round the waist as well as over the shoulder. I have been told I am not to do any lateral movement of my arm at all and all I am allowed to do is lean forward and do pendulum swings.

    I have been taking my sling off at home as like Darlene I get terrible cramping mainly in my upper arm but some in my forearm and quite a lot of neck pain on the side of the injury which I know Dan and Snappa have experienced.

    I am desperate to use the arm and shoulder more but do not want to cause any damage.

    Take care

    Vicky x

  34. Dan says:

    Hey vicky,

    Same as you…the sling with the wrap around the waist and 6 weeks give or take.

    Have you heard anything about when physio can start?

  35. vickyb says:

    Hi Dan

    I may have jumped the gun a bit re physio as patience is not one of my strong points and booked an initial session straight after seeing my surgeon on the 17th August, I am hoping everything will be ok and I can get going on some exercises straight away! It will have been 6 weeks and 2 days since my op on the 17th August, not that I am counting!!
    If the surgeon says no then I can cancel the physio session as it is at the same hospital.

    Have you been given any information on when you can start?

    Take care

    Vic x

  36. Snappa says:

    Depends on the corrective surgery for time in the sling guys.

    If you have hardware put in to hold ligaments in place, or synthetic ligaments, or just your own tissue scarring up your body will need the time to heal.

    Did you noticed when you first did the injury you shoulder drooping on that side? Well you body is now healing to hold the whole weight of your arm up again. I had know idea the clavicle and AC was so important. 🙂

    In my own case I have a plate screwed in which holds my shoulder up until my own tissues heal. If in doubt I strongly suggest talking to you surgeon. My surgeon said it was alright for when at home on sick leave to take the arm out of the sling and do some specific range of movement stuff. But my arm is held up by the plate so I am not sure how it would go for the other procedures.

    I understand your frustration Vicky and Dan, I am itching to do more but don’t want to hinder the healing. As a result I brought my specialist appointment forward two weeks, I really want to get this rehab ball rolling

  37. John Ryker says:

    Hi Guys,

    It’s 5am here in Tulsa,, I’m on my way to the Hospital to get my shoulder repaired.. I’ll bring an update soon as I’m able..

    John Ryker
    jshryker58@yahoo.com

  38. Dan says:

    Hey JR, hope it went well!

    Just had my 2 week follow-up. Staples were removed, and more x-rays taken. Doc says everything’s looking very good. Says the surgery went well, they didn’t even need to shave off the end of the clavicle in my case. As well as the screw, they sutured up the ligaments which will be supported by the scar tissue as it forms. Incision is healing very nicely.

    As far as movement & physio…said I should keep the sling on for another month. Suggested that once or twice a day, I remove sling & bend the arm at the elbow, I think he said several times, maybe 10. I’m going to get one of those squeeze balls for my hand as well.

    He said that next month I’ll get a follow-up, and at that point they’ll see if I can lose the sling & start physio.

  39. John Ryker says:

    Thanks Dan.. My Doc said things went well. My follow is on the 26th. I’ve been rotating the arm moving chair with my cold therapy.. However the cold doesn’t seem to be penetrating the bandage.. I’ll take the bandage off tomorrow. Pain is better today,, and I started lengthening the time between pain meds.. Less pain meds makes me feel a little better,, maybe my appetite will come back a little.

    All-in-all at least I’ve done all I can do for now to fix my shoulder.

    Still hurts to type.. so further updates later

    John Ryker
    jshryker58@yahoo.com

  40. John Ryker says:

    Hey,, while I’m using “the chair” I’m starting to feel vibrations,, not pain at the top of my elevation range. Is this normal,, or should I back-off to where there is no vibration? anyone experience this?

    And I don’t expereince pain using the chair,, but afterwards I’m ready for some ice.

    John Ryker
    jshryker58@yahoo.com

  41. Dan says:

    What is “the chair”?

  42. Snappa says:

    Hey John. Nice to hear you going alright. The cold might not feel like it is going through due to numbness. Keen to hear the type of procedure you had, and, like Dan what is the chair?
    Remember mate it is the first week, enjoy the rest as best you can

  43. john ryker says:

    The doctor had a rehab chair sent to the house ($70 out of pocket cost to me). The chair supports my arm and moves it back and forth,, then up and down. The activity is totally passive on my part. I started at rotation 35 degrees and elevation at 40 degrees.. I’m supposed to increase by 5 or 10 degrees each day. There is no pain during the activity of the machine, but when I’m done the shoulder is swollen, tight and sore. I’m it the chair for 3 x 2 hour sets (yes 6 hours a day)..

    I thought that was a standard treatment.

    My follow-up is not until Monday the 26th, can’t wait to get the details of the surgery.

    Right now,, my biggest problem is tightness. IF anyone else has had experience with the rehab chair,, please let me know how fast you increased the settings.. It’s hard to gage since you don’t feel pain or fatigue until your done with a session.

    Disclaimer: all spelling and gramatical errors and cohesiveness are completely related to pain medication 🙂

    John Ryker
    jshryker58@yahoo.com

  44. Dan says:

    Well for myself & the surgery I got, I’m not supposed to raise my arm at all. I have read about some doctors who get their patients to start raising their arms the day after surgery…and come to think of it, that was with the modified Weaver-Dunn as well.

    I know that post-injury – but before I got the surgery – as my arm got better, I started trying to get back to my workouts. Often the pain wouldn’t come until AFTER the workout, and I think I went too far and set myself back further. So, while I would certainly follow your doctor’s directions, I’d also be very cautious and try not to push things too quickly. Sounds like an interesting physio device though, and I’m somewhat envious that you get to start some kind of physio so quickly. Let us know how it goes.

  45. Katie says:

    Hi all.

    I have a grade V ac injury after falling from my horse 16 months ago – conservatively treated until now due to being 9 weeks pregnant at the time of the injury.
    I have seen 3 consultants… the first (trauma clinic) diagnosed a minor grade 3, ignorant of my complaints of pain 9 weeks on he referred me onto an upper limb specialist who diagnosed grade 5 & after extensive xrays and scanning they also diagnosed a small piece of bone in the soft tissue – they booked me in for the modified weaver-dunn procedure but I had to cancel as my baby was only 10 weeks old at the time and I couldnt bare to leave her.
    And so to today… Ive just seen my third specialist, Ive a severe grade 5 with a large displacement & a huge amount of muscle scarring (was torn) & wastage both in my arm and my shoulder blade/back.
    He’s requested another scan and I had more xrays today, he said the MWD procedure wouldnt be effective due to the muscle wastage so I have to wait for the scan to find out what could be done.

    I have pain pretty much all of the time, I have an 8 month baby who I just about manage with but as she gets heavier the more I struggle, the prospect of being strapped up again (after wearing the sling for 9 weeks after the initial accident) is concerning me but Im also realistic that I need to get my ability back.
    Ive not ridden since, I *manage* with my 3 horses at home but only the basic things and some days are a real struggle, I cant cycle and even pushing the pram down the lane (bumpy!) is hard.

    Its great to find people who are actually going thru it rather than just copy/pasted stories which seem to be the same on every website Ive looked at!

    Wishing you all a fast & sucessful recovery & I hope to update in a couple of weeks with whether surgery will be an option.
    🙂

  46. John Ryker says:

    I had my Post-op with the doctor yesterday,, here’s my Q&A —

    1. Did you find the amount of damage we expected to find?
    Answer: Oh yes, the damage was extensive as the pre-op examination determined.

    2. Did you follow the procedure we discussed? Or did you make changes based on what you found?
    Answer: We followed a new procedure, which still involved the resection arthroplasty (removal of the end of the clavicle) BUT they did not end up sacrificing half of the coracoacromial ligament (the one in front of the clavicle and shoulder). This procedure involved drilling a hole in the clavicle and the coracoid and using a washer on top and bottom of the holes and suturing the clavicle back into place. Then cleaning up the existing ligament and sewing them back together to heal with scare tissue.

    3. Things I’m experiencing, and are these items normal:
    • I still have some numbness on the top of my shoulder.
    Answer: This numbness may not every go way.
    • After using the therapy chair, my shoulder is swollen or puffy, heavy, and a little painful, But it only take a few minutes of cold therapy to reduce.
    Answer: This is normal, and the doctor seemed very happy that the pain level was low.
    • Current level of Pain-Meds are: 1 – 10mg around 9pm, 1- 5mg (or ½ of 10) before noon, and maybe another 5mg in the afternoon depending on the time of day and level of pain.
    Answer: When able, keep backing the pain meds off (So far today I have not used Pain Meds)

    4. What are the next steps?
    Answer: He will set me up with a PT and start next week. This week I can start range of motion, light stretching and walking my fingers up the wall.

    5. When will I get a timeline on goals and activity?
    Answer: This will be determined as I go, Right now no running for 6 more weeks. Only Cardio he suggested was stationary bike. AND I can start driving to and from work only for now.

    Thats all for now,,

    John Ryker
    jshryker58@yahoo.com

  47. Dan says:

    Hey John, that’s very interesting – glad to hear things are progressing so well.

    You’re officially allowed to drive already? Are you still in a sling?

    My doctor told my work I’m not supposed to drive yet – I guess until I can lose the sling.

    Again, I’m envious that you have already statred p.t. I can’t wait to get going. I can actually see my arm getting smaller, it’s freaky. I’m dying to get back to regular work outs. Right now I use the stationary bike, sit ups, squats, and I’m even kicking the heavy bag. Just have to be careful not to jolt the shoulder.

  48. John Ryker says:

    Dan,,

    Yes, I’m still in a sling, but the doctor has given permission to let my arm out for small amounts of time each day. He really only released me to drive to and from work, anywhere else he prefers I use my wife or one of the kids as a driver (not sure that’s any safer 🙂 )

    I’m a little surprised at the start of PT myself. I’m worried the numbness around the incision might be masking some of the pain, but I’m willing to go forward and see what they have in mind.

    Using the heavy bag is a good idea.. I might get my kids to hang my bag up for a few kicks myself. Not sure I’d risk using any of my upper body though, you’re right the jolt could cause damage.

    I can tell already in my chest and shoulders that I’m getting smaller.. It’s been 8 weeks since my injury and I’ve lost 8 lbs.

    I know recovery is going to be a long road, But at least now things are in place and I’m on the recovery road.

    John Ryker
    jshryker58@yahoo.com

  49. Snappa says:

    Out of the sling :), stretching away with range of movement stuff.
    Shoulder is still weak as buggery but I have another post op appointment with the surgeon on Tuesday. Look forward to a more defined rehab program which he said will start after the 6 week period.

    Like John said I have lost all muscle on my shoulder, neck and pec on that side too.

  50. Dan says:

    Hey guys, had a follow-up with the surgeon last Friday. Said everything’s looking good and I can lose the sling.

    Today I went for my 1st physio therapy (am now at 6th week post surgery). Luckily I got referred to someone who seems very experienced and knowledgeable. She did some shiatsu style stuff – pressing down firmly on certain muscles in my back & shoulder to loosen them up. Then she gave me some strengthening exercises to do – using a rubber tube to work biceps, triceps, and lateral movements. The idea she said is to get the back & area around the shoulder to start providing the support the shoulder needs. There is definitely a loss of muscle mass on my injured side.

    Anyway I’m thrilled to have something to actually work on for my shoulder instead of just letting it waste away in the sling. Now it’s a long haul to get myself back to normal. It’ll be several months before the screw is removed, maybe even 6 to 9 months. Realistically I’m looking at a year post-op before I’m working out as I was pre-injury…who knows, maybe even longer…doctor said it could even be as much as 18 months for some people. So…just one day at a time!

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