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
Good deal Dan!
I’m now 4 weeks post-op, I’ve been to my second PT and my guy was very passive in the treatment. My treatment is mainly to start me moving the arm, not really using it..
After four weeks now, some things are already a little better, like I can reach my shoes to tie them, and eat with my right hand again.
I’m hearing the same 1 year to 18 months before I’m back to pre-injury activity, that will be difficult.. I’m hoping to be released to run in a month, and that my shoulder will be able to take the jarring.
John Ryker
jshryker58@yahoo.com
Hi Guys
I have finally ditched the sling too, my surgeon took one look at it yesterday, told me I had wrecked it and threw it in the bin! I am so happy to have my arm back even if it isn’t quite functioning as it should yet.
I am now clear to start physio, I already have pretty good range of movement as I did push my sling to it outer limits of stretch! But I kept it on though. But not a great deal of strength.
I am getting back on my horse this weekend and will be attempting not to fall off again at least not for a few weeks anyway!
Hope the PT is going well for you guys and we can now all look forward to a return to pre accident fitness
Take care
Vic xx
Glad to hear you guys are progressing.
I’ve had a couple more physio appointments…going twice a week for now. One thing they had me do is to hold my arm out straight in front of me and see how high I can raise it. Damn, it feels so incredibly weak once I get to shoulder level, and can barely get it higher than that. Then I try the same movement except lying on my back, and holding my injured arm’s wrist with my good hand for support. That way I can get it to go a lot further. I have to do that 2 x / day. It’s freaky how limited my arm is now, but I know it’ll just get better and better. Sometimes I feel nothing in my shoulder; sometimes I have a constant low level pain / discomfort. Particularly in bed when I turn from my back on to my strong side, I have a sudden pain in the injured shoulder. You guys get that at all? In the morning as well when I get out of bed, there’s a strong discomfort that lasts for about 5 minutes.
I’ve actually been on the bicycle for some short neighbourhood rides…it’s great to be able to take my little one in her trailer hooked behind me to the playground…while I’m not geting the workout intensity I crave, at least I can still do stuff with my kids!
Vicky, be careful on the horse! It would be brutal to wreck all the surgical work & start over again! BUT…I have to admit, I’m looking forward to getting back on the motorcycle soon…I HAVE to at least get some fall riding in!
Hi Dan
I am trying to be infinitely sensible about my riding and not go galloping about jumping over stuff like before, so far my horse has behaved like an angel, long may it last!
i do suffer from discomfort in the morning same as you and sometimes when I am doing something that requires raising my arm repitively for example grooming my horses neck, I feel a ping in my shoulder and I get low level pain, almost like my shouklder is saying enough of that movement now give it a rest. It then aches for a few hours and then returns to no pain. I also feel like I have a metal band around my bicep sometimes especially first thing in the morning.
I am thrilled to be out of the sling but same as Dan saddened by how weak my arm is and impatient to be back to my pre acident self, I know it will take time but it is definitely improving day by day.
Right back at ya Dan, go out and have fun on your bike but be careful, I don’t know about you but the thought of going through it all again is too much to take right now!
Take care
Vic xxx
Vicky,
Sounds like your doing great, how many weeks are you post-op? I’m in my 5th week post-op, I have good range of motion, and still very definitely feel the pains at the outer limits of my shoulder range. Today, my PT guy started me on an 8lb dumbbell, a 10lb tricep extension.
Is everyone happy with the way their shoulder looks post-op? Sometime when I look at my shoulder I think it is still bumped up, other times I look at it and think, wow compared to before it really looks good. Of course my muscle mass is down a little and Iām a long ways from being able to build, I got to heal first.
Just thought Iād ask..
John Ryker
jshryker58@yahoo.com
As far as appearances, my bump is completely gone and I love that fact.
HOWEVER, I still have the clavicle held down by the screw. The surgeon told me that once the screw is taken out, the clavicle may rise a little. It’ll still be better than the huge bump pre-surgery.
When I was trying to decide on getting surgery, everyone downplayed the appearance of the bump. But to be honest with you, it was really freaking me out. One of the benefits of the surgery for me was getting the clavicle back down where it belongs, and losing the bump.
I also was bothered by the bump, may bump even was casting it’s own shadow,, and that was part of my motivation for the surgery as well. Overall having the pieces back in place is what I wanted and I can already tell the shoulder is working a feeling more solid than befoer the surgery.
I have a before picture,,I’ll have to take an after picture to compare. And I expect to get size back in my shoulders once I can start lifting again. I believe that will help change the appearance.
John Ryker
jshryker58@yahoo.com
Well I got back on the motorcycle and took her out for a couple of hours – another milestone!
My range of motions is improving slowly. Strength seems to be improving as well, though even more slowly – I think thanks to the physio, which I’ve been sticking to every day. Seeing the therapist twice / week.
It’s nice to be able to return to some activities I couldn’t do before. That helps deal with the fact that it’s going to be a year or more before I’m 100%.
I went to my 8 week post opt today.. The Dr. was thrilled at my range of motion (ROM) and the way things look on my shoulder. Still he’s concerned with me getting too active, too soon. He thinks I’ll be back to about 90% by mid November, he cautioned that I was still in “healing” mode, and not to over-do-it. He released me to run 3 miles or less (which is really a warm-up), and to continue with therapy. He thought I could get back on my bicycle soon as I can lift my bikes saddle bags.
Therapy is going well; I have enough variety of light exercises that take about 45 min in the morning and 45 in the evening, with only a few repeats. Most everything is really high reps with resistant bands OR 8lbs dumbbells or less. I am seeing small improvements everyday. Hopefully I can make the same gains in the next 8 weeks.
John Ryker
jshryker58@yahoo.com
Hello all, I had the hook plate removed on Thursday just gone. The second op went great. There was hardly any pain what so ever compared to the first surgery, and my shoulder feels so great!!
I have no lump at this stage and I have almost full range of movement.
Now the slow bit of getting the strength back in the arm and shoulder. Over all I am very happy the procedure so far. It is a nice feeling compared to how it was before š
Snappa
Saw the surgeon last week. He’s pencilling me in for a November secondary surgery, to remove the screw from my collar bone. This is, as with Snappa’s procedure above, relatively minor compared to putting it in.
I’ve started running again – another milestone.
Have started doing some light exercises with dumbells. Things are moving slowly but surely.
hi there…well I am coming from this from a different point of view,…5 weeks ago I rolled over my handlebars of bicycle and separated my shoulder…grade 3…I also went to the surgeon and discussed my options and have decided to wait and see regarding the surgery…after reviewing the data it seemed that the outcome in those who chose surgery vs those who went with conservative treatment was about equal.. also there was the risk of infection, bleeding, arthritis and 2 surgeries one to put the screw in and the other to take it in about 3 months.yes the first few weeks were hard..my husband had to change me and put my hair up..but it is now five weeks and I have been back to running about 5km..sure there is a little pain with distance but I am encouraged…also my range of motion is improving daily and I am back to work( I am a doctor) and and can now wash my hair with both arms… I have to do daily range of motion exercises and band therapy but so far so good…we will see if how things progress and whether I will be able to swim again and be as active as before
Thanks Amal for hosting this great collection of experiences! Hello everyone. Glad I found this ongoing conversation! I read through about half of the stories (going back to January) It’s comforting to hear others have shared the same frustration I’ve had. One of things I really liked was the detail of some of the stories — that really helped . So for anyone new arriving with a fresh injury I’ll give my situation here — and if anyone has recovered satisfactorily without surgery for over a year or more it would be great to get your perspective.
I am 52 years old, healthy, and active outdoors — Daily mountain biking and road biking. weekly hiking, climbing, and yearly scuba diving, snowboarding My job is not manual labor intensive. On a local mountain bike trail where I’d been getting close for weeks to a daily round-trip of one hour (within seconds) and with the intent to beat this magical time barrier I was full out one day in mid July — an by now you know where this is going. On a tricky downhill, something went terribly wrong (where did that rock come from ?) and my left shoulder took the full force from the high speed endo crash. Really nasty lacerations/contusions. A friend of mine had to take me to the emergency room. However, unlike
most of the stories here- the emergency room diagnosis was “wow no broken bones thank goodness – but you’re really messed up — you’ll need to take it easy for a few weeks ” I didn’t have the classical bump from the clavicle. So with daily doses of oxycodone, ibuprofen and Neosporin I went about working through getting mobility and was soon back on my bike . But, taking it easy! My shoulder was very painful. I switched the road biking , because the jarring of the mountain trails was too much.
Unfortunately , two weeks later, in a 30 mph road bike left bank curve that I had made 100s times before my front tire suddenly lost traction and pressure and I went down hard and somewhere in that crash directly smashed my left shoulder. Now — amidst the road rash on my shoulder , was the classical bump. I had no idea what it was — but I knew it wasn’t right ! I walked my disabled bike home, cleaned up, and went to the emergency room where the x-rays revealed a grade 3 AC joint separation. Amazingly to me, with a bone pushing the skin out my shoulder, the emergency room surgeon could not say whether surgery was required or not! He said I needed to see an orthopedic surgeon to discuss options. They dressed my wounds and put me in a sling and gave me some pain medication.
I got an appointment with the best shoulder orthopedic surgeon in my city for that afternoon. He examined my wounds, took an additional lateral x-ray, articulated my arm a little bit, and confirmed the grade 3 separation. Amazingly, he started explaining to me how surgery was not indicated in this case.. He cited recent studies and “all the data points to no statistical benefit for surgery over conservative treatment.” “Unless you’re a heavy weight lifter for your job, like carrying cement bags every day, or professional athlete, requiring repetitive upper arm motion, the recommendation is conservative treatment” I really couldn’t believe it. Just like everyone has said before, it just doesn’t make any
logical sense. Something is broken. Something should be fixed. This is a surgeon. He can fix it. But he won’t! Very frustrating. Anyway, I went back several times to him to rehash out all the details to try to figure this stuff out. I felt like I was a “statistic”. The data was all about the last 20 or 30 years — about surgery techniques that were done over the last 20 or 30 years.. what about me? What about my situation? What about the surgery techniques that are available now? Which of my tendons were ripped? How badly are they ripped? It took a long time to get all this information out of the doctor. It was as if they knew full well I was going to be skeptical , but they really don’t have a process to
let you know up front that everything you’re about to hear doesn’t make any sense. Finally he said “look, you sound like you need a second opinion. I’m telling you, no one is going to operate on your shoulder.” One of the elements he said in my situation was that I very healthy after a few days already exhibited good range of motion and had a good pain tolerance.
His point was that with a high amount of physical therapy and subsequent activity I would return to “close to my pre-injury capability ” and get back “most all of my strength and mobility”. The frustrating part is that words like” close” and “most” are just relative terms. They’re not scientific. They can’t be measured and they can’t be argued or debated. It was all too vague for me. So I looked for another surgeon to get a second opinion. A prominent medical university here has a huge orthopedic fellowship and clinic and they repair injuries to professional football and baseball athletes. I had an examination with their top shoulder surgeon, 14 days after my injury. I had already been in physical therapy doing 2 sets of 20 reps extension, rowing and fly exercises with 3 lbs with icing. He and several of his assistants examined me, making me do resistance tests pressing both arms and hands together and pulling apart so he could measure my strength, had me do side and upper reaching motions palms up palms down, rotated my arm behind me and flexed me in various directions. His conclusion? “I’m not touching that shoulder” “you’re gonna be fine”. He could see the shock on my face. “I know you came in here expecting
me to say we need to operate on that- but no- the bone is sticking up yes – but if we go in there we’re going to make it worse than if you leave it as is and you work through it ” he cited ballplayers with the same injury that he’s given the same recommendation in they’re back out playing fine. he said let pain be my guide. Stick with the physical therapy and get back into my routine.
So now I’m 6 weeks post injury and I’ve dealt with all the issues described here like back pain, muscle spasms, some impingement sometimes, grizzly sounds, not confident motion, cant sleep on that side for long periods, etc. My clavicle is about 3/4 inch displacement and not movable when i press on it. But i have good range of motion, can close the door to my cars, carry 20 lbs things, get my arm in and out of t-shirts, wash my hair with both hands, and have returned to the gym and upped my arm PT routines to 5lbs. I can reach straight up with both arms– Still some clicking in certain movements and I’m not imagining i could do bench pressing weight or chin ups/pull ups any time soon. But I think I’m seeing good enough rate of improvement here at 6 weeks and a clear path forward with no surgery. I’m not happy with everything but I think I could live with it. But if I’m honest I read these successful surgery stories here and I’m jealous. And consider that sometime I may see if I could get repaired. I totally get that those who did get surgery are happy. I cant imagine anyone would be on this site complaining of serious malfunctions of their surgeries. Thanks for reading and if you are new hope this helps. I’d like to know if others who did not get surgery are very glad they did not. For all of us its just too early to tell anyway no matter what.
Oh- here’s the deal… 8-31-10 http://s1192.photobucket.com/albums/aa339/tiptopper/?action=view¤t=AC-Joint-Separation-grade3.jpg
Hi Dan
I suffered a grade 3 separation in college and I decided that I wouldn’t get surgery, it has now been around 12 months and my shoulder is as strong as it ever was if not stronger. There is a rather large bump on my shoulder it is especially noticeable if I reach forward or move in certain ways.
I did a Grade III seven weeks ago today. Advised by 3 different surgeons to go the conservative route (always like to get other opinions). Seems to be getting better. Was wondering what sensations others have in there shoulders. I have a ‘tight’ feeling in the front of my shoulder – has anyone had this and did it eventually go away? Also the joint clicks abit, especially in the morning. Will this eventually go away. I’ve been doing physio and daily strengthen exercises with bands and light weights. Seems to have gotten better in the last week. Also has anybody found an other good resources on the Net. Stay strong and positive.
Not sure what grade my separation is although reckon its somewhere between a II and a III.
did it 13 days ago whilst playing football, I also have the tight feeling as mentioned by Phil above although do have pretty good movement. The famous bump is also there although it seems to be more pronounced when I am pointing forward. Has anyone else noticed this ?.
My doc has mentioned surgery but said the conservative approach can be equally effective although a little slower with regard to recovery
“My doc has mentioned surgery but said the conservative approach can be equally effective although a little slower with regard to recovery” – Matt
Are you sure? Usually it’s the other war around…surgery requires a longer recovery period. That was part of the difficulty in me deciding on surgery (though I went for it anyway).
I thought that too until I realized he meant “full” recovery, meaning no pain, good strength, full range of motion, etc. This also depends on when you get the surgery… if you get it just after your injury, you will recover more quickly than letting it go on it’s own. He’s only 13 days in, so I’m sure the surgery will work a bit faster for him at this point than letting it go. Make sense?
Beats me…I just remember my surgeon saying that recovery is longer with surgery. Reading all the posts & stuff on the Internet, and what my physiotherapist tells me, I do get the impression that whether you get surgery or not, you’re looking at 12 to 18 months before you’re back to 100%. That time frame was given to me by the surgeon for recovery from surgery. Would you say it’s similar for those who don’t get surgery?
I’m only 4 months post surgery so I have quite a way to go. I still have to get the screw removed next month. My range of motion is coming back, though it still doesn’t compare to my uninjured arm. I can run & bicycle, and can now do at least 20 push-ups (still a far cry from what I could do pre-injury). At my current rate of progression, I can see it indeed taking a year before I’m back to pre-injury abilities.
Yeah, skipping surgery, I’d say it took me a good 12-14 months to get to what I consider “fully recovered”. My range of motion is as good as (if not better) than my uninjured arm (maybe the extra “slack” gives me better “stretch” – haha!) and the strength is very good.
The only difference I notice is that my whole back and shoulder area on the injured side get fatigued quicker than the other side, so repetitive tasks like loading trucks or lifting weights take their toll faster on that side, but if I actually had a stretching and workout focused on strengthening that side I think I’d be fine.
“The only difference I notice is that my whole back and shoulder area on the injured side get fatigued quicker than the other side….” -Amal
See, that’s exactly what I felt in the weeks that followed my injury…very acute fatigue in the shoulder blade area (injured arm side), to the point of pain. That’s the muscles compensating to provide the support that’s been lost. That was one of the main reasons that I went with the surgery…I figured that all that compensating would tire me out faster, and ultimately have some long term negative consequences. Such negative consequences are speculation on my part of course (supported by further speculation on some of the sites I found). But I’ll tell you – the same day I had the operation, that particular fatigue and soreness was gone, and I haven’t had it since.
On the flip side – as I’ve mentioned before – one of the guys at work had a grade 3 ac separation 11 years ago. He did NOT get surgery and he swears that he’s 100% with zero negative consequences (other than el bumpo). As I recall, he said that in general he was back to normal activities in 6 months, and 100% within a year.
Hmm, maybe after 11 years I’ll have a left side that can keep up with my right š
Thanks for the replies everyone, I am back at the hospital on Wednesday so I will see what the doc has to say.
Also can anyone confirm whether the left over bump is more pronounced when doing specific movements ?
Amal,
You were correct I was refering to complete recovery , thanks
I’m pretty certain that the screw in my collarbone broke. There is a very slight bump where the old huge bump used to be, which from what I understand does happen & is to be expected when the screw is removed anyway. Since the collar bone has not popped back up like it did following the injury, it would seem that the long term goal of the operation has worked – in that things appear to have remained connected even without the screw.
Anyway I go for my 2nd surgery tomorrow (Nov. 24th) to get the screw removed. They’ll do a stress test to make sure everything’s properly connected without the screw. I guess I’ll be back in a sling, but only for a short while. I’m just looking forward to getting all this surgical stuff over & done with once and for all.
Well in fact the screw did NOT break. It had simply loosened a bit which is normal. The hardware was removed and the stress test indicates that my ac joint is stable. So, success.
This time I was closed up with stitches instead of staples. I get them removed on Dec. 8th and then that’s it for medical procedures. I’ll stick with the physio for a while until I feel that I’ve gotten what I can from it.
So, I’m still glad that I went with the surgery. The real test will be next spring / summer, when I’ll know whether I’m back to 100 % or not. I feel that with my progress to date, I’ll get there.
my daughter got a 4th degree AC joint separation 8 months ago….sucker still hurts…she tried to live with it but just not working…scheduled for arthrex graft rope reduction and a cadaver ligament in 2 weeks….lm a wreck but the surgeon said its a when for surgery not an if…she has a long life in front of her..of course its her dominant arm and she plays volleyball…she made it through the season but was unable to do anything overhead…she did passing and digs…it was pain all the way…we could have lived with the hump but doc says the bone buttonholed into the trapezius….l wish we could live it…..
Yeah, 4th degree means surgery is the only way to fix it. I’m wondering though, did it start out as a grade IV or did a grade III get pushed into a grade IV?
that lm not sure about…it was pretty bad to start….he boyfriend (x-boyfriend) flipped the golf cart over they were in….she reached out to break the fall…so it was the pressure of the cart as well as her body…she was told 2nd degree…lm a nurse and l dont do orthopedics but l never believed that one for a second….but my daughter also recieved a concussion (she blacked out and was confussed)..her whole face was black and blue…a contussed ankle and a ripped ear lobe…so l doubt that would have been a good time for her to go into surgery anyways…so she did PT for months…and then started volleyball season…she was still in alot of pain so l took her for second opinion (all sports ortho guys) and that guy was confusing as well..but at least he ordered an MRI which should have been done right at the beginning…that said severe AC joint separation…didnt give the number…but l didnt like that doc too much either as he kept contradicting himself and gave little assurance of his own work…we were out of there…so first said..do anything you want to comfort..only a grade 2..second guy said NO SPORTS…covering his butt lm sure…and the 3rd we went to cause she was still complaining of pain (her back..her neck..the bone itself…her shoulder..and trust me big pain tolerance lve learned).. the little med students saw her first and did the exam…and he was like..oh we dont wanna rush right into surgery…there are other things…dont wanna rush to surgery…then the doc walks in…examines her shoulder…(they actually did a lateral xray that she couldnt do at the first visit)..he says..your pain is due to the bone protruding through the trapezius muscle…your a grade 4..your surgery is not for cosmetic reasons..and you do need surgery…this isnt elective this is functional…its not an if just a when….he was very matter of fact and basically the only one who was sure of what he was saying…he is a top ortho guy in santa monica and shoulders are his specialty….he has a shoulder institute and trains other docs from all across the country…he told her she could continue to play volleyball the damage was already done…he said the grade 4 showed up on the original x-ray…so l dont think she made it worse..although l cant imagine playing volleyball that way…her coach taped it up every game and practice as instructed by the PT guy…it was important for her to finish with her team for her senior year…and she did it….the bump is not a bump..its a huge hump…and honestly we would have lived with that if pain werent present….the second guy was gonna do a 7″ incison for just the cadaver ligament…this guy will do a 3″ incision and do rope and ligament…she asked him how he could do it smaller than the other guy…he said…cause l know how to do it and you dont deserve a 7″ scar ….you deserve your beautiful l7 year old shoulder back and lm gonna do all l can to do that for you….this was the first doc that even addressed that fact that she is a she and only l7…HELLO…girl here…not football player….so..thats where we are at….what l heard from that doc is that there arent other options…and there will be future issues later in life if not fixed…sucks…but lm hoping surgery will be good…she has been through alot…many people have no idea how bad this injury is and l even had a hard time just understanding it…
“DISASTER” and “PAIN” is the only way I can describe my surgery! A whole year of inactivity, being unproductive in my personal, social and finacial well being. After a whole year of being told everything was doing normal and in the end the surgen telling me my 5th degree seperation is as screwed up now as before the surgery. They used a new method where they have a disolvable screw so they don’t have to have a second surgery, my impression was the screw desolved to early.The Surgen said the procedure failed because I was noncomplient with post-op instructions to keep my arm in the sling (I didn’t sleep with my sling on at night). Sooo I guess I have no other coice, but to live with my 5th degree seperation. Any suggestions folks, I’m open.
What great information about grade III AC separations. I’m 63 and was riding my bike on a bike path, at a nearby lake. In order to keep motor cycles off the path, huge red posts are placed on the path upon entering or exiting. I missed the red posts by an inch or less, breaIking my fibula and tibia. Oh, and of course after flipping 5 feet over my bike, and breaking my leg, I landed on my shoulder. AFter the oncological orthopedic surgeon (she’s very well qualified) placed a rod from my knee to my ankle an a plate and unknown number of screws in the fibula, I am nearly 4 months out. From wheelchair, to walker, to crutches…I am finally weight bearing, with a brace. The brace keeps the pressure off the tibia and on the patella.
I was scheduled to have surgery on the 28th, for the AC separation, but I’ve chickened out and want more healing time for my leg. I’m now scheduled for surgery on March 3rd. My orthopedic surgeon that repaired my leg doesn’t do soulders, so I’ll be going to another surgeon. I live alone and don’t want to have my boyfriend taking care of all my needs after this surgery.
After reading all your comments I’m glad I’ve postponed my surgery. My leg should be healed by March and I’ll be more independent to have te AC separation surgery, with som,e certainty of success. I think the clavica sticking out is horrible It’s like I have a new friend sticking it’s head out in my business. One of my sisters even put hair, eyes, nose and mouth on the silly thing. Too funny. I don’t want her to stick around for the last third of my life. I won’ miss her.(Not my sister-the golf sized bump.)
“One of my sisters even put hair, eyes, nose and mouth on the silly thing.”
Haaaa haaaaaaaa haaaaaaaaaa! Now THAT’s funny!
Be forwarned though that even with surgery, the bump doesn’t necessarily go away completely. In my case the clavicle rose back up a little bit – nowhere near as much as before the surgery, but you can notice it (though not with my shirt on – before the surgey you could see the bump even when I wore a suit jacket). The most important thing for me was getting the clavicle re-attached to the scapula, though lowering that bump is a big bonus and was part of my motivation in getting the surgery.
Once they removed the screw from my clavicle, I regained what I believe to be 95% to 100% range of motion. Now I’m just working on regaining my strength.
we had to reschedule my daughters surgery…she got the flu and had a temp the day b4 and the day of…so lm glad it wasnt done at that time…she cried when it was cancelled..just so sick of living with this thing and the cold is making it worse…sleeping on it makes it ache the whole next morning..her friends have named it “simon” and she was so sick she missed her own ligament party the nite b4 surgery….on the preop the doc said that clavicle is totally wedged right through the trapezius like those chinese torture finger things we used to play with when we were kids…so when she moves it just yanks on the trap….cant imagine looking forward to surgery…but thats when you know you really need it…l’ll be back here after the 4th to say how it went…she is getting the arthrex graft rope with ac joint reduction..repair of the trap and a cadaver put in…this is one brave l7 year old girl…
daughter had the surgery yesterday…doc said the bone was so embedded in and right through the trapezius muscle it was hard to back it out of there…all the ligaments were completely shredded and he said there was a ton of scar tissue to remove..he also cleaned up the bursitis caused by the injury…the surgery took 2.5 hours…one hour after the surgery she said her back felt better already and like it was aligned again…she was definately a grade 4 and living with pain like that every day was not gonna be a solution….the doc was able to do the graft rope…and cadaver with a 2 inch incision…this guy is amazing…..we are now headed for a l2 week recovery…l’ll let you all know how it goes..Val
He guys I must say you guys made my decision pretty easy when consider yes or no to surgery with my grade 3 here in Australia.
I like most had a car on bike and came of worse for wear. I had the accident mid december 2010 and surgery the next week. I am 4 weeks post surgery and I am thinking i am either very lucky or i dont know what. I am reading 4 weeks post op and my story is vastly different 4 days post op I was out of a sling and riding on a wind trainer after 2 weeks not much pain and 4 weeks post op i went for a 5km run 2 days in a row. I am now worried I am doing too much but like you all it is making me crazy doing nothing. Has anyone been this active and did it still go ok, my surgeon said run if you like but it seems you guys have been told not till later on. Sleeping is the bigeest killer….
my daughter coming up on 8 weeks recovery…doc said all looks great!..wants her in the sling whenever she is in public till she hits l2 weeks….she still cant drive and dont know when thats gonna happen…said she will start PT at l2 weeks….she can take the arm out of the sling at home but he is concerned about people bumping into that arm at school…shes been doing pulley exercises since the first week…the scar is bigger than l thought….more like 4 inches instead of 2…still its almost meaningless compared to having that injury…still sleepiing upright and sleeps with the sling on….
HI
I am awaiting the ac graft rope operation. i am wondering does anybody know who does it in the US and if it is successful
Hi, was just searching for others suffering same injury as me… I did 4th degree AC separation 4 weeks ago today… No questions about surgery, it was done at 9am the next day – I had no choice. I am lucky enough to be living in Switzerland though where I have private health care and living in a ski resort where they are highly experienced in such things. I fell on the slope… last run of the day, on way to the train. THey took the x rays with 5kg weights in each hand – think that was the worst bit. I have a 35mm screw in shoulder and will be having it taken out 2-3 months after the op. Have been told I can’t lift my arm more than 70 degrees from my side and no repeptitve movements, The scar is about 10cm long but when I have the screw out the doc will do it in his surgery justa couple of stitches. Recovery gong ok, as well as can be expected. I still wear the sling out and about but not at home, except for sleeping, which I definitely have to d ounitl screw removed.
Hi all,
I am so glad I found this blog. Like Adam this has put my mind at ease about what to do about my grade 3 separation. My dominant arm is affected, and most of the active things I do involve overhand capabilities, so I have decided I want surgery. My question for you all is, what surgery did you recieve? The doctor around here only do a modified weaver-dunn, which still involves removing the end of the clavical. From what I’ve read, it seems there are several new techniques that actually work on attaching the original ligaments, and also may not need to be an open surgery.
Has anyone had one of these newer procedures done? How has it worked out, how did you decided on what you want to do?
I learned my lesson though… no more boarder-cross runs for this guy…
my daughter had AC joint reconstruction with allograft ..he drilled a hole in the clavicle and one under the shoulder bone…tied them together with a titanium wire and graft rope with buttons on top and bottom…he also used a cadaver ligament to rebuild all the shredded ligaments…in 4 to 6 months the rope/wire will break but the body will have made its own tissue within the graft rope..he said the weaver-dunn is old stuff already….l know its hard finding a good doc…it took us 6 months to find ours
I had a high speed crash in a cycle race 4 weeks ago, did a grade 3 separation. Within a few days I had 85% ROM, but still lots of pain.. made great progress with physio but things still felt ‘wrong’. Strapping helped a lot, but as soon as removed things felt wrong still. Forced my sports Doc to refer me to an Ortho shoulder specialist (all docs/physios were of the “no surgery for grade 3” stance). Specialist had another x-ray done and confirmed was a mild grade 4 – hence the feeling of ‘wrongness’. He said I may function just fine without surgery, but in all likelihood would need intervention at some stage. So I go in on 25/2 to have a AC tightrope procedure, and have the ligaments sutured together (hopefully). If not operated on within 6 week window, you have to use a graft ligament. I cant emphasize enough how important I believe it is to get the opinion of the person likely to do the operation -I guess being a grey area, most doctors cant be expected to be up to speed on every procedure for every body part. If the surgeon says X operation will/wont work, thats the opinion you need. Just like if a mechanic says he can/cant fix your car, you go with that..
Will keep posted on how it all goes, 6 weeks inactivity in a sling will be hard!
I had the hook and plate and am scheduled to have it out next week, 14 weeks I have lived iwth it for and am I glad it is getting removed. i am lucky my suregeon is a mate but the one thing he did say was if you have the surgery more than 3 weeks after the injury it is a LOT more complex as if it done properly it should involve synthetic grafts otherwise the likelehood of a full recovery is low. If I had my time again I would have the same surgery I have read and heard of too many rope an wire ops breaking bones due to the pressure it put on them. My advice go with the old school method here is the link to the website of my surgeon unfortunatley he is in Melbourne Good luck
http://www.theparkclinic.com.au/index.php/Richard-Dallalana/Shoulder/Acromioclavicular-Separation.html
So, I’m now 6 weeks since I hurt my shoulder, and I must say how impressed I’ve been with how much movement I already have. My range of motion is probably back to somewhere around 80%, with really only issues using my arm above shoulder level too much.
I have found a doctor a few hours away that performs a titanium rope surgery, but he wanted to wait to see if the collar bone would lower back on it’s own, as by the time I had seem him it had already lowered quite a bit. The big issue now is that he thinks I may have torn my Labrum when I fell, so I’m waiting on some test results from that. If that is the case, he’ll probably fix both things at the same time. If not, then I guess I don’t know what to do anymore… Guess we’ll wait and see. What’s another week at this point š
In January 2010, I fell on a frozen lake while running and sliding on it with some friends. I’m a healthy, active, young guy, and it hurt bad. Turned out it was a Grade III AC separation. First ortho said no surgery, no way, no how. Without even asking about my lifestyle, activities, job (I ran ropes course for crying out loud). I went to a second ortho and he said surgery immediately, right away. Turned out he was basically crook, and tried to sell me super expensive physical therapy, and later was busted for medicaid fraud! Third ortho, said he could do the surgery to correct it, but wasn’t trained in arthroscopic techniques, which by this point, from massive research I knew I wanted. So he referred me to a fourth ortho who he knew could do it arthroscopically.
Fourth ortho was terrific. Knowledgeable to the extreme, works on the college football team regularly. He could repair it if I wanted. I decided against it at the time.
A year later or so, lots of pain began again, after going away a few months after injury. Weird pain in my arm and back. I knew my clavicle just needed to be connected correctly again. It’s supposed to be connnected so it should be, in my book.
Had the surgery last week, just five days ago, and going back tomorrow for the first check up. He did the latest procedure, using the AC GraftRope with a cadaver tendon attached. Drilled the hole in the clavicle and acromion, thread the GraftRope through, pop the “button” under the acromion, and pull tight.
There was a lot of scar tissue so it took him longer than he thought. He’s expecting 100% recovery, but I’ll find out more tomorrrow on the plan. I’ll keep updating, and please all do the same!
Here’s my update, unfortunately not such good news. They found two tears in my rotator cuff cartilidge, and so now I have surgery scheduled for a few weeks from now, where they’re going to repair that as well as fix my AC joint separation arthroscopically. Unfortunately with both surgeries, it seems like the recovery time is somewhere around 3 months before I can even start serious PT, with a 6 to 12 month window before I can start contact sports/over hand activities.
Despite all the bad news, I’m just glad there’s finally a plan. Hope all are recovering well from their surgeries, and I will continue to update on how it goes in my neck of the world.
AJ, as long as that recovery time sounds, it’s owrth it in the end. I had my initial surgery at the end of June, and ever since I had my screw removed at the end of November, I’ve been going from about 85% to 97% recovered. In another month I’ll be at the 1 year mark since my initial injury. It’s been a long haul in some ways, but everything’s relative.
For those of you who are really into fitness and are worried about getting out of shape while you recover:
I found that 1) I was able to focus on certain specific exercises even while I couldn’t work my injured arm…squats and crunchies, and the stationary bike for example.
2) While your inured shoulder & arm will certainly atrophy, especially for those weeks that it’s in the sling, you actually regain that muscle very quickly once you can start working the arm again. (Starting with the physiotherapy – very important, stick with it.)
Before getting back into doing bench presses and shoulder presses, I started going to some power yoga classes. Don’t laugh, this is actually a challenging workout that makes you sweat and really works your core. Great way to start regaining strength and balance. Before I knew it, I was able to start pumping off the pushups and get back to lifting weights.
John B.H., I felt my shoulder was “back in place” as soon as I awoke from the surgery. All that back pain from my back muscles compensating to provide support was gone. So for me, the surgery and the recovery time was worth it in the end.
Dan, that was EXACTLY my experience! In the six to eight weeks or so before I decided to have surgery, I had started having very strange pain across my back (the injury at that point was a year old). Even pain down into the forearm of my injured shoulder. Painful tingling, just stopping me from doing anything. I’d hold my arm straight up to sort of relieve the pain, but even that had stopped working. In fact, it was all this pain that was the main reason for now getting surgery. And, just like yours, the previous pain points were gone immediately. Huge, immediate payoff from surgery…as well as the bump being gone. Of the four benefits I wanted…pain relief, cosmetic reduction, mobility, and strength…the first two were immediate.
Stength and mobiity I basically had before surgery, but obviously in the first few weeks after surgery, that goes back to nil. At my five-day check-up, my ortho said wear the sling now only in “uncontrolled environments”, like in public, and while sleeping. But, for example, at my desk at work, or while eating cereal at home in front of the TV (his example, haha), take it off. Do that, and keep the arm low, waist to shoulder high at most. Then come back in four weeks, which will be April 27th.
Well, I did the sling as instructed for all of two days. I don’t wear it all now, basically just considering all my environment as “controlled”. Only two weeks out from surgery, and sling is gone. I keep the arm low still. But it feels basically normal….just waiting for time to pass and get next set of exercises from my doctor. (I had to really ask for SOMETHING to do for these current few weeks. My doctor, who is extremely good, basically wanted me just to take it easy, wait. I think more for my peace of mind, he’s letting me do an any easy PT exercise daily until he sees me again on April 27th.)
At this point, my advice to anyone with Type III separation: have the surgical repair immediately, find an orthorpaedic surgeon who’s trained in arthroscopic technique for this repair, and make sure it’s the AC graftrope procedure (where the two holes are drilled, and the graft takes the exact place of the missing ligaments). Obviously, you’ll have to make your own decision, but my thought in this advice is that you’ll be recovering from the injury anyway, so why not recover with the shoulder in its correct place? And if you get surgery later, you’ll be thinking, “Man, why didn’t I do this immediately so I didn’t have to recover the same way twice?”
AJ, totally hang in there. My educated guess is that recovery times are exagerrated. Better to underpromise and overdeliver, the docs must think. Your experience individually will probably be much quicker. Either way, it will be a distant memory after your shoulder’s back to normal.
Thanks, all. I’ll be continuing to check in here!
my 17 year old daughter is 16 weeks post op from the graft-rope cadaver procedure…april 23rd is a year since the accident..so she did go through the recovery twice…hey..we didnt know it was a 4th degree separation…poor girl finished up a volleyball season like that..with the bone ripped through the trap…wasnt a very good season to say the least…however from her experience of trying to play and daily back and neck pain we knew it was more than the 2nd degree they claimed it was…i kinda knew it the day i saw it…but all it takes is a doc to say to an impressionable kid…oh you dont need surgery…and l had a fight on my hands for months….she wouldnt even discuss a surgical appointment…but in hind site…the timing was off anyways..i didnt know of a good surgeon and better to wait then to let a crappy one do the surgery…by the time we found just the right guy she was ready and wanting that surgery…8 months after the fact…so there was tons of scar tissue…but all went really well…she is thrilled to have had it done…we actually didnt have a choice..it was a functional issue..not cosmetic…we arent sure of the limitations at this time ..its still early…but she has been in PT for 5 weeks with one more to go…she can raise her arm over her head now..there is just some side movements that arent there yet…she wont be playing volleyball for a college this year..but in the scheme of a lifetime…whats a season of volleyball…so far things are progressing as they should be…this is not a quick fix injury….but well worth the fix
To Val: yes, definitely, definitely worth the fix! Unless she, I, and others on this blog are so unique, I would honestly tell anyone with Type III separation to make surgery the default option unless there’s a reason not to have it, which there certainly could be.
Yes, you were both absolutely correct to find THE right surgeon for the job. I went to four, and until I found the specialist in arthroscopic shoulder repair, I was going to wait. So glad I did, as my doctor is terrific. For example, in debriefing me about the surgery, he told me that in 37 minutes into the surgery, the graft was inserted, the bottom “button” was half way through the hole, and every thing was going smoothly, and just a few minutes more to finish. Then, the button got stuck half way through the hole! So, he spent the next two hours working on getting the button through correctly and smoothly, and not forcing it through, which could have resulted in the bone (the acromion) breaking or being fractured. A lesser surgeon would have just tried to force the button though, to get it finished. So glad I had Dr Cox. It went from a forty minute procedure to a a two-hour and forty minute procedure. (Of course to me the patient, it seemed instantaneous.)
No doubt your daughter will make 100% recovery. These last side movements may take a little longer to get to that 100% from the 95%. Strange how at Type IV was confused with a Type II. Type IV as I understand is pretty rare, usually from a car wreck or something similiar.
Update back when you can.
Hi,
I had a Type III. It has been almost 3 mo. now. I have full range of motion but not strength. For whatever reason, I had no pain during the healing process or the injury. I think shock, then meds, and then I healed fast left no time. My doc said the ligament would heal on its own. Was this a lie? I’m 33 and have been playing sports all my life and don’t intend to quit. I felt like I was just getting into my prime. I’m patient so I dealt with the stupid sling, the figure 8 brace, and the unprofessional wait times at the doctor’s office. (why are they exempt from being on time?) My major hang up is this big retarded bump on my shoulder. I understand why it’s there, but really? You’re telling me there is no way to make this little bone go down? We have put a man on the moon, knocked down the Berlin Wall, and made 7 Batman movies, but we can’t push a little bone down without old school barbaric surgery? Didn’t we invent the laser because it made everything better from DVDs to corrective vision? Why don’t we have some futuristic fix for this? I got hurt in a football tackle in 2011; I didn’t fall from a Roman chariot. Just as they did then, they do now. Here is your sling, now rest, completely ridiculous. If anyone knows how to naturally reduce this bump, please let me know. I offered suggestions to my doc and he shot them all down, but had tried none of them once. Who knows a ligament guru?