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
yes…your right..its pretty rare….her boyfriend was horsing around and flipped her over in a golf cart on the street…she also hit her head and got a bad concussion…contussed her ankle and ripped the shoulder off the bone…the bone was ripped right through the trapezius muscle…but the docs we saw just didnt catch it….maybe cause they didnt do an MRI for 6 months…the world is full of em folks…but thank God there are some good docs out there too….turns out she has a shorter clavical bone than most people and l guess when they looked at it…they just thought it was a 2…they were probably thinking a 4 was so rare also…too bad they didnt do more thinking than that…when she had the surgery it took the doc over an hour just to pull the bone back out of the trapezius…some of the muscle tissue was dead cause it had been in there for 8 months…he stitched it back up pretty good…the surgery took 3 hours…l dont know how she walked around like that for all that time…the doc doesnt either…lm guessing..a very high tolerance to pain…yesterday was one year since the accident…a year later and she is still in PT…still recovering…again…thank God for good docs!
Hello everybody
I’m glad to find some people relating their acromio experiences, I injured myself 10 days ago on a skiing holiday type III seperation. Most of the research I’ve read on the condition reveals that it’s a fifty fifty for surgery vs conservative. On the day of the accident my shoulder was a freak show I had a two cm bump and the pain was atrocious. but recovery so far without surgery seems quite rapid and thanks to the sling and straps the bump is only 1cm or invisible depending on the position. I can drive my car but surprisingly tying my shoelaces is agony I don’t feel as if I’ve lost a lot of strength but when I move the arm I am very caucious to avoid pain. I’ve got major exams in may and june and although my shoulder is important to me finishing this academic year is as well. I’m off to see the orthopedic surgeon on tuesday I’ll keep you updated
Hey all you Bruisers,
Look, I’ve also done my AC joint back in Dec 2010, have a 2 to 3cm lump on Left “Non Dominant Side”, diagnosed Grade V separation. But actually now hardly feel it, obviously is weaker but pains generally gone, except at times if sleeping on side, but not really sure if is pain or more just a awareness, not quite right or if it is just in my own head ! Memory recall of the early couple of weeks when pain could be quite intense if I bumped etc I guess? Anyway I am also tossing up on having the surgery, actually think Iam committed to the surgery only issue is What PROCEEDURE do I have ?
I have been recommended, Modified Weaver Dunne, using “SURGILIG” which is a Synthetic ligament (Braided Polyester) has a loop each end, they wrap it round the Coracoid , thread one loop through the other loop and pull to tighten around Coracoid. They have a pre drilling hole in Clavicle and wrap the other Loop end of the “SURGILIG” round the Clavicle, secure it by fixing a a screw through the “SURGILIG” Loop into pre drilled Clavicle hole. Note during operation they excise 1cm of Clavicle and detach the Armorion end of “Coracoaromial Ligament” to transfer the CA Ligament and is sutured to the Lateral end of the Clavicle.
Hay Geno,
From everything I’ve read, anything above a grade III ac separation definitely requires surgery…with a grade V, there isn’t much decision making.
As for the type of surgery, I can’t help you there…I didn’t have any choice, I went with what the surgeon said, and he only uses one method. On this site, it seems I’m one of the only people to have had a temporary screw placed through my clavicle connecting it to the coracoid process portion of the scapula. I’m in Canada and I think the other person was in Australia. Maybe in the U.S. they prefer Weaver-Dunn & modifications thereof.
Yeah Dan me mate,
Thanks for the reply, thing I will bit the bullet a go for it while my Health Cover , will pay for it.
Just intersted if any one else had it done using the “SURGILIG”
Hey guys.. I had 3rd grade separation last year while snowboarding. pain went away after a month or so (worst pain in my life), but bump is still there. even tho it bothers me a lot having that bump and not be able to do pull ups or pushups, I keep playing sports such as soccer (all the time), lately i started takin tennis lessons.
The only thing makes me consider surgery that every time i run i can hear the sound of my joint, and its kinda loud and it freaks me out a little that after few years there might be consequences..
theres no pain, unless u lay on that side for a long time. but theres definitely no gym of lifting , so i feel limited. and 50 50 on surgery doesnt give any confidence..
wish u all good luck and fast recovery.
Get mine done , this week, Yeah i dont have any Real Pain, only notice, sleeping on that side. I have Grade 5 seperation, Pity as is good Party tick, really freaks people out when i show them , its like my shoulder is tripple jointered, Actually think Iam goining to miss the attention! from old mate on Shoulder, may have to have a wake for him when hes gone?
Just checking back in. I’m a little more than 4 weeks post op, and am generally pain-free, just really sore (first few days out of the sling). It hurts less now than it did before surgery, but at this point I can’t move my shoulder really much at all, but I’ve started some range of motion stuff and it’s getting a little better everyday.
I had surgery for my AC separation (graft rope) and arthroscopic rotator cuff repair with bicep tendonesis (tore my cartilage almost all the way around the join!), so my results might be a bit different than others here. That first week post-op was the most painful couple of days I’ve ever had, but after the first week, the pain went away pretty quickly, and while I’m pretty sore right now, I’m pretty confident that in the next week or two my arm should be doing pretty good. I have a long way to go (I literally can’t move my arm in any direction more than a few inches when I’m standing), but a month out I’m happy with my choice.
My only advice to those out there is look around for doctors. The first 3 doctors I saw looked at me and said I’d be fine. The last guy is the only one who looked at my whole shoulder. Maybe in a few months the other doctors would have caught it, but I’m glad I didn’t wait to find out.
Near 3 month update:
I missed my scheduled surgrey for AC Tightrope, due to the earthquake in Christchurch where I live… was due for op 2 days after quake. I got booked back in a couple weeks later, but had to hav ea gratrope done as was past the ‘repair window’ for existing ligaments to heal if reattached. I had a hamstring tendon harvested (same one they use in ACL recon), as my surgeon said this will have the best healing properties.
As a cyclist I was pretty aprehensive about this, but I couldnt compete with a broken shoulder either way!
Surgery went well, and I had no complications. I even managed to walk out of hospital the day after!
6 weeks 24/7 in the sling, and nearly finished the 6 weeks of passive movement.
Observations – atrophy was much more than I thought, especially being my dominant side which was bigger to start with. sleeping was fine, as long as i wedged myself between pillows so couldnt roll. Now have about 90 ROM in front and to the side, less with arm behind back. Long way to go still to regain strength and confidence, but I feel positive itll come.
Slight bump where collarbone is, about even with other side now (was completely flat post surgery!) I have been told the collarbone needs to move to function, so hopefully its all normal.
Id definitely reccomend the graftrope, its the only surgery that correctly recontructs the original anatomical function of the joint.
Hello, reading these accounts has been useful and informative for me so I will add mine. I had a grade III separation 6 weeks ago in a mt bike accident… I only have fragmented memory of the actual crash.. basically a full body slam to the ground. I’m a 55 year old male in pretty good physical condition- was biking 5 days a week, lifting, cardio, etc.
Emergency room x-ray confirmed grade III separation. Got a recommendation for an ortho surgeon who I saw the next day. He suggested surgery was preferred option based on the x-ray.. specifically “tight-rope” procedure. I made an appointment for surgery but after doing some research decided to get a second opinion. I saw a shoulder specialist who suggested a “wait and see” period so that’s where it stands now.
I’ve regained pretty good ROM and have started doing some cardio workouts (carefully!) which feels good physically and psychologically. A little bit of resistance work. Pain comes and goes- taking Ibuprofen daily. Bump is annoying but I’m glad it wasn’t worse! I don’t relish the idea of surgery and a long recovery.. still undecided.
On a side note: I was experiencing some dizziness (vertigo) after my accident. I thought it was a side effect of pain meds but after I stopped taking pain pills the vertigo remained. I learned of something called “benign paroxysmal positional vertigo (BPPV)” which can happen from an accident of this type. It involves the inner ear. I was able to fix the problem on my own using exercises I found on the web (you tube).
Thank you all for your stories.. Joe
Feel like I should try to keep this going with a 3.5 months update. It probably took almost until the end of the second month when I was finally no longer “tilted” with my arm out of the sling. it was extremely evident at first, but got better quickly. I recently had my 3 month checkup, and things appear to be going well. I’ve been starting my lifting (no PT, my doctor preferred to let me just do it at home). I’m currently doing arm raises on my back until I can do 30 reps of 10-15 pounds, then I can start doing them while vertical. I’ve also been trying to do back rows to strengthen my back, and have been also working on my arms a little bit.
It’s been about 3.5 months, and I can do just about any normal activity. Some days it’s still tough to reach across my body, but mostly that’s good now. It’s still not super comfortable to sleep, but it’s gotten significantly better.
My biggest challenge now is holding back. I have this tendency to start doing everything right away, which has always been a terrible idea. I go back in a couple of months for my 6 month check-up, and then I can start focusing on overhand activities again.
Overall, extremely happy with my surgery to this point. I’m mostly pain free now unless I try to do something stupid, and even then it’s nothing compared to that first week post-op. If you read this, and you’re thinking about getting surgery, I would recommend it.
Hello all
I also did me a type III injury 4 weeks ago now. Fell off my bicycle to avoid getting hit by a car, broke left hand, right wrist and type I left shoulder, and type III right (dominant) shoulder.
Left shoulder (type I) only had about three days stiffness and has been 100% since then. Right shoulder (type III) has taken longer, I opted to go the non surgical route, and am geting used to the 1-2cm bump.
I too am a conservative believer in the miraculous power of the human body to heal itself, and anything non-biological put into a joint like a shoulder will limit range of movement.
Having a cast on wrist all this time has limited any physio to shoulder, but it comes off in a week (cant wait), and I will return to gym to start strengthening shoulder again. It has been stiff and uncomfortable but am already able to lift it over my head and do 90% range of motion with only limited pain/awareness of shoulder sensitivity.
I am glad doctor recommended non-operative recovery, as it is coming along well, and am sure I will be back to my active self in a few weeks. As he said, it comes down to psychology, in whether you need medical surgury to feel like it has been “fixed” to put your mind at ease. But there are no magic cures, and most surjuries will give complications later on in life, as they break down and will ahve to be replaced at least twice in a active persons life time.
Good luck to all new ACL type III members that join the club.
Hi David,
Re: “most surjuries will give complications later on in life, as they break down and will ahve to be replaced at least twice in a active persons life time.”
That must depend on the type of surgery. I had a screw inserted on a temporary basis (a few months). Once removed, there was no foreign body in my shoulder to break down, and I regained full range of motion.
I agree on the pyschological component. I definitely had a need to feel “fixed”. Having said that, I felt better as soon as I had the surgery. It’s been over a year now since my initial surgery, and just under a year since I had the screw removed. I feel great and have regained full strength.
Glad you’re comfortable going with the conservative treatment. There are definitely risks that come with any surgery, and if you’re cool going without it, that definitely makes sense not to go under the knife. The hardest thing for me was making the surgery or no surgey decision.
Hello Everyone,
Thank you very much for all this info, it is really helping my get through this week. I was in a mountain bike race Oct 1. I was about two miles from the finish line when all of a sudden I was on the ground, Splat! I couldn’t tell you what exactly happened except that I was tired and did not listen to my conscience to slow down. That was Saturday, On Monday I went to the Ortho and he told me, after a couple of X-rays with weights, that I had a 5th degree joint separation. Pretty bummed when I heard this because on race day the Docs told me it was a III degree. The Ortho however was pretty cool and told me that if it were him, that this happened to, he would wait and see what the body would do before I committed to surgery. He continued by mentioning that it would not make a difference whether I did the surgery now or in 5 yrs from now the degree would not get any worse. He also said that he wanted me out of the sling as quickly as I could bare it but no longer than 3 day from when he saw me. I took the sling off after that check up and have been moving my arm around little by little every day.
Geno, do you think you could have lived ok without the sugery?
J. Flutain= what is the You Tube Video that you are about. I did not hit my head but I feel slight Vertigo.
Hello All,
I had a type III separation of the left shoulder and also dislocated it over 10 years ago. The end result today is pain in the shoulder , loss of strength, and limited dexterity in that shoulder. I was told that surgery wouldn’t help and that it was experimental 10 years ago and insurance wouldn’t cover it. If it were possible I’d have the surgery today to at least attempt to fix it. I was also told it would be fine without surgery and that at my age of 46 that I wasn’t that active! Wrong! Now at 56 I’m still extremely active and have to do most things with the right shoulder. Anyone who says you don’t need the clavicle attached to the skapula should really consider the activity level of the patient!
Hey to everyone!
First thanks for your post they have been really helpfull. So here is my story and I would really appriciate your feedback. Nov 27 2010 fell from my bike on jump landed on my right shoulder resulting a grade III separation… Whet to the hospital got an MRI and as with most people was recommended to wait and see. With time I would say I healed regaining range of motion, yet not quite the strength I had. I struggle with push up or bench press. Due to the injury my activity level has decreased and can’t really compete at the level I used to pre injury… Whet back to the doctor after almost 1 year and he now says I must get the surgery. I am scheduled for an arthroscopic assisted weaver Dunn procedure next week. I would like for some one to realistically tell me what can I spect? Will I be at 100% with in reasonable recovery time? How severe is the pain? Should I consider taking some time off from work? I’m rather nervous and would really appreciate any input anyone can provide. Again thanks for your time !
Hello everyone. I too am experiencing some of the frustration due to AC Joint Separation done back on 4th of July. We are now 5-months, and weeks after the accident, full ROM, but anytime of eccentric aka negatives of resistance of arm out in front of me with pushing up or pushing down, major pain in the front shoulder area over where the 1.8cm bump is located.
I have been in and out of physical therapy, and I can do shoulder presses with 10lb weights, even a 35lb dumbell, but they have to be wide shouder presses, not close ones in the pocket.
Pushups suck because I run a military style fitness boot camp and demostrating is a NO NO. I can now do a serious of upper body exercises with minimal pain:
1. Lateral Dumbbell raises.
2. Tricep Pulldowns
3. Arm Curls
4. Face Pulls
5. Shoulder Shrugs
6. Bent Over Rows
7. Upright Rows
8. Inverted Rows (On straight bar like on playground(
9. Any type of theraband work
10. Alternating Shoulder Press
11. Kettlebell Swings
12. Kettlebell Snatch and Press
The exercises of pull-ups, pushups, front dumbbell raises over 5lb pounds are where I really feel week and pain is apparent big time.
On pushups, which is my main exercise for over 25yrs is really hurting my strength and my ego….it really sucks for a guy not to do pushups, especially in my past and current profession.
I have made strength gains, but this is from a guy who could snatch and press a 150lb tire up over my head and throw into my pickup truck….what a drag man.
On pushups, I have to do them angled on kitchen counter, on the steps at home, or a little on my knees.
Also, going from doing shoulder presses with 35lb weights in each hand, to only 10lb pounds, that hurts also just as much.
So, in closing, I think TIME is key and building up the supporting rotator cuff muscles, triceps, biceps, upper back of rhomboids, infraspinatus and supraspinatus tendons, and trap muscles is key to getting back to my future strength and minimizing reinjury.
The surgery, is postponed, doing PT of ultrasound w/heat, then ice and doing deep tissue or ART (Active Release Technique) and eccentric exercises of those aforementioned and sticking to it.
I am also entertaining the idea of PRP (Platlet Rich Plasma) injection into my shoulder to regenerate the tendon and ligaments that are torn in the shoulder or AC or CC Joint area.
If this doesn’t work, then looking at surgery in Dec 2012 or in 2013 as last resort.
I think PT, doing PRP, these are the two ways to go first….then last resort, shoulder surgery to repair torn ligaments in AC Joint.
Hope my dialogue helps others with what you might be thinking on what to do and what someone like me is going thru and can relate to all your frustrations.
Hi Everybody,
I read these pages (and countless others) religiously back in May 2011 after I came off my bike and suffered a grade III separation of my right AC Joint.
After initially getting x-rays at the hospital I was sent away with a sling and painkillers and told to see my GP who then promptly referred me to a Specialist here in Christchurch, New Zealand.
The Specialist recommended to me that I have the tightrope procedure. In my favour was that the surgery was to be booked in within 4 weeks of the injury so I would not have to use any part of my hamstrings as he could reattach some of the ligaments.
I definitely didn’t take the decision to have surgery lightly. I am a very active person who goes to the gym alot, plays golf every week, runs and plays a bit of squash and tennis. The thought of not being able to do any of this for an extended period of time was very off putting.
However, the surgeon noted that even though I could recover without the surgery he said to me that I would probably get arthritis in the joint in the future and I obviously would always have the bump.
The surgery was uneventful, although the pain in the couple of weeks afterwards was awful. However, I was now bump free! The post-surgery plan was ultra-conservative. Sling on for 6 full weeks only to be taken off for wrist and elbow movement exercises. Following the removal of the sling I faced a further 6 weeks of unweighted range of motion exercises.
The surgeons strict instructions were that no weight was to be lifted until I had full range of motion back. My sports physio and I became very frustrated with this approach, especially as I felt like I wanted to push things along a bit and the loss of muscle and tone in my upper body was really getting me down.
However, I stuck with the surgeons plan and after just over 12 weeks I was finally able to hit the gym and slowly start to rehab the shoulder with weights.
In the next 6 weeks or so I really saw some quite good gains and things really started to happen. I played my first round of golf after about 20 weeks and now over 6 months down the track I feel like the shoulder is about at about 98%. I am now back playing squash and tennis as well without any issues. My physio even commented that he was initially very sceptical about the conservative approach the surgeon wanted but on seeing my rapid progress after the initial 3 months of very little he now saw merit in it.
My range of motion is now brilliant, the golf swing is good, I am lifting at pre-accident levels at the gym and I have no pain in the shoulder. It only clicks on the odd occasion and gets a bit stiff after a nights sleep (especially if I sleep on my side).
Overall, I feel that I made a really good decision getting the surgery. However, I feel that the ultra conservative approach that my surgeon made me adopt has definitely contributed to my excellent recovery.
I hope my two cents here is useful to others. Whilst I know surgery isn’t for everyone (and the 6 weeks in a sling was horrible!), one of the key factors for me in getting it done was the fact that the joint was to be put back to the position where it should be and that I am minimising (hopefully) my chances of complications in the future with regards to artritis and joint problems (and I had the bonus of getting rid of the bump).
Hello again!
It’s been approximately 9 months since I had the tightrope surgery (in addition to my rotator cuff and bicep tendonesis procedures), and really at this point I think I’m close to 90-95% of where I was before my accident. My doctor also had a conservative approach, and I didn’t even start seeing a PT until after 6 months post-op. My range of motion is really good at this point, except I still get a pinch if I try reach too far across my body.
I’ve also been able to throw with decreasing discomfort every time (my rotator cuff is still kind of tight, but I was told that could take a while to feel “normal” again). Overall, things have gone pretty well since surgery, and I think, at least for me, it was the right decision.
My should does still occasionally get tight, and it’s still sore to contact where the incision was, plus there’s about an inch by inch square on my shoulder near the incision that is still numb if it’s touch, although I think this is starting to get a little better as well.
Good luck to all, and I hope you choose to do whatever you feel comfortable with to address these types of injuries. Just remember that if you don’t feel comfortable with one doctor, there are lots of others out there that might be better for you.
OK….l have been living with a AC Type 3 for along time..round about since 1992 of a simple softball accident in the military. Now its 2012,,, and my should still feels the same after my operation..of which I had two of them. To those who have had this or have it…no matter what you try to do to make yuor shoulder healthy again as before yoiur accident or how ever you broke it..it will never be the same. I have been living with this…much discomfort…mostly in the winter and depending on what type of work or sport you have mastered…it will not help to bring your shoulder back to 100%. I have tried many years…and if you like to know more of my experience knowing how to deal with it…..pls email me at kwyjii11@googlemail.com will glady give you advice on my experience on how to deal with and mostly ….TO ACCEPT IT:::::YOUR SHOULD WILL NEVER BE THE SAME AGAIN::IT TOOK ME YRS TO FACE IT MYSELF:::ACCEPTANCE
Hi – great thread and thanks to all (and the hoster) for keeping it going. There are so few places to find first hand info such as this.
A month ago I suffered a grade 3 separation after avoiding a car accident on my bike, plus some broken ribs. Broken ribs were quite painful, and shoulder separation was only noticed 2 weeks after crash. I’m now at a touch over 4 weeks.
Pain has lessened significantly and I have good ROM. Strength is not near where I was before crash. I am normally very active, cycling over 300ks a week, run 30k, swim,, rock climbing etc. I am determined to get as close as I can to full strength, as physical activity is important to me.
Anyway, original surgeon recommended conservative treatment, but provided very little info. Also implied that as I am an office worker it is less of a concern. I was underwhelmed by this experience and sought second opinion.
Second surgeon similarly recommended conservative approach, but was willing to hear my concerns. He stated that if the conservative approach did not get the result I wanted, it is much more difficult at that point (say 6 months down the track) to achieve the best results from surgery. Essentially, the sooner the better if I want to do it (contrary to original surgeon’s advise that time didnt matter, much like Amal’s experience).
Soo … I am still tossing it up, but leaning toward going ahead with it. I am concerned about the recovery period, but figure that short term pain is worth long term gain. I should add I am 34 years old and have other back issues, including arthritis and a herniated disc, so don’t welcome the idea of another chronic issue!
I wish my ortho had told me it would be more difficult for a surgery to be successful if I waited. Instead he said I could do the surgery at any time down the road, and I should wait AT LEAST 6 months to decide. What I can say is that my shoulder is now 100% fine… strength has even fully recovered with time (I don’t even exercise it). I still have a lack of endurance on that side, because the muscles have to work harder without supporting ligaments… but my day to day is not affected by that because I work at a computer not lifting hay bails or anything like that. The only other artifact of my type III separation at this point is the typical bump on my left shoulder. What has not gone away or gotten better with time is my right shoulder AC joint. The x-ray supposedly did not show any damage, but I think it has been separated as a type I or possibly a type II, because it often hurts if I sleep on it wrong… I wake up with a very sharp pain in that joint that lasts almost all day. I can also get a clicking noise and a pinching sensation in that joint if I really work the arm moving heavy objects.
Still, even though I don’t have much to complain about with my type III separation, if I had the option to do it again and I had an insurance plan that covered the surgery, I’d do it in a heartbeat. The recovery time is about the same… it took me 30-60 days to get back to decent usability (75% mobility / 35% pain), and from what I hear it’s about the same length of time to recovery from surgery.
Got a separation 5 days ago… saw a general doc and initially he didn’t think it was separated, then upon x-ray thought it was slightly separated, then called back a couple hours later and said it may be more serious, Type 2 or 3… referred me to an ortho who I am seeing tomorrow and the referral form said Type 3 🙁
Judging by what it looks/feels like, I’m hoping it’s not a Type 3. It’s hard to feel/see much of a bump. Pain-wise the first day was awful, but now it’s already much better, probably 25% of that first day, a lot of which was probably muscle bruising/trauma. Can wash my hair (gingerly), hold a few lbs in my hand, eat with that hand, etc. with minimal pain. Things that hurt are pulling hard on it, reaching across my body like when trying to put deodorant on my other side, etc. Haven’t been in a sling, but doing a lot of computer work so my arm is supported by the desk the majority of the day. Taking ibuprofen and some ice.
We’ll see what the ortho says tomorrow. I’m 27 and very active (racquetball, heavy weightlifting, mtn biking, rock climbing, snowboarding, you name it), and this time away is killing me. I want to get back to 100% ASAP, and want to avoid surgery if at all possible, but if it is indeed Type 3 I don’t see how it’s physically possible to come back 100% without reattaching things… 🙁
Sounds to me like you might have a type 1 or 2! You would not be improving by 75% on day 2 if it were a type 3.
Thanks! Let’s hope so! Yeah, a good 75% of the pain was gone the next day, but I’m cautious in saying that because a lot of pain was from my trap muscle, which was hit directly and extremely sore, so I can’t say that 75% of the separation-specific pain receded. Since Day 2, the progress is much slower, but a tiny bit better each day. Things like putting on socks/shoes hurts, but it’s by no means unbearable like it was that first day.
I guess we’ll see what happens tomorrow at the ortho. I’d be thrilled if it was only a Type 1 or 2, as especially with summer approaching I’m really down about not being able to be active. I was weightlifting 5x/week plus racquetball 3x/week, and basketball and rock climbing 1x/week. I always knew I was active, but didn’t realize how big of a part of my life it was until now!
Yeah, it’s been a while since my accident, but I can tell you there was no way I was putting on socks and shoes on day 3. That arm was totally useless and doing anything on day 3 but lying still was nearly impossible… and even lying down hurt.
Lying down on my back is fine, no pain. I’m a stomach sleeper normally, and can do that ok, but since moving in/out of that position is a bit difficult I just sleep on my back for now. Side sleeping is out. Although I avoid it, I can use the arm to do most normal things like putting away groceries and stuff – as long as it’s not too heavy or a lot of force, the pain is pretty minor.
Sounds promising – I’ll keep my fingers crossed for tomorrow’s appt! BTW, this is such a great resource!!! Thanks!
Hi Derek
I concur with Amal on this, with my grade 3 that arm was pretty incapacitated for a few weeks, so you may have gotten away with a grade 2 – fingers crossed!
I’m now 6 days post surgery. First few days were very very painful. I was unfortunate in that I was discharged quickly so didn’t get Physio brief before I left. As a consequence, isn’t have arm properly supported for first couple days at home. Big mistake!
Anyway, pain is slowly easing now. I’m doing very limited pendular arm exercises 3 times a day to ensure shoulder oesnt seize up, and still on a swag of painkillers. Shoulder itself looks good but early early days. Had dressing changed on second day following as it was blood soaked, but has stayed dry ever since.
I have review with surgeon in about 10 days so I’ll keep u posted.
Best tip so far is to make sure u get a good and detailed Physio approach before u go home. We also went to trouble of motorised bed (like hospital one) to assist getting in and out. It’s been a huge help. First night I slept in normal bed and it was awful ( too low!)
I’m optimistic from here on in though! Arm still in sling for number of weeks, then plate du to come out at around 4 months.
Sounds like you are recovering well, Mark. Good luck!
Ortho said it was “between Type 2 and 3” which I didn’t really understand, but she said she’s really impressed with my ROM and pain levels at only 6 days. Said I probably don’t even need a sling at this point, can probably start doing some sports like racquetball/basketball in a month and weightlifting in 2 months. The lump isn’t all that visible because I have some pretty good shoulder muscle, but you can definitely feel it, and that shoulder slumps down a bit more on the side than the other.
Other than that, she said I’m doing very well. Only major negative for me was the increased propensity to develop arthritis in that arm (my dominant arm) in the future. Is there any history/record of this? How much is this affected?
I think that between 2 and 3 means that not all, but perhaps some of the ligaments have separated. A grade 3 is where all ligaments have separated. Glad to hear you and your doc are pleased with progress.
In terms of the arthritis, that was a significant concern for me also as I already have arthritis in my lumbar spine, and a solid family history too. I think it’s another area where opinions differ, as I’ve had a couple of differing opinions and online info varies. I suspect it’s probably difficult to establish one way or another, as many people develop arthritis as they age. If you don’t have a history of it, I wouldn’t be too concerned …
Well my mom has rheumatoid arthritis, but that’s more of an autoimmune disease really. Other than that, no particularly major instances of arthritis in my family. My body in general is quite solid (very rarely have any kind of joint pain) but I’m only turning 28 this month.
Hey everyone! Thanks for all the posts! VERY helpful. My injury is VERY recent, so I thought I’d throw it into the mix and see if anyone has any thoughts.
Class V tear of ONLY the ligaments (no tendons) a week ago. Stupid fall. 40 years old and NOT a pro athlete BUT lift at the gym and do cardio often. The surgeon I saw 3 days after the fall gave the diagnosis and said I could do the surgery with approximately 4 full months of recovery, OR… just start living my life with the bump that he says will get a bit bigger once the initial swelling goes down.
Here’s the weird thing: I had some pain (soreness really) for 3 days, but there’s really nothing anymore and it’s only been a week. I have full ROM and just a little tender when I reach across the front of my body. I’ve read 100’s of accounts of our shared injury and it seems to me that with a class V, I should still be VERY laid up with little ROM. My surgeon said I could wait indefinitely to do the surgery, so I’m just giving it a few more weeks to see how my body does.
Another note: I had a surgery to reconstruct my elbow (from a fall) in January. I believe my shoulder was strained from that fall but no one noticed at the time, and then I pushed it further in April to push it over the edge. My physical therapist (who I’m going to for my elbow) basically said the ligaments are completely torn so I might as well start strength training since I can’t screw them up more. I’m always torn between leaving my arm in a sling to take weight off the shoulder joint OR light strength training.
On the fence with surgery since I just got out of one. Don’t love the idea of being cut open again and I’ve always been with the thought that if the surgeon says, ‘DO IT!’ then I do it… he just made it seem like it’s elective almost.
Also wondering it through strength training, exercise or regiment that there’s a way to minimize the bump.
Getting hurt sucks!
Thanks for everyone’s stories and experiences. VERY helpful and best of luck to everyone!
Scott in California
P.S.- In response to ‘Determined’s’ post in October 2010. THANK YOU! I checked out the photo and it looks like we had a similar injury. Your post helped a LOT as I’m only 1 week in and saw how you were doing at 6 weeks with NO surgery. If you happen to still be checking in on these posts and feel like giving an update it would be greatly appreciated. Thanks again and best of luck!
Scott in California
mckid814@aol.com
hey all. I also have type 3 separation. It happened on feb 18th. I’m a pro wreslter and i took a bad bump and landed bad on my shoulder. Never knew i had separated it. Noticed a bump about 2 weeks after this happened and went to the hospital. Hospital xrayed me and said…it was just a sprain. Still was feeling pain and then went to see a Orthopedic doctor. Indeed he said I separated it and xrayed me again this time with weights hanging at my sides. It’s a type 3. I have full rom but the thing is stiff and moving my arm a certain way will aggrave it. Its been about 8 week…I don’t know if i should go back and see another doctor. or if i should get surgery. My wrestling career is over…But i miss the gym. I also have gone into a state of depression cause my 2 passions the gym and wrestling are gone. what does anyone think i should do? also…i have no medical insurance so it makes it even harder on me.
I had a grade five and I walked around a whole year in pain and worked at a physical job with the injury. My first doctor said that the surgery was only comistic and wouldn’t help. I should have listened to him cause a year later I got a second opinion and the surgery. I gain ull range of motion back but not like it was befor the injury. Strength, ha I can’t hold a eight pound baby for more than 10minutes standing up. I continue to do my exercises and strength training because I’m very optomistic, however my first doctor was right it only made my shoulder look better. I hurt from days and weeks in. I may get two or three days out the month pain free. My bra makes my shoulder hurt, standing or sitting up too long or even walking. Depressing yes it is and funny thing about it all my employer thinks I can mobilze mental patients with the bumbed arm. I respect honest doctors and despise one who’s just trying to make to make a dollar. Reality of it all even if you work as resepionist you will still be on pain meds so working isn’t an option unless you are able to work under the influence. Disability is hard to get unless you are missing half of your damn body these days so I say research and ask every question possible because recovery after the surgery is a bitch. Oh and I’m still unable to cook or clean smdh.
Hi Scott,
I’m not sure how a class V could not involve tendons. By definition, class 3+ is a full separation of both AC ligaments and tendons… the higher classes are simply to indicate the scale of separation (distance your scapula has fallen).
Hi there Mr. Rage,
It’s probably because of your initial muscle strength at the time of injury that you didn’t notice the bump or have much pain. Muscles are the only thing that hold your shoulder together after a type 3 separation, and if you’re strong enough in that area, ROM could be high and pain fairly low. The weighted x-ray is the only way to really have a chance at determining which type of separation you have, so I’d trust that diagnosis. Getting an x-ray without weights, especially if you already have good shoulder strength, won’t tell anyone anything. I’d give an ear-full to that hospital and argue the fee for the x-ray… it was an expensive waste of money for someone without insurance, and it was nothing but their incompetence that cost you.
I don’t know if getting surgery would help you at this point, but I do know it took me several months (approx 6 mo) to get to a point where my shoulder felt “normal”. Right now your body is forming all kinds of scar tissue, and while it will never be the same I still think you can get back to a sense of “normal”. Your strength can’t help you with this process, it just takes a while for your body to adjust to it’s new configuration.
In another couple months you should be able to hit the gym. Start slow with that shoulder. You will notice the injured shoulder gets tired faster than the uninjured one, but with time you should be able to get your strength and endurance up to at least 95% (if not higher). I occasionally have to go up on the rooftop of a commercial building, and there is a big heavy wooden hatch cover I have to push up and over to get up there, and I have to move it back into place when I go back down. It took me a year before I could move that thing without noticing weakness in my left shoulder… but I never really worked my shoulder in the gym either.
Hope that helps.
Hey Holly,
It sounds like something else is going on… a post-op separation should NOT still be hurting after 2-3 months. Has it been two months since you got the surgery? Also, can you confirm you have not re-torn your shoulder? Some people re-tear things by doing too much in the 2-6 weeks following surgery, and they never know it. Because you went a full year before getting the surgery, that limits your options as to the type of surgery you could have… so I’d find a decent ortho and tell them your story, and that you have very low usability and you’re still in pain.
If you are still within the 2-3 month time period after your surgery, then first you need to make sure you didn’t re-tear your shoulder. A grade 5 is a grade 3 separation + additional damage due to the distance your scapula has fallen away from your collar bone.
Finally, because you’ve lost your AC joint and the tendons that hold your shoulder up to your collar bone, the only thing left to do that job is your muscles. Everyone goes through a period of recovery where your entire upper back area on the same side as your AC separation will cramp up… this is your entire musculature trying to compensate. If you had a grade 5 separation for a full year without knowing it, there might be some issues with muscle strength as well, or it may be possible that you also tore muscles as well as your AC joint and tendons. If you injured the muscles that go between your collar bone and scapula, then they are not able to help keep your shoulder up and may be the reason you’re still experiencing pain and very low strength in that shoulder.
I’d suggest talking to an ortho who can team up with a physiotherapist to get you back on track. If you’ve not damaged your muscles, then training them to do the job your tendons used to do will be critical to reducing pain and increasing strength.
Hello Amal.
Thank you for responding and posting my experience. As we all know, this is a tricky injury to deal with and it sounds like we ALL get mixed information regarding it from all sources, including the doctors… and this thread has been VERY helpful to me.
I am seeing my orthopedic surgeon tomorrow for a follow-up and I am going to ask him about the class 5 diagnosis. He told me that ALL my ligaments are torn so I can either get surgery (now, or 10 years from now apparently doesn’t matter) OR…. ‘just start living my life’. He didn’t push me hard on surgery so I am hoping to avoid it. My BUMP has gotten noticeably bigger since the swelling from my injury went down and I’m living with the hopes (delusions?) that with conservative therapy and working out my delts and traps that the bump will ‘go away’. Am I crazy for thinking this??
I am going to leave my email in case any of your other posters want to chat directly and/or share pics of the ‘bump’. I think this is one of the trickiest things for all of us to deal with. I’m not sure if mine is abnormally big OR small OR if I’m OCD about it and it would be be helpful to see what others are dealing with. I’ve conversed with a LOT of people online as well as on the phone about this injury. A great guy ‘Buzz’ from Valencia opted for no surgery 4 years ago and he’s VERY physical and still has the bump, but can do his numerous sports/activities. Others I have spoken with have said it has diminished over time and/or with the help of exercise.
Is the surgery simply for ‘cosmetic’ reasons to get rid of the bump, and if so… does it always work in achieving this?
I have been using the exercise bands and cardio at the gym and my arms are SO WEAK. (as aforementioned I broke my radial head/elbow in late December). I can BARELY do 10 pounds on an overhead press shoulder lift, 30 pounds on chest press, and light flies. It’s a lesson in patience, to say the least.
Thanks again Amal for your insight and help in bringing people together to help with this. I’m not sure what direction (surgery vs. no-surgery) I am going to go with yet, but hearing first-hand from other people who have dealt with this is the best information I have received and what I am going off of to base my decision.
I will post tomorrow after I meet with my surgeon and get his take on where I’m at and the options.
Best,
Scott in California
mckid814@aol.com
Hey Scott,
That’s exactly what my ortho said to me: “you can get the surgery now or 10 years from now” – but this is a lie of omission. The TRUTH is, that if you get surgery right away, you can get a type of surgery that simply lifts your bones into place with a screw, and they can sew your own ligaments together and they will grow back together. After a few months, your body has converted the entire area to scar tissue, and you can no longer get that kind of surgery… you have to use a cadaver (dead person’s) ligament in your shoulder to hold things together, and with all that scar tissue, it’s possible you will experience various arthritis difficulties later in life.
Make sure you press your ortho on exactly WHAT kinds of surgery options you have now and 10 years from now, and what the risk/benefit outcomes are associated with each.
I’m personally doing well now without surgery, but the side is still “crunchy” to sleep on… it doesn’t hurt, but it’s not perfect. If I had to do it all over again, with insurance covering almost all of the cost, I would have gotten surgery IMMEDIATELY. Now that my body is basically considering my left shoulder a wasteland, my options for surgery involve dead people, and I lost my employer insurance when I switched jobs, I don’t plan on getting surgery any time soon.
Hey everyone,
I injured my shoulder 3 days ago in a rugby match. I was in a lot of pain still two days after so I decided to stop by my physicians to see if I did more damage then I originally thought. I had some X-rays done and turns out I have a type II separation. The doctor never gave me a sling, just a referral to an orthopedic. When I called the orthopedic to set up an appointment, they were completely incompetent and I let them know this. So I just cancelled the appointment and called my physician for a different referral. I have yet to hear back from then and it’s been about 3 hours. I am in an extreme amount of pain and I’m at the point where I don’t even care to go to the orthopedic considering I already know what is wrong with me. I just bought a sling and it’s more comfortable already. I’ve been icing it and keeping it elevated. I read online that that’s all that’s done for a type II. So I was just wondering if it’s worth even going to see the orthopedic.
Thanks in advance,
Jenna
Hi Jenna,
If it truly is a type II, then I believe you can get a kind of surgery to repair the AC joint itself, but if you want to try mending on your own there are two options. The first is to just do what you’re doing and it will scar-over in a few weeks and within a month or two you will be in pretty good shape. The other option is to tie the sling in such a way that it lifts your arm and forces your AC joint together. In the old-days, before surgery was an option for any kind of AC separation, very tight slings were used to lift the arm into place and let the body repair itself. Success rates were close to zero though, because you’d need to keep your arm in a perpetual state of “straight jacket” like tightness for around 6 weeks. That means no washing, no nothing. Also, the old slings were just cloth and had to be re-tightened every week or so.
In my non-medical opinion, you’re probably fine just doing what you’re doing. A separated AC joint will click and pop sometimes when you sleep on it, but there won’t be any pain. With a type II you may have a very tiny bump, but nothing compared to a type III.
UPDATE:
I just got back from my orthopedic surgeon (I’m going to a well respected institute in Southern California which has a very solid reputation) and he now says I should get the surgery. I asked him a million questions.
He confirmed that I have a Class 5 separation and ONLY the ligaments are torn to pieces (no tendons). Apparently, the reason it is class 5 instead of 3 is the extent to which it is separated. I have a HUGE bump. My injury happened about 2 1/2 weeks ago and I saw the surgeon 2 weeks ago. At the time he was on the fence and didn’t push me in any direction. I was very swollen. Now the bump is extremely prominent. I have VERY little strength in my arm/shoulder and over the past couple days I get a ‘shooting pain’, kind of like a funny bone or charlie horse. I think it’s because my collar bone is now pushing against the surface of my skin whereas before it was protected a bit by the swelling.
I asked the doctor about the surgery. He used to do the Weaver-Dunn procedure, but not anymore. He said that he doesn’t like using screws at all in either of the 2 bones that they used to be used on because once you screw into a bone it obviously weakens the bone (makes sense to me). He does the surgery orthoscopically. ONE small incision on the front of the shoulder and ONE small incision on the back of the shoulder. A slightly larger one (2 inches) across the top. IF I get the surgery soon, he basically goes in and ‘ties’ the collar bone down, essentially replacing the ligaments. I have considered waiting until December when work was slow and he said the only thing that would change is that after that much time he would then use a cadaver ligament instead of the synthetic method he’ll do now. The reason for this (as you mentioned Amal) is that everything has scarred over at that much time and they need to use the cadaver one.
I REALLY was hoping to avoid surgery at all costs. The surgeon said I will be in a sling for 8 weeks. After 4 weeks I will start physical therapy to get ROM and strength back.
I’m not super physical or an extreme sports kind of guy. I’m 40 years old and go to the gym a lot though. Classes, light weight lifting, cardio and such. I am an actor though and while I haven’t been shirtless in a great deal of my work, I don’t want this bump to be a hindrance in this respect. I don’t consider myself that ‘vain’ BUT if I ever lost a job because of the bump it would really suck. That’s probably the main reason that I am steering toward getting it done.
My surgeon has been working on shoulders for 18 years plus his training before that. Seems to know his stuff. They’re running my insurance and seeing what the cost to me will be and I guess I’ll make that decision at that point. Knowing what I do for a living, taking into account my age, and I think the severity of the separation, he’s strongly suggesting I pull the trigger and get this done.
Anyway, there’s where I’m at now. You were 100% right about the cadaver ligament if you wait Amal. If anyone has any questions, suggestions, thoughts, feel free to post or reach out.
Good luck healing and thanks again for all the personal stories. This is a REALLY crappy injury and talking to people has been invaluable in regard to helping me make my decision.
Best,
Scott
mckid814@aol.com
Hey Scott,
Thanks for the update! As an actor, I’d think the bump would be really off-putting to casting directors. You can cover small scars very easily, but not an asymmetrical bump like that. If you get the surgery, let us know how it goes and how your recovery progresses!
hello , i,m richard from the uk. had a grade 5 over 4 weeks ago playing rugby , had a tight rope surgery 5 days later
have a 5 inch scar on my shoulder but its healing well and apart from being sore the shoulder feels pretty good
been told to keep wearing a sling for another 2 weeks which i am trying to do but not very practical
only taking a few pain killers now, seeing the physio next week
anybody know any good rehab exercises once i get the green light?
Hi Scott, dont think you ve any choice really with a grade 5 , my bone was pushing out the top of my shoulder and other than frightening the kids it was pretty useless
as i read it , a quick surgery means that the ligaments can repair by pushing the torn end together?
Hi Richy,
In response to your question “a quick surgery means that the ligaments can repair by pushing the torn end together?” – yes… at least that’s the way I understand it to be 🙂
Hello Richard. Don’t meet too many Grade 5’s. Hope it’s healing up well. I’ve researched this thing 24/7 for a couple weeks now. Here are a few of the sites/links I’ve found for exercises. Obviously I’d clear them with your therapist first:
http://www.sportnetdoc.com/shoulder/luxation-of-the-joint-between-the-shoulder-blade-and-the-collarbone
http://www.youtube.com/watch?v=hm7xqu-pOEc
http://www.separatedshoulder.net/
Richard, do you have the bump still OR is your collar bone back in it’s proper place? My surgeon told me that it’s a full 8 weeks in the sling.
Best of luck with the healing and keep us posted!
Best,
Scott
Hello Richy. Yeah, I was kind of looking for my surgeon to give me an ‘out’ but with this extreme of a separation he more or less kept nodding his head and affirming that surgery was the way to go. I am hopeful with this newer technique he’s doing. I never liked the idea of drilling holes in my shoulder blade and/or bones and I CERTAINLY didn’t like the idea of going back for a second surgery to remove screws.
I am in the bizarre situation where after I met with the surgeon I went downstairs to the physical therapy wing of the institute where I am finishing up PT for my broke radial head (aka elbow) which I had the surgery for on 1-5-12. I ask a LOT of questions of my doctor down there and it appears that I’ll continue seeing him for the rehab of my shoulder now. DANG! It REALLY sucks. Anyway, he explained that the the shoulder is a ‘fixed joint’ as far as where the ligaments attach. The movement is all within the ball and socket area of the shoulder. With this crazy separation I basically have no stability so I think you’re right Richy, my shoulder will basically be useless as far as lifting anything ever.
As far as the ‘quick surgery’ and the ligaments can ‘repair’ I’m really not sure. Going to ask. I was always told that once the ligaments are completely torn they’re gone forever. But I see Amal said that if the surgery is done soon they can kind of be salvaged. I’m a little confused but will ask my surgeon. I think he wants to get me in in the next week and if I’m going to do it, I might as well get it over with.
What class separation did you have and did you have surgery? Where are you at with it now?
Hey Scott,
Please do ask your doc. After much research and some pestering, my understanding is that if you get surgery soon enough, they can somehow lift your bones into place (rope or screw) and either sew your ligaments together or let them try to attach on their own. Wait too long and that option is gone, and you can only use a cadaver ligament.
As for lifting with your shoulder, don’t despair on that front. I didn’t have any surgery and though it took a long time (over a year), I can now lift just fine with that shoulder. It does get tired faster than my “normal” shoulder, so rep counts are down. If the recovery time is bumming you out, also remember I never did anything to help it… no physio… not a single weight above my head or anything… I just tested it occasionally by running through a few standing overhead reps using a 30lb dead hand weight. If you actually get the surgery, wait for proper recovery, and go to physio… you’ll be back to “normal” in way less time.