Not sure what grade this is, but I am guessing a 3; looks like 2 of the 3 ligaments are torn. I have dislocated my shoulder and broken my collar bone but this was by far the most painful. It's been 5 days and I have about 50% of the range of motion back. Just feels really really weak and my shoulder gets fatigued fast.
My experience so far:
1. It hurts a lot when the joint absorbs any type of shock or vibration. Driving my truck down a crappy road is enough to make me grind my teeth. I won't be riding anytime soon.
2. My trapezius on the affected side is almost always in a tight knot because of the bone pushing against it. I wasn't expecting the referred pain to be in my upper back.
No problem... I'm glad to help people understand they can still do the BIG stuff after incurring shoulder injuries!
Originally Posted by scottwest
Lately I've been nursing a broken 5th rib, minor pneumo, and possibly a type I shoulder (left side this time).
I was just sorta riding... a bike... all innocent-like in the woods, when I came upon this interesting dirt gap jump and... err, sorta rode the bike... over it. Fast and Hard!
The first time was great! I landed it alright and rather enjoyed it.
The second time was not great! Another lesson in human anatomy/physiology, physics, and aging issues.
At least I've lived up to my promise to NEVER land hard on my expensive shoulder (the right one I had operated on).
Only trouble is... NOW I'M OUT OF SHOULDERS! Not sure what to land on now instead of my shoulders?
My head perhaps?
That might help me learn to stop doing stuff harder than my experience, nerve, weight, etc etc, will allow. LOL
I can say for sure that the year 2011... has been a very ODD year for me!
I had a pitbull bite my arm just a week earlier... luckily he was a nice maddog and only bit me once, and my girlfriend in the back of her leg once.
My arm got infected (interesting red streaks almost to my armpit the next day), and I got I.V. antibiotics for the next three days.
Heck! I've spent more time in my E.R. as a patient than I do when I'm working!
Too many injuries for just one year... I figure I'm off the hook for a few years now... time to heal up and get back out there and RIDE!
Originally Posted by b52doc
Your AC is G...O...N...E! ADIOS SUCKA! ASTA LA VISTA BABEEEEEE!
Perhaps your CC is gone as well, but I'm not a real doctor... I just pretend to be one online... hehehe
Seriously, you have taken out your AC for sure from the xray you posted.
That huge a gap between your clavicle and ac process makes it appear your CC ligament is injured as well or completely torn.
Since you have an xray of it, you should have some word from a doc about the extent of the injury.
What have they said, what are your options?
I can tell you I am glad I had mine operated on. You will see from some of the comments here and elsewhere though, that some folks live on without getting their shoulders 'fixed'.
I am 99% positive I need surgery; the distal end of the clavicle is displaced up and posteriorly into my trap muscle and the pain it causes is unbelievable. Today I made the mistake of bringing my injured arm across my chest and I nearly blacked out from the pain. I have tried a couple times to push the clavicle down and out to reset the loose end against my skin. I can't bring myself to try again and my gf won't do it for me lol.
Originally Posted by wsmac
Despite what the xray looks like and what is common for this injury, I don't have any lump on my shoulder; you can't see the end of the clavicle pushing against the skin because it's pushing into my trap instead.
The NP at the urgent care gave me a referral to an ortho surgeon but I haven't gone yet.
I am being optimistic about the injury because it's the only thing I can do; can't afford to take months off of work to rehab from surgery. My gf recently lost her job and we are barely getting by on my salary alone.
It sucks but that's life.
Last edited by b52doc; 11-16-2011 at 11:21 AM.
I feel for you. My advice though, is get professional advice, get it early and then follow it. It will cost, but - speaking purely from my own experience - it is the way to go.
Originally Posted by b52doc
And given what you describe with the position of the clavicle, pain you're getting etc, I'd say it's even more important in your case.
I went to two ortho drs and then had pretty intense PT for about 5 weeks (two visits a week). I obsessively and fanatically did all the exercises etc that were recommended.
I also got back into the pool early (breaststroking at about week 3) with the blessing of my physio, and have been swimming twice a week since then. I think the swimming has been a major factor in my recovery. Breaststroke in particular seems a perfect exercise for a separation since it really works your upper back/shoulder blades as well as your shoulders.
I'm now 8.5 weeks out from the injury. In my case, surgery wasn't indicated. I have 100% motion back and strength is getting there too. I'm back to swimming freestyle at my previous pace over decent distances, too.
I'm back on the bike too - riding as much as I did before (did a race last weekend). I'm not attempting any major jumps though, but that's because I'm now more wary of the risks not because my shoulder couldn't handle it.
Good luck with it. Don't forget to share your experiences on this board - I've found it invaluable (thanks all!).
I knew I needed surgery at about 4 months most injury after following Dr advice. I waited 15 months before going under the knife and looking back, should have done it much sooner. Don't wait too long.
Originally Posted by b52doc
Your clavicle doesn't actually rise all that much... there's no mechanism for pulling it up in that direction.
What's happening is that your shoulder is actually falling because it's not connected correctly to the clavicle any longer.
Because your clavicle is loose at one end, you can move your clavicle around by pushing on it, but it's actually the rest of the shoulder being unsupported that makes the clavicle 'pooch' up as much as it does and create the bump many people wind up with.
This is why you should be in a sling right now.
You need to support the rest of the shoulder as well as your arm since the clavicle can't.
Hope that makes sense.
When someone suffers a type 1 or 2 injury to the AC, if the arm/shoulder is supported by a sling, there is no further pulling on the torn ligament and this allows it to heal and often pull back to a more normal state without the bump.
If the weight of the arm and shoulder is left on the torn ligament, healing won't be as fast or as complete.
Until you can get in to an Orthpod, go to a drug store and buy yourself a cheap sling. Nothing fancy. You might even get two so you can shower in one, switch to the dry one and let the other dry in the meantime. Sometimes a thrift store has them for $1 or $2.
If having your arm lie flat against your body is too uncomfortable, you need to add some space between your body and arm. Some slings come with a large foam block to help create a better angle to the arm and relieve tension in the shoulder so you feel less pain.
You can make your own block or buy a sling that has one with it.
If you look at my pictures a page back, I had something called Ultrasling, which had the block. Only thing is... the sling did not keep me from moving my arm around on my own, nor did it keep me from removing it easily and leave my arm hanging again... which did not help my first surgery 'take' at all.
My surgeon put me in a firm brace after he went back in to fix my shoulder the second time. This was more stable all around, and even though I could still remove it if I wanted, I was less apt to do so.
Do something for it as soon as possible though. No reason for you to live with the pain like this.
Last edited by wsmac; 11-18-2011 at 12:42 PM.
AC Joint Separation alternative solution?
Hi guys! I just took up MTBing this year but have been doing road since 07. Well, I had a very nasty spill last Saturday and went OTB on a downhill portion of a trail. I tried to roll on my shoulder but as I was still clipped to the bike it fell down on me and I heard this sickening SNAP as I landed.I wasn't in much pain and after checking my collar bones, which were whole, I noticed this lump sticking out of my shoulder. Went to the ER and had x-rays done which I've attached (just as an aside, I used a spare inner tube as a sling to immobilize my hand, comes in handy during emergencies).
I didn't really feel much pain except that the ER put me on a sling, which was uncomfortable. I went to see a couple of Orhto's already and they both said that I don't need to have an operation done. I'll be able to retain full range of motion eventually and be able to swim again. Unfortunately, there will be that ugly lump sticking out of my shoulder for life, which I can live with.
The 2nd Dr I saw said I can take off the arm sling but suggested that I put on a sling bag (or man-purse) loaded with books and sling it across my body with the strap resting on affected clavicle and then keep on shrugging my shoulder. He says that this will help put the clavicle closer to the scapula as the scar tissue forms, making the bump less noticeable. Needless to say it's a b***h to have to constantly have the bag on (i think it weights around 6lbs) which he says i have to do for 4 weeks.
My question is, have any of you done this type of method or encountered anyone using this method to heal the bones closer together?
Hey bad luck with doing that in your first year! Sounds like you're pushing yourself, which is to be commended ;-)
None of the ortho's I saw had any specific recommendations for helping it heal along those lines, just wear a sling until you no longer feel you need to, and no need for special exercises, just wait until it feels strong enough before getting back on the bike.
Can't say the advise your ortho have you sounds great personally: it's going to be impossible to apply a constant pressure so you're going to just move it up and down more (as well as stressing your back); but I'm no ortho.
J, get a second opinion! The bump is more from your shoulder drooping, not your clavicle sticking up.
Slowly slipping to retrogrouchyness
HA! I just noticed this was THE AC separation thread... thought it was a new one.
Originally Posted by G-reg
Anyway, I agree with G-reg.
I'm no doctor, but I have A&P training and medical experience going back a ways.
The clavicle may move upwards when detached from the scapula (the most common injury is damage to the AC and CC ligaments) but not to the degree most people seem to think... especially when looking at the bump.
Your arm and scapula are suspended from your clavicle, so once released, they actually drop pulling the skin downward. The clavicle may rise somewhat which pushes against the skin. The combining actions form the bump.
The degree of detachment dictates the size of the bump.
Minor tearing of the AC ligament can heal to a state where the bump does not exist (if one was present in the first place), while moderate or severe ligament damage will leave a lasting bump should you decline one of the many operations designed to bring the shoulder back to a more normal state.
All this is specific to AC and CC ligament injuries... rotator cuff is something else (many people seem to link rotator cuff with any mention of shoulder injury).
You can keep on seeing Orthopods for as long as you or your insurance will pay, but eventually you need to decide what you are willing to live with.
Shoulder injuries are common enough that there is a plethora (always wanted to use that word ) of information on the internet.
To make sense of your xrays, we would actually need to be able to do some measuring of the gap between your clavicle and the ac process. Not so easy with the small pictures you have.
The idea about suspending weight across your clavicle sounds a bit radical to me. I have never heard of anything like it before.
Again... it's not that the clavicle alone is flying upwards all loosey-goose... the scapula and arm are dropping.
I just don't see how you can pull your clavicle down enough to help the ligament heal properly.
Generally, slinging is the treatment whether or not you have surgery down the road.
The idea is to bring your shoulder back to as normal a state as possible while the damaged ligaments heal.
Slinging does what your clavicle normally would do... suspend the arm.
If you can take the pull off the injured ligament, it will be more likely to heal to a more normal state.
I mentioned in another post here that it may help to move your arm out a few degrees away from your body.
Putting a towel, pillow, or block of foam between your arm and body can create that angle.
I can't tell you what angle this is precisely, and the block should go between your forearm and body, not the upper arm and body.
You may find comfort with your slung arm more towards the front of your body, or right at the side of your body.
This is the sort of stuff an Orthopod or Physical Therapist would know better than me.
Hope this helps.
Thanks twe,beast, G-reg and wsmac. You're right and I think the ortho did mention that my shoulder is drooping. I went to a 3rd Ortho yesterday and the first thing he said was..."Oh wow, that's a type 6. Let's do surgery while it's still fresh. We'll just skewer a pin through the end of the clavicle bone" Yikes! After discussing with him though, although it was his first reaction, he said i can get the full range of motion back even if i don't do surgery, so that is that.
I asked him about using the bag slung across my shoulders and he said that among all, that will be the most helpful but it will not be exactly back to normal. I'm not a medical pro but i think the 2nd ortho mentioned the clavicle popping/locking into place. My best guess is that keeping the clavicle into that position as long as possible will create a "hole" of some sort that the bone can rest in and eventually heal into. He did say though that I don't need to use the sling if i don't need to, but then again, it helps keep my shoulders into a "shrugging" position and the protrusion is not as bad.
Wsmac, how long do i have to be in a sling? It's a b***h to wear, specially if I don't need to be using one . Oh, and i'm attaching a clearer image of my x-ray.
I'm quoting you so I can read your post while I type my reply...
Originally Posted by J-ay
I agree with something you said a post or so before... that intermittent use of a weighted bag would seem to allow the clavicle to spring back-and-forth as you take the bag off-and-on various times of the day. It won't do you any good sleeping unless you sleep in a straight-up position .
I am not doctor. I have been an EMT since 1978, an airborne medic, worked in E.R. and EMS situations, etc etc...
In no way do I wish to contradict any of the Orthopods you've seen so far. They do have more specific training and experience than I do in this matter.
Okay... disclaimer over...
I can see where downward pressure... ala the weighted bag... could help, but only if you could keep that pressure constant throughout the healing process. Once the lig's are solid again (and in your case it sounds like they ain't gonna be .. at least on their own), removing the weight wouldn't pose an issue.
Guess I'm not seeing what the docs are seeing in recommending that approach.
Seems to me you will be unweighting your shoulder numerous times throughout the day by sitting, just getting tired of the weight and accompanying discomfort and intentionally taking some of the load off the shoulder, sleeping, showering...
As far as the surgeries go...
There are several to choose from. If you ask each of the Ortho's you have seen about the various methods for surgical repair... you may get completely different recommendations.
What I'm hearing around our hospital lately is a move towards less metal installation.
I haven't read up on this, but I know some docs feel they are seeing more arthritis in people who have had certain metal hardware repairs done.
Other options for shoulder repairs utilize synthetic "ligament" with metal buttons, cadaver ligament with synthetic screws, and there are more.
The clavicle is a pretty sturdy bone, but as we see just here on the forums, a hard enough impact can break it or definitely damage the connecting ligaments.
Any repair will necessitate drilling holes in the clavicle. It's not the same as other long bones in that it isn't "hollow" like, say, your arm or leg bones. It's also the only long bone that lies horizontal in the human body... for what that's worth
In my case, my surgeon decided on a repair that I was happy with. I looked at the other options, and we even discussed one other option he had experience with but was moving away from.
Unfortunately, the first repair didn't work so he had to go back in and put larger synthetic screws in the second time. Those two holes in my clavicle mean a possible catastrophe if
I ever land hard on that shoulder again. Basically... major reconstruction with current methods.
This is why I now fall on my left side only... the cheaper side
I know of two people who elected not to have surgery after grade III (1 guy might have been a grade IV I think) injuries. They have normal shoulder function with the bump, but they do feel a difference in their shoulders. They both mountain bike (and road bike), and one of them I ride with so know how he rides... fast and furious.
It really seems to be a toss-up as to whether a person should have surgery or not, if there is no obvious medical need to. It boils down to personal comfort, how well your body heals, how well you follow any physical therapy recommended to you...
I chose surgery (my shoulder was a type IV), largely because I like the idea that things are as close to normal as possible.
The reality is that my clavicle is only secured to the scapula by one ribbon of cadaver ligament from below at the coracoid process (the process below the clavicle), and not the acromion process (the one that the lateral end of the clavicle joins to).
It's far from 'normal', but I like a bit more secure attachment than none at all. Since I do not have the ligament between the end of the clavicle and the acromion process, the surgeon cut a bit off the end of the clavicle to give a bit more 'space' between the two.
I worked really hard on my ROM exercises, stretches, and strengthening exercises.
In fact, my current broken rib is driving me crazy because it's still hard to do the exercises I want. But... today I did pull out the bike and give her a spin around the yard with success I hate being sedentary!
About the sling... and I know I'm a bit long-winded in my posts but I'm almost done
The recommendations I have heard (and been told) say to wear it all the time (out of bed that is) for several weeks. This could be up to 6 weeks, but it could be shorter.
In your case, none of the docs seem to recommend the sling and I'm supposing that's because you have no ligament attachment at the AC and CC, so there's no ligament healing that necessitates taking weight off injured parts. Hope that made sense.
If you just had torn ligaments, the sling would keep the tear from being pulled upon and allow it to heal better. Since you've blown your ligaments (which it sounds like), the sling would only be taking weight off the muscle and skin surrounding your clavicle. In that case, nothing is going to change without surgery. You can put the sling on and take it off all day long and you won't be accomplishing much, or so it sounds.
Difficult choice for some... easy choice for others.
You will hear from docs that your shoulder can be 'repaired' anytime in the future though.
They can cut you open and do whatever magic fix is current in the future should you decide you hate the way your shoulder feels/functions/looks.
Just a caution though...
If you think you might want surgery... and you have insurance now that will help pay for it... I'd seriously consider doing it. I did partly because I have great insurance.
My bill for the first surgery was initially billed around $40K, the second just under that.
Counting in the ED visit, meds, xrays (and radiologist fees for reading them)...
I am lucky to only have to pay a few thousand.
The original bills were negotiated down between the insurance company and the hospital/providers, which is the usual process from my understanding.
I also had the extra benefit of having all this done through the hospital I work at and we get certain considerations for being employees.
If you choose to have surgery down the road... who knows how you will cover the costs?
That's something for you to consider.
I wish you well no matter what you decide!
Thanks for the reply, Wsmac! Quite comprehensive and informative. I've already set my mind to no-op as long as I don't need it. Range of motion is getting better every day. Will see the Dr again next week to see how I'm progressing.
One thing I've been doing is using the "10 lb man-purse" remedy. What I did as an extra is to fasten the straps under my armpit on both sides with a race belt to keep the strap as secure as possible over the bone jutting out. I shortened the strap length to a minimum so I still wear it while seated. According to the ortho, the muscles relax when we sleep so it's ok not to have it at night. I'm just super tired at the end of the day from having to carry this extra load. In any case, will report back to the forum if it works.
Oh, also, now I wear the sling when I go out in public or go to meetings. It prevents people from grabbing my hand and shaking it violently or from tapping me on the affected shoulder. I forgot to do so yesterday and someone said "Hi" by tapping me on the shoulder and then shook my hand violently
Life is not a journey.....
“Life is not a journey to the grave with the intention of arriving safely in a pretty and well-preserved body. But rather, to skid in broadside, thoroughly used up,totally worn out, and loudly proclaiming .... WOW what a ride.”
LOL ! Switched it to a computer bag as it has more padding in the sling. Have a good ride
Update - No Surgery Six Weeks Recovery
This is an update from a guy who decided NOT to have surgery after a Grade III.
Crashed on October 9th. Hit the gym doing very light exercises two weeks later. Rode my first trails on November 3rd, but easier stuff (Backbone and Sage at Pt. Mugu if anyone knows them).
For Thanksgiving, I had two friends in town and we rode three days straight, Pt. Mugu, Elings, Romero Canyon, and Jesusita here in Santa Barbara. Rode every section of every trail, and faster than ever. I seem to ride with a little more focus these days...
Basically six weeks recovery time.
So how's the shoulder feel?
Originally Posted by NJMTB
How is sleeping and other normal life activities?
I don't sleep all that well on my right shoulder (the one operated on), and I'm still nursing a grade I or II on my left shoulder from my most recent crash, so there's some pain, and it's too annoying to sleep on that side unless I sleep with my arm straight down my side... which is unnatural for me and puts pressure on my ribcage (broken rib).
I get away with it for a while, then I flop onto my back for the rest of the night.
I've been back to doing my stretching, and I'm starting weights again really soon.
I'll try pushups, but pullups are out for a bit longer I think.
GAWD I HATE GETTING FAT AND OUT OF SHAPE!
That's really the worst thing about getting injured to me... decreased activity!
My operated shoulder can basically handle all the normal stuff I used to do and it's been since... eh... April? I think from the last surgery.
Like I've said before, I know at least a couple of MTB'ers who opted out of surgery and live with things the way they are. No complaints, and at least one guy rides just as aggressively as ever.
Hello fellow daredevils! It has almost been 4 weeks since my fall and ROM is pretty good. Drs are advising not to do any lifting still for another 4 weeks. I have a nasty looking bump from my drooping shoulder which looks pretty bad, specially from the back. Looks like I have a gremlin growing.
My clavicle is still moving up and down freely (any experiences how long this will last?) I laid off the heavy weight for a week as I just got tired of it. The resulting x-ray today showed that my clavicle moved up a bit/separated more than my previous x-ray 2 weeks ago when I was carrying the weighted bag. So My doctor has recommended to do a PRP injection to speed up the healing while using the bag. Does anyone have any experience with this? Basically he wants to get the gap to be as close as possible or i might have problems with arthritis in the future.
Hey, I'm new to your 'club', with a class 3 separation! I always thought it would be mountain biking that would do the first major damage, but in my case it was skiing (first run of the first day of the season, figures).
I am seriously considering repair surgery, so I want to hear from those that went that route. Most of the posts here have been from those that went without.
So, if you had repair surgery, how did it turn out? How long can I expect to be at a low level of activity? Will the area be less vulnerable to arthritis down the road than without the surgery? Will the shoulder be able to take a fall again, although hopefully at a lesser impact?
Any information would be very helpful, as I have to make my mind up soon. The main reason I am considering the surgery is because I want to try to minimize future problems. Like Wsmac posted above, I have the insurance to do this now, but I will not likely have the same insurance later. I'd hate to develop debilitating arthritis in ten years and drain my bank account to reconstruct the joint.
Thanks for your help.
I haven't had surgery and was told that with my grade 3 I didn't have a greater risk of arthritis. The reason given was that grade 3 is clean separation so that there's in fact less contact, friction etc than with a grade 2 and therefore a lower risk of developing arthritis.
I was told that surgery wasn't going to change those odds for me.
Originally Posted by bloodpuddle
As an aside, I was trying to find out more info on our injury and stumbled upon this guy who taped his clavicle down and was successful in keeping it down. There's hope for the newbies in the group. I'm going to try the taping instead of the weighted bag as it still pops up whenever I take off the bag.
1 year 8 months later grade 4-5 no surgery
I separated my shoulder April of 2010 going down a narrow chute. I switched jobs and did not have insurance just yet so decided not to see a doc.I diagnosed myself with grade 3. Pain eventually went away and got full range of motion so felt no point in seeing a doc anymore.
Finally saw sports injury doc 3 months ago because I wanted to start lifting weights again and was paranoid without expert opinion. He saw my x-ray and his reaction was of surprise cus it look like grade 4-5 to him. He says that if I saw him when I first was injured he would have had me have surgery during the acute phase of injury. He does not see importance now since I have no pain/discomfort and have full range of motion and I'm not in acute phase.He says getting older won't make it worse.
I've been back on bike for a while now and shoulder feels fine. I could bunny hop, wheelies and do drops etcs. I can lift weights including shoulder work outs and there is no pain. I can swim etc.
If I had the choice I would have done surgery during the acute phase of injury just so that it can be close to 100%, but surgery would not benefit much anymore. I had to get over the self consciousness of the deformity. People really don't notice the shoulder unless I point it out to them.
If you decide to get surgery make sure you make that decision during the acute phase if not surgery will help minimally. Otherwise when pain goes away and full range of motion is back lift weights and make surrounding muscles stronger. You'll have to deal with the aesthetics of the droopy shoulder.
A spotless bike is a bored bike.