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  1. #576
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    Well yesterday I endo'd pretty hard, the front wheel was completely pinned so it happened very fast. I was going about 15 mph at the time, and didn't even realise I crashed until I was on my back. Apparently I landed squarely on my right shoulder (glad I'm a lefty).

    Anyway after I rode home and very painfully removed my shirt(s!), I noticed my shoulder was hanging low, and my collarbone was sticking out, so obviously my shoulder was separated. Since it was Saturday, I went to the Urgent Care. They x-rayed me and referred me to an orthopedic surgeon. The doctor thought it was a grade 4 separation and would definitely require surgery, but obviously I will need the ortho's diagnosis and recommendation. I will schedule an appointment with an ortho ASAP on Monday morning.

    I am 31 and want to regain as much of my shoulder function if possible. Really bummed about missing spring/summer activities. Also, my mtb race schedule is totally thrown out. I just hope I'll be able to race Iceman on Nov 2. Also was hoping to do the Lumberjack 100 again, but that is now totally out of question.

    I have attached the x-rays I got at urgent care. They are not terribly clear, but if anyone has any comments on them please provide. Thanks to everyone else for providing their experiences, I'll be reading through them. I'll update my progress for the benefit of others who experience this common injury.

    Ac Separation (shoulder Separation)-separated_shoulder.jpgAc Separation (shoulder Separation)-separated_shoulder_2.jpg

  2. #577
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    Quote Originally Posted by WillTheGreat View Post
    Well yesterday I endo'd pretty hard, the front wheel was completely pinned so it happened very fast. I was going about 15 mph at the time, and didn't even realise I crashed until I was on my back. Apparently I landed squarely on my right shoulder (glad I'm a lefty).

    Anyway after I rode home and very painfully removed my shirt(s!), I noticed my shoulder was hanging low, and my collarbone was sticking out, so obviously my shoulder was separated. Since it was Saturday, I went to the Urgent Care. They x-rayed me and referred me to an orthopedic surgeon. The doctor thought it was a grade 4 separation and would definitely require surgery, but obviously I will need the ortho's diagnosis and recommendation. I will schedule an appointment with an ortho ASAP on Monday morning.

    I am 31 and want to regain as much of my shoulder function if possible. Really bummed about missing spring/summer activities. Also, my mtb race schedule is totally thrown out. I just hope I'll be able to race Iceman on Nov 2. Also was hoping to do the Lumberjack 100 again, but that is now totally out of question.

    I have attached the x-rays I got at urgent care. They are not terribly clear, but if anyone has any comments on them please provide. Thanks to everyone else for providing their experiences, I'll be reading through them. I'll update my progress for the benefit of others who experience this common injury.

    Sorry to read about your injury. If the Orthopedic Surgeon suggests a Weaver-Dunn or any version of the procedure, walk out and find a different doctor who is more up to date on the current fixes for AC separation. Refer back to my most recent post (prior to this one). What you want is a Anatomic Coracoclavicular Reconstruction using Semitendinosus tendon using either an allograft or autograft. The modified Weaver-Dunn is a success if it produces a joint that is 30% as strong as the original joint. The newer procedure, using a hamstring tendon to rebuilt the Coracoclavicular Ligament has been shown to reliably produce a joint with 85% to 95% of the strength of the original joint.

    I've had a lot of injuries. I hate to say it, but recovering from this surgery has been one of my longest recoveries to date. I had surgery on October 25th of 2012 and it's just in the last month that I feel I'm better than before surgery. So, 3.5 to 4 months. It is very important to be conservative for as long as the doctor recommends. There has also been a shift to a longer, conservative period. Previous thinking was that the rebuilt joint would be mostly healed in the 10-12 week post surgery period. More recent studies as pushing that out to the 14-16 week time frame. As the newer surgery uses a tendon to replace a ligament, it actually undergoes changes on the molecular level. Even though you will be feeling much better, the new ligament will be weakest in the 12-14 week period. It is a well understood phenomena as this is the same tendon used to rebuild injured ACLs.

    It's been a tough recovery, but I'm confident enough to say I'm glad I went under the knife. If you read my previous post, I lived with a grade 3 separation for 5 years, but a subsequent fall made it a grade 5 and there really wasn't much question that I needed surgery. Having gone through it, I would like to have had surgery much earlier, but if I'd done it after the initial grade 3, I would have had the less successful, older procedure, the Weaver-Dunn.

    PM me if you have any questions, or ask them here.
    Disclaimer: I no longer fix bikes for a living.
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  3. #578
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    As I've mentioned here before, if a full-thickness tear of a connective tissue component is not the case, few surgeons these days would recommend surgery prior to a period where non=invasive therapy is tried. You'll find out soon enough what category your shoulder is in. Until then don't do anything to aggravate it. A sling might be in order, but you will find out son enough.
    I agree with downhlldav.........shoulder surgery is a serious thing to rehab from. You have age on your side, so you gopt that going for you. Best of luck with whatever you decide to go with.

    And I'd add that you should not be shy about seeking a 2nd, or even 3rd completely independent opinion, from another Ortho Doc, or from a Physical Medicine Doc, as well. So many cases. in our rather "unique" for-profit health care system, are driven by financial incentive and/or what that patient's health care coverage will pay out for, and not necessarily by what evidence-based case studies might indicate.

    Keep a positive attitude, and an open mind.
    Re-Cycled Person who rides a mountain bicycle.

  4. #579
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    Good points from Ray. The doctor who did my surgery was the third surgeon I had seen, fourth doctor if I count the ER doctor I saw right after the injury. He was recommended to me by my physical therapist when I started having issues a few years after the grade 3 separation. He convinced me to keep doing physical therapy instead of surgery the first time I saw him, and even the second time when I was in for a different injury so I trusted him when he said surgery was the best, only real solution when I injured myself further last summer.

    Surgery is generally indicated for grade 4 or above. The prevailing consensus is to pursue non-surgical treatment for acute grade 3. Only when grade 3 becomes chronic is surgery indicated by consensus.

    There was recently a study published (I'm still trying to track it down again) that looked at long term results of the modified Weaver-Dunn procedure performed shortly after initial injury versus non-surgical treatment. It concluded that for both types of treatment, in the long term, you are very likely to develop osteoarthritis that will eventually require at least arthroscopic debridement. This is one of the reasons for the controversy about surgery vs. non-surgery. I would very much like for this type of comparison to be made between the newer repair and non-surgery.

    Unfortunately the long term results of the newer procedure that I had performed have not been compared to non-surgical treatment in this way (as far as I've been able to find at least), though it's been shown to produce results that far surpass the modified Weaver-Dunn in joint stability and strength. From this, I've inferred that it should at least take longer to develop osteoarthritis compared to the non-surgical treatment of a grade 3 separation.

    Surgery was not a decision I came to lightly. I'd been researching it since very shortly after I injured my self initially, over 5 years, and discussing it with a doctor I trusted for over 2 years. Prior to injuring it worse last year I was getting close to seeking out a surgical solution as I was beginning to have minor, though constant discomfort, was treating with ice at least once per day and resorting to pain killers more than 3 times a week. Sleep was also becoming difficult due to pain.

    Good luck with whatever you decide.
    Disclaimer: I no longer fix bikes for a living.
    National Ski Patroller to feed my winter habit.

  5. #580
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    Here's a dissenting opinion disguised as an update on my shoulder. In short 4 years ago I got 4 opinions from or those, all gave different opinions. My full story is in here somewhere, but I didn't have surgery.

    Things like wide grip pull ups hurt a bit and sleeping on that side will leave it sore when I wake up. I've fell on the shoulder hard enough I'm pretty sure that I'd have broken my clavicle or blown up any of the AC surgeries, had my AC joint still been healthy or "repaired."

    That impact hurt, but not too much more than when I sleep on that side. The real danger is if you hit hard enough or just right a healed cat 3 could become a 5.
    Slowly slipping to retrogrouchyness

  6. #581
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    I fought surgery for years. While you can strengthen the other 17 muscles and tendons that cross the shoulder, you can not do much for a full thickness hole or tear.
    I agree w/person: 30% surgon vs. 70% rehab!

    No improvement over a year is a condition for surgery.

    R

  7. #582
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    I appreciate everybody's advice and shared experiences. I had follow-up x-rays performed yesterday, and they showed that the end of my collarbone is also broken off. The doctors said that I will definitely need surgery.

    There is a chance that some of my ligaments are still in tact and attached to the broken-off piece of collarbone. It is possible that I may have less ligament damage than I originally thought. At this point, though, it is uncertain.

    I live in a university town, and went to the university hospital. It is a top ranked medical school, and I have an appointment with the orthopaedic surgeon for the football, hockey, etc teams. He is also a professor. I have to assume that he will be able to provide good advice based on modern procedures. I think it is a plus that he is used to working with athletes as well. I will also seek alternate opinions, of course. I don't want to name the institution in this space, but it is obvious based on where I live.

    It's been 3 days now since the injury, and my shoulder is feeling better. I was able to put on a button down shirt today for work, so that is progress! I have been wearing a sling since the injury, applying ice, and taking Ibuprofen for pain/inflammation. I have been sleeping well, but only on my back of course. I sleep in my sling because sometime I jump or move suddenly in my sleep. I've been trying to maintain my normal schedule and life because I know that things will get much harder after the surgery.

    Here are the newer better x-rays:

    Ac Separation (shoulder Separation)-busted_shoulder_1.jpgAc Separation (shoulder Separation)-busted_shoulder_2.jpg

  8. #583
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    Grade 3 AC checking in here. Clean separation of the shoulder, with no breaks or fractures, and 2 days out, already hitting about 50% of my range of motion. The doc recommended a wait-and-see. Said about 4 weeks from the pictures.

    All told, I'm pretty happy, considering I came down from 6 feet on top of it.

  9. #584
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    Hi All

    Here's an 8-month follow-up report to my grade 3 - operated with the double tightrope procedure acutely.

    In my first post I was saying I wanted to be get back to surfing - mission accomplished. No worries. Super weak on the injured side to start off with, but that disappears within a week or so of hard paddling (I have to say that I spent a session or two in the local pool for about 8 weeks before I started surfing again).

    As for daily things - carrying around bags can be a bit annoying when the straps go right on top of the tightrope button that sits on top of the clavicle. My AC also clicks occasionally now - when reaching across the body or putting arm far up behind the back. But in comparison to what I hear from guys who haven't had the OP - there's no "crunching", just a bit of what they call "crepitis". Doc said I will/might have arthiritis in 10 - 15 years time. I don't think that's a problem as long as it's just the AC - they usually just do the clavicle resection OP.

    There's still a little lump, but I think I'm the only one who notices it...According to the literature the tightropes give a little over time and the gap increases.

    Here's some exercises that I found to be good (on advice from Physio):
    * Y's, T's and I's
    * Lateral raises with small weights and big reps

    Cheers

    Greg

  10. #585
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    Hey all, I've been reading these forums since I did my own grade three separation at the end of July '12 (almost 8 months ago) and found them helpful so I figured I'd add my two bits.

    Separated my right (dominant) shoulder bailing on a way too steep BMX jump at a jump park. I had just finished a ride with a friend and was feeling good on my trail bike with clipless pedals. What was I thinking?

    Anyway was diagnosed with a separation by emergency room doc. Made an appointment with my own doctor about 10 days later who confirmed a grade three. Told me to live with it and that I'd still make my planned trip to Moab two months after the injury.

    My wife is a nurse and she told me that I should avoid the surgery if it wasn't required because of all the things that can go wrong when they cut you open and start messing around.

    First while after the injury was brutal. Had to sleep on my back. I was in a sling for about 2.5 weeks. My shoulder fatigued from just having my shoulder out of the sling.

    Saw a physio who gave me some really basic exercises that I did with a two-pound sack of coins (tied into an old sock). Five pound weights were too much. One thing that helped was leaning forward and using a table for support and then gently letting my injured arm hang down and very gently swinging it like a pendulum in circles and back and forth, side to side. You can find pics/vids on the web I'm sure.

    So I really took it easy the rest of the summer. I did physio daily but sat on my duff most of the time. Slowly the strength returned and the pain subsided.

    By the time the Moab trip came around I was a bit nervous of getting out on the bike. I went for a few timid rides near my place and figured I was good enough. Gotta get back into it.

    I went down with a handful of guys for the Outerbike show in the fall. I'm glad I went, I rode 8 days hard riding. It was the first real riding I'd done since the injury and actually I have to say that my saddle was more in agony than my shoulder. Although by the end of day eight, going from zero riding to eight days straight my shoulder felt like it was going to fall off. This went away with rest though.

    I keep generally active and over the winter I did about a month of the P90X workout program. That helped with strength and I didn't have any shoulder discomfort at all during this time as the increased strength helped. I have since fallen off the 1.5 hrs a day six days a week wagon.

    I had to modify some of the exercises a little but overall I was fine. The only exercise that gave me problems was a side raise where I'd lie on my side, tuck my left arm/hand up on my right shoulder and lift myself up with my right (injured) arm/shoulder. My clavicle would move around in there and even make some "shloop, shloop" kinda sounds. hearing those made me a bit queasy and I stopped doing that exercise.

    Fast forward and a couple of weeks ago I was doing a pushup -- I'm lucky pushups haven't been too much of a problem for me, same for sleeping on my side. I heard a tearing sound and my shoulder popped a little bit. It was really weird, I was tender and a little sore, but my shoulder (especially my clavicle) felt much more solidly attached.

    I told my wife the good news and she told me to call it a "readjustment" instead of a tear followed by a pop.

    Has anyone else experienced anything like that?

    Overall shoulder is definitely getting more solid. I have some discomfort in my right trapezius, associated with weakness I think -- I really should get back on the workout program but it's nice out now and I want to ride.

    Riding has been fine. I can ride anything I used to bunnying and pulling up on the bars is no problem.

    I do have a lump on my right side. It's not so bad, I tell myself. And only one person has pointed it out to me so really nobody's looking at it but me (which I seem to do a lot).

    I'm hopeful that the weakness/discomfort goes away. I think that going no surgery was better for me. Got me healed more quickly for sure. Good luck to anyone out there with this injury.

  11. #586
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    Update time.. I went to the doctor monday and got good news.... I don't have to go back! 18 weeks post op and I was released from care. I can finailly get into the wood again although he said slow and easy for another 6 weeks and careful after that. He wants the allograph to fully strengthen and says 6 months it should be there. I feel great ROM is almost 100% in every test. Strenght is getting better every week. At this point I feel great and I'm really glad I had the surgery.
    As someone has stated here already everyone is different and every injury is too. There for take my posts as you will for what every its worth to you.

    I'm ready to put the new Tallboy LTc in the woods for sure! I will tell you it won't be hard to take it easy as I really dont want to travel this road again!!!

  12. #587
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    New to the forum and guess what AC SEP stage 4. due to my occupation surgery was a must. cant ride, cant golf, cant do anything. having Surgery April 8th and was wondering what i should exspect and if there are any MUST HAVES prior to the cutting. ie recliner, plenty of pain meds

    any help would be great.

    happy trails

  13. #588
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    Separated shoulder at about 13 never x-rayed it, just toughed it out. 4 months ago hit some rocks on motorcycle, had x-rays, a good grade III sep. Oh by the way I'm 55 now. Just had Anatomic Coracoclavicular Reconstruction 11mar2013. Hoping for the best, being very careful to use sling.

  14. #589
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    A recliner is great for the first few days. I only spent 3-4 nights in it then sofa and then the bed. Get an extra sling to take shower in the first 2 weeks I had to wear te sling 24/7! After that I could take off the shower and dress and thats was it!! 6 weeks is a really long time! Your should (orat least mine) will freeze up and grow to be very weak. Don't push it, if you read this thread completely there has been a couple of guys that have and had to go back under the knife for a re-repair. I'm not going there if at all possible! As far as pain meds I took them for about 3 days and stopped all together, I really hate the way they make me feel and the pain was not too bad. Don't get me wrong I was sore. I have had a good result with the surgery. My ROM was very slow and strength is still not 100% but I feel very close to normal now. Good luck guys its a long road but not too bad other wise.

    Andy

  15. #590
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    Almost at 4 weeks after injuring the shoulder, and I have, generously, 95% of my RoM back. My strength isn't where I would like it, but I started riding on the road last week, and it has helped in that area tremendously. I still have a little bit of a pulling sensation when I reach down to the left, but most of the pain subsided around the same time that I gashed my fingertip with a rotor! After the tetanus shot that I got just about two weeks ago, my other shoulder has been giving me the majority of my pain. It would appear, as they say, that I cannot win.

  16. #591
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    Andy

    Thanks for the reply, you may have said previously but did you have anatomic reconstruction with tendon grafts or another procedure.
    Thanks again

  17. #592
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    Andy thanks for the heads up. i hate painkillers as well. how long did you go from injury to surgery? and what kind of surgery

  18. #593
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    When I first went to the doctor he checked me out and told me to come back in 2 weeks so surgery was about 3 weeks after injury. I was injured on sept. 24 and had surgery on nov. 20. I did have teh anatomic repair with a allograph (donor tendon). Pain wasn't too bad really, I was sore and your not going to move it period. I froze up really bad in the shoulder after being in a sling for 6 weeks. The last 2 weeks are tough you are not sore from surgery and want to move it and get the show on the road so to speak.
    ccrecon your half way thru the sling and well on your way. You guys be careful and wear the sling!
    My new tendon hasn't streched at all, I have no bump and I am getting to where I can sleep on that shoulder again with my arm over my head it has taken a while for that.

  19. #594
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    Ac sep

    Andy

    Thanks

  20. #595
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    I fell a year ago - level 2/3 seperation. I couldnt lift my arm for a month and it was three before it was pain free & stronger. Broke a lot of things....but this was the worst. Went to PT and did the exercises on my own since then. Lots of light weights and reps 2x a week. It felt as good as new after 4-5 months - until I fell on the same shoulder last month!

    No pain this time - worked OK vs. 1st time - but now its closer to a four...ripped evertying off - a big bump and very lose. I can move the collarbone about a half inch back and forth - shoulder too. Going to rehab myself it again.

    I wouldn't reccomend surgery to anyone - I think it hurts more / takes a lot longer.....(unless your a pitcher). Check with a sports ortho guy - get a few oppinions. Remember they only get paid when they do surgery.

  21. #596
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    seem to be a touchy subject Surgery vs Non surgery. after 4 consultations with 4 different surgeons, i feel that in my case surgery is a no-brainier. after reading this entire blog it seems to me that people with a grade 3 or higher that chose not to have surgery noticed a drop in there range of motion, and for some mild discomfort longer down the road. as a PGA golf professional i cant take that risk. Surgery bound and cant wait.

    i think you (chief muckymuck) should possible talk to a orthopedist to see if your injury could be recurring due to NOT having surgery. Either way this Forum is a really good testimonial for anyone having to weigh the options for surgical/non surgical treatment. im really happy its here for people.

    i hope your Shoulder Heals up soon.

    see yah on the trails
    NV-Nelly

  22. #597
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    Ok - no surgery unless your a pitcher... or a PGA golf professional. A little lose....not quite as strong for awhile. A little lose & sloppy is your problem...not relevant to 99.98% of the population.

    Recurring because I flipped over the handlbars and flew 10 ft. and landed directly on my bad shoulder on a big jump / downhill....nothing to do with not having surgery. As a matter of fact it would have been worse if I hadn't built up all the muscles for the last year - thats why it wasn't as bad this time even though the injury was much worse.

    Good luck you you -and given your profession it is a no brainer...but most of the other people i've read about on this site DONT need surgery...just time and the correct exercises. I'd suggest everyone else who doesnt need 100% accuracy try the no surgery option for at least a year. If it doesn't work you can always do it later.... I've had no loss of range of motion either time - Make it move and it does.(12 yrs. of Yoga...welcome to CA) Sloppy is different. Busted AC's are a bit sloppy...esp. 3+

  23. #598
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    Quote Originally Posted by chief muckymuck View Post
    Ok - no surgery unless your a pitcher... or a PGA golf professional. A little lose....not quite as strong for awhile. A little lose & sloppy is your problem...not relevant to 99.98% of the population.

    Recurring because I flipped over the handlbars and flew 10 ft. and landed directly on my bad shoulder on a big jump / downhill....nothing to do with not having surgery. As a matter of fact it would have been worse if I hadn't built up all the muscles for the last year - thats why it wasn't as bad this time even though the injury was much worse.

    Good luck you you -and given your profession it is a no brainer...but most of the other people i've read about on this site DONT need surgery...just time and the correct exercises. I'd suggest everyone else who doesnt need 100% accuracy try the no surgery option for at least a year. If it doesn't work you can always do it later.... I've had no loss of range of motion either time - Make it move and it does.(12 yrs. of Yoga...welcome to CA) Sloppy is different. Busted AC's are a bit sloppy...esp. 3+
    There is little debate about grade 1/2, no surgery. Grade 4 and above indicate surgery. Again, almost all parties involved agree with that. The only time it's debated is for grade 3. Speaking in absolutes is not helpful. Every person is different, every injury affects people differently. For some people, surgery is the better option. Others live the rest of their lives without surgery or problems. I do agree that it's best to try rehab for a year before getting surgery on a grade 3.

    I tried no surgery for 5 years. I went 6 months after making it a grade 5 before surgery. I wish I hadn't waited so long to get it done. I'm much better off than before surgery, better than before making my grade 3 into a grade 5. It's been so long, I don't remember what 100% (pre-injury) feels like, but I'd say I'm there.

    Also, not all surgeons suggest surgery just to make money. Mine kept me from doing surgery for several years. It wasn't until I made things worse by falling again that he said surgery was the better option.

    My other shoulder (not the one I had surgery on) has a grade 2 separation. It's been 6 years since that injury. The only time I notice it is doing push ups. I wouldn't even consider surgery for that.
    Last edited by dwnhlldav; 04-06-2013 at 05:57 AM.
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  24. #599
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    Andy made some great points. I bought a second, cheap sling for wearing in the shower. Sling was on 24/7. If I was sitting in a recliner with my elbow supported to keep weight off my shoulder, I was allowed to take my arm out of the sling and move at the elbow. My shoulder didn't freeze up completely, but it did take a a few months after getting out of the sling to get my ROM back to normal. I swim in addition to riding. I'm now back in the pool, and I notice that my repaired shoulder is still much tighter than my injury free shoulder. Swimming takes a lot of shoulder flexibility so even thought the doctor and pt say my ROM is back to 100% against their standards, I don't think I'm back to my 100%, but it's coming.

    I took pain meds for 3-4 days then stopped. I started taking them again a few days later, but only at night so I could sleep.

    It's been almost 6 months since surgery. I still can't lay on my repaired side for more than 20 minutes before it gets irritated, but I couldn't lay on it at all before surgery.
    Disclaimer: I no longer fix bikes for a living.
    National Ski Patroller to feed my winter habit.

  25. #600
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    I picked up an EVS SB03 (shoulder brace) today. I'll have a review in a week, after using it for a while, but my first impressions are quite nice. After about 20 minutes of getting used to how it feels (and apart from it being made of neoprene, ie: breathable as a rubber suit) it has my shoulder bump fairly smoothed out, but still obvious.

    More to come as it gets used more.

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