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Ac Separation (shoulder Separation)

495K views 1K replies 376 participants last post by  weevie 
#1 ·
I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The Doctors Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!
 
#62 ·
I did mine 2 1/2 weeks ago. I went to the ortho yesterday and he told me that I had a mild grade 1 seperation on the ac. I was feeling really good until I went to the Chiropractor. The ER doc said that I had only inflamed the tendon so I figured a good adjustment would get me back on track faster. I have had really bad pain since the chiro. I told her to stay away from my shoulder but I guess she new more about my body and what pain level I had then I did. Thanks to her she upgraded my inflamed tendon to a grade 1 seperation thus sayeth the doctor. Oh well. I am starting all over with the healing process....:madman:
 
#63 ·
Hey folks,
Just got back from my Ortho follow up. He was impressed with how much I've healed in 4 weeks. At the moment I've got full range of motion, and 70% strength. And I wasn't exactly a powerlifter prior to the injury. The Doc said I'll continue getting better for 6 weeks or so. I already forget about it. It will never be 100%, but I'll probably only notice the injury when I look in the mirror. The best part is I'm cleared to ride and work out, and get back to flying!
 
#64 ·
Me too

About 4 1/2 weeks ago i did a nasty endo on my head. The Doc in Urgent car said I had just pulled the ligaments in my back. Sent me home with muscle relaxants and a pat on the head.

I started PT about 2 weeks later. The PT said, your left shoulder is higher than you right. He said must be muscle spasm. I went along with that diagnoses until this week when i said BS. I want another opinion. The pain was too great after 4 weeks just to be a muscle spasm. :nono:

Sure enough, I see a new Doc today and he says it's an obvious AC separation. Now I get to start over with a sling and more PT in two weeks. :thumbsup:
 
#65 ·
I'm one month on from my Grade 2. Everything is feeling quite good in terms of healing and day to day activity. Riding off-road is still a long way off. I tried yesterday and it was hopeless. The first gentle dip tugged at the shoulder - nothing to undo any of the healing but the promise that one false move could set me back weeks.

It seems mountain biking needs shoulders to be at pretty close to full strength.:( I pretty much figured this was going to be ~3 months before I'm going to be back in action properly.

More information from GPS logs on the accident itself shows that it all happened at 40kmh (25mph). After the pedal strike I was airborne to the point of impact. The more I think of it the more I realise I was lucky to get away with just an AC injury. It is going to take a while for my confidence to come back.
 
#66 ·
I am about 6-7 weeks into mine. I have very little pain but my range of motion sucks. I cannot raise my left shoulder high enough to get stuff out of my jersey pockets. I have the strength back I just cant move very well. I have been riding but I have been taking it really easy. I hope I dont fall on my shoulder again. Does anyone where any sort of shoulder protection? I wear a chest protector when I ride my dirtbikes but there doesnt seem to be anything out there for the bicycle crowd.
 
#68 ·
G-reg said:
Well the verdict was level 3-4, with the dead guy ligament surgery as the recommendation. He only thought it would add a few weeks to recovery compared to leaving it alone. Being an active person was a big part of them suggesting surgery, and this was from a respected Ortho from a sports medicine clinic. He implied that doing nothing and just leaving it there, especially with grade 3, was more for folks who don't plan on hitting the gym after re-hab. The dead guy ligament is to reconstruct the inner ligaments and then they can repair the outer one, eventually giving a 100 percent joint without the crazy bump and equal length arms.
Thanks for posting on this AC joint problem. I have one from a single track fall and it really prevents some activities. I've been looking at various options. My concern has been that some of the stuff I read on the surgery is that there can be problems down the road from making the joint too stiff. Has anyone heard of this new Regenexx procedure? Sounds interesting as they place your own stem cells into the shoulder to heal the ligament tear (see www.regenexx.com). I'm also considering prolotherapy, but have seen pros and cons on the web. Have any of you had either of these?
 
#70 ·
I endo'd on my bike a week ago and suffered a Type III AC Separation. The acromioclavicular and coraclavicular ligaments are completely torn from the collarbone. I went to the ortho and he recommended that I don't initially receive the surgery. He said considering that it was my left arm (my non-dominant arm), the fact that surgery has the potential to cause arthritis problems down the road, and that recovery can be 6-8 months it would be best to see what happens without surgery. The first week sucked. I couldn't do anything with my arm and it felt like it was hanging differently (because it was). The pain has subsided but I can still feel the collarbone loose in my shoulder (feels pretty weird). I bought a shoulder brace and wore it through the weekend. I can't do much with the arm (it is stiff to move and hurts as I raise my arm above shoulder level from the joint rubbing) but the brace supports it. I can put a little weight on it now, but not much. I hope to be able to ride at least a bit by next weekend. We'll see...
 
#72 ·
jesse.futrell said:
I endo'd on my bike a week ago and suffered a Type III AC Separation. The acromioclavicular and coraclavicular ligaments are completely torn from the collarbone. I went to the ortho and he recommended that I don't initially receive the surgery. He said considering that it was my left arm (my non-dominant arm), the fact that surgery has the potential to cause arthritis problems down the road, and that recovery can be 6-8 months it would be best to see what happens without surgery. The first week sucked. I couldn't do anything with my arm and it felt like it was hanging differently (because it was). The pain has subsided but I can still feel the collarbone loose in my shoulder (feels pretty weird). I bought a shoulder brace and wore it through the weekend. I can't do much with the arm (it is stiff to move and hurts as I raise my arm above shoulder level from the joint rubbing) but the brace supports it. I can put a little weight on it now, but not much. I hope to be able to ride at least a bit by next weekend. We'll see...
I feel for you, sounds like my situation a couple of years ago at this same time of year. Non-dominant arm and doc said about the same thing. I was riding again in about two to three weeks. Didn't really bother the injury to ride for some reason. There were a lot of other things that I could not do though if they involved weight bearing or lifting. Lots of those things just take time.

Try stretching/lifting the arm upward by using a wall to walk your hand up and back down. I found this really helped to get the range of motion back. Best thing is to start physical therapy ASAP if you possibly can. If not available then at least start using rubber resistance bands to start building strength back. Search the net for physical therapy for the shoulder and you will find a lot.

Yes it will feel weird probably from here on out. Mine still pops and moves around strangely even after two years. The bump is still there and it does still feel like my arm hangs lower than it should unless I concentrate on holding it up in position. Strengthening exercises do help though. Your shoulder position will now depend 100% on muscle strength and tone since you no longer have the joint to bear the load.

Also see my post #32 above if you are concerned about crashing again.
Good luck :thumbsup: .
 
#73 ·
Just to check in again, 8 months later. Cliffs notes: Class 2, 3 or 4 depending on who I asked. Ended up not getting surgery. Strength is nearly 100%, the strange situations where it's less than 100%, my uninjured shoulder is pissed too. Looking back, I'm REALLY happy I didn't have surgery. My understanding was that unless the injury was operated on within 24hrs, the main joint will never be repaired. Very few of the surgery options did anything more than trade the goofy bump for a scar. The ones that repaired the joint didn't give me a warm fuzzy about the actual usefulness of the joint after all is said and done. Looking toward drinking less and training more for next season, I'm not scared about re-injuring that joint......it doesn't exist anymore.
 
#74 ·
kmacon said:
I feel for you, sounds like my situation a couple of years ago at this same time of year. Non-dominant arm and doc said about the same thing. I was riding again in about two to three weeks. Didn't really bother the injury to ride for some reason. There were a lot of other things that I could not do though if they involved weight bearing or lifting. Lots of those things just take time.

Try stretching/lifting the arm upward by using a wall to walk your hand up and back down. I found this really helped to get the range of motion back. Best thing is to start physical therapy ASAP if you possibly can. If not available then at least start using rubber resistance bands to start building strength back. Search the net for physical therapy for the shoulder and you will find a lot.

Yes it will feel weird probably from here on out. Mine still pops and moves around strangely even after two years. The bump is still there and it does still feel like my arm hangs lower than it should unless I concentrate on holding it up in position. Strengthening exercises do help though. Your shoulder position will now depend 100% on muscle strength and tone since you no longer have the joint to bear the load.

Also see my post #32 above if you are concerned about crashing again.
Good luck :thumbsup: .
Thanks bro, the shoulder is already feeling better. I'll post back after my first ride. For now it's work on the stationary bike
 
#75 ·
ok guys its been 10 weeks, It was doing good and pain free untill a day ago. I tried to do a push up and it hurt a little so I didn't to any more, then today it's been hurting just about all day. Did I really re hurt it by doing a push up? How long did it take you guys before you could do push ups pain free?
 
#76 ·
Dude,

If you are still suffering from pain after 10 weeks, you need to see a good shoulder ortho today. You may have some other issues other than a separated AC joint. You should be able to return to activities after 6 - 8 weeks with little or no pain if the separation was a mild one. Good luck!
 
#77 ·
Here is my shoulder story. Last August (08) I dislocated my shoulder, it was out of the socket for a couple minutes and slid back in on its own. Being the stubborn (stupid) man that I am I chose not to go to the doctor. Basically just rested and worked on range of motion for a couple months. I tried lifting weights again this winter only to reaggrevate something in there, laid up for another few weeks.

A couple days ago I took a pretty mild spill, arms outstretched to brace for impact. I felt the shoulder pop out a couple inches (out the front side) and as I was getting back up it it slid back into place. Not really much pain, I contemplated to keep riding. Now the rear of my shoulder is sore, and am kinda back to square 1.

Does anyone have a link of exercises I can do to strengthen the entire shoulder. I travel a lot for work (months at a time) so its not the easist to get into a doctor or a regular PT program. Thanks for any insight given!
 
#78 ·
BTDT... Type 3 separation after flying over the handlebars going downhill in a race.

I researched the hell out of this injury and read every article I could on it. Visited three orthopedic docs, all told me to let it heal on its own and see how I do. Six weeks of PT, and about 6 months later it was 90% of the way back to normal (normal being full range of motion and strength), a year later I was probably 98%.

Will always have that hideous bump though. There goes my modeling career.



 
#79 ·
Shoulder Separation is different from Dislocations

LAXCARP,

You seem to be suffering from shoulder dislocations and this is a much different problem than a separated shoulder. There is a real limit to how much you can strengthen the shoulder to keep the shoulder socket from popping out, there are ligaments and other structures in the shoulder joint that hold the shoulder in place and these can get stretched and damaged when you pop the shoulder out. The bad news is that while proper PT will make your shoulder feel better it may not make that much of a difference in your shoulder stability. The good news is that there is alot that a good shoulder ortho can do to tighten things up - but it may involve a surgical procedure to do so. Best of Luck!
 
#80 ·
Just did myself a grade 2-3 AC separation yesterday while practicing 4x at the BMX track. You know, dumb crash because of a big round rock that rolled on the track accidently. Doctor said, after the X rays confirmed no fractures, to wear the sling for about 2 weeks and go to PT. Right now, the pain is not to bad, and I have a pretty good range of motion even if I feel limited in a couple of position.

Any tips on what to do for sleeping, as it seems to be the worst part for me yet. Do you keep the brace on for sleeping?

Thanks guys and fast healing to everybody.
 
#81 ·
zoro said:
Just did myself a grade 2-3 AC separation yesterday while practicing 4x at the BMX track. You know, dumb crash because of a big round rock that rolled on the track accidently. Doctor said, after the X rays confirmed no fractures, to wear the sling for about 2 weeks and go to PT. Right now, the pain is not to bad, and I have a pretty good range of motion even if I feel limited in a couple of position.

Any tips on what to do for sleeping, as it seems to be the worst part for me yet. Do you keep the brace on for sleeping?

Thanks guys and fast healing to everybody.
By the sound of it you have a fairly low grade separation for 2-3 since you can lift your arm at all at this stage. It took me at least a week to get my arm to shoulder level then I really had to work to lift to the sky. Do the physical therapy. After ripping your tendons/ligaments apart, the only thing that holds your shoulder in position is the strength of the muscles. Strength training for the shoulder became much more important to me after the separation.

Sleeping was definitely the worst (with the exception of getting up off the floor from a lying position). The first few nights I tried sleeping on my back on some inclined pillows and could at least lean toward the side. After a while I got a really thick (firm) pillow that holds your head and neck up high off the bed. This takes a lot of the pressure off of your shoulder wanting to fold over.

Two years out and still sometimes I get up and feel that I put too much stress on the shoulder while sleeping.

Good luck, maybe you will heal fast.
 
#82 ·
Zoro,

kmacon already gave you some great advice. Some stuff I would add to the mix is this:

1. Try to get yourself off the sling as soon as you can. Only wear it if you feel discomfort.
2. Start slow but try to recover your range of motion sooner rather than later.
3. Be diligent about PT.

Monitor the progress of your recovery. You should not be in pain after 4 - 8 weeks, you may still have some strength deflicit in the injured shoulder, but you will eventually work this out. If you are experiencing significant discomfort or have not regained your range of motion, you should consult with your doctor again. Also before you start doing strength training, you should get cleared by the PT or Doctor.

While the shoulder will heal over time, you may have lost some (Grade 2) or all (Grade 3) of the ligaments that hold your shoulder together. Strength training will be key to you being able to return to your sport. You may also need to alter some of the things you do for strength training, i.e. NOT doing the bench press or at least modifying it since this excersize places such stain on the AC joint. Consult with a good sports trainer about how to proceed.

Good luck.
 
#83 ·
Thanks for the support and tips guys!

As for the sling, RacerX58, I thought having it stabilize your shoulder was supposed to be an important part of the healing process, as it helps to put everything 'in place' together again. I would feel comfortable to go on with my day without it, but I don't know if it's a good idea yet.

Right now, (2 full days after the crash), I can move arm shoulder high without pain in most positions, except when moving it backwards. Pain mostly comes when I do a sudden move or try to lift something.

Last question: when should one start the PT treatment? I know it varies from individual to individual, but what would be a rough guideline??

Thanks again!
 
#84 ·
Zoro, it is important to use the sling - but if you use it too long - you may get some painful adhesions when you start using your shoulder again. So try to reduce your use of it, key here is that you do not feel discomfort. Another thing to consider is the position of your shoulder, chances are your shoulder is pulling a bit forward because your muscles are trying to support it. You might experience some tightness because of this. A person familiar with muscle release therapy can help you with this and it will really make you feel more comfortable. Just make sure that the person knows how to treat arm and shoulder injuries.

As for PT, it varies quite a bit and you seem to have medium grade shoulder separation of either a type 2 or 3. If it is a type 2, you could return to activities and begin more active PT at 2-4 weeks, if you really have a type 3 - then it can take 6 - 12 weeks. It really has to do with your level of discomfort and the types of excersizes you can do. Range of motion stuff you can do as soon as you can tolerate it. But in general don't hurry and don't push yourself to get your strength back. The first 6-8 weeks of recovery from an injury is very important, so let your body heal. Here are a couple of links you might find useful:

This is an excellent source of information about AC separations.
http://www.uptodate.com/patients/content/topic.do?topicKey=~8Xm8h.pwl70pNy

This is a link with rehab excersizes that you may find beneficial
http://www.med.umich.edu/1libr/sma/sma_shldsep_rex.htm

This is a recent article about Grade/Type III AC separations and treatment
http://www6.aaos.org/news/pemr/releases/release.cfm?releasenum=788

Take care,
 
#85 ·
Thank you very much for the links and the tips (especially the one with the exercices). As for the position of the shoulder, you might have touched a point there. I just don't know if the position I have it in in my sling is the proper position to adopt. Seems to induce more pain when I am in the sling than when I have it loose.

Will try to consult for that, or call PT maybe to schedule an early appointment in order to have tips for the use of the sling etc...

Happpy healing to everybody (if there is such a thing...)!
 
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