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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!!!
 
#102 ·
Like your wells quote btw... I use that in my class whe teaching debate basics....

I can raise my hand over my head real slowly... I know this is stupid but.. I am thinking Idont ride my bike with my arms raised :)

I am feeling almost confident enough that I am internally debating to ride or not..
I ride about 80-90 km a day going to classes..
I knoe I cant do that now... but was thinking 26 km in 13 km splits...

The thing is half of my route is through peasant villages in China.... I am clearly aware that even in my safety zone I can srew up my body for the rest of my life as what got me hear was going over the bars completely unexpected from an unseen speedbumpp... I mean who the hell would have thought.

The biggest issue to me riding right now is I am thinking I should buy medical insurence as I have two children and one on the way. I naever thought I would get hurt on a bicycle... but all y iuds depend on me and yeah the streets i china are dangerous but I got taken out by a spedbump on a street with no traffic... Freak accidents I guess can happen. I mean going down ski slopes in Germany or coming down out of the mountains in colorado 50 mph on a bike thats too small doesnt kill me... it is the speed bump going 14 kph...

SO I guess I am going to have to get insurance.. But my bike is chained to my office desk and it is soooooooooo tempting... I seem to get fatter each day and cant stop drinking beer... I want to ride so bad.
 
#103 ·
Grade 3 separation

I suffered a grade 3 (left side) in a snowboarding accident in early Dec. 2009. Now Feb. 2010, I have regained motion, and strength seems to be returning. I have returned to the slopes. I still do favor it a little. My biggest concern is my arm gets achy when I'm on my feet for a period of time. Example: if I'm at the mall or shopping for an hour, my arm starts to ache. My arm also gets achy when I wear my brace skiing and snowboarding, but it won't ache if I leave the brace at home (always have a backpack on). Sleep is still uncomfortable on the left side.

My question is, will the the aching go away with time, or is it here to stay? I also have the "bump" and its hideous. Does the self-consciousness go away with time too?

Thanks, and sorry for thread jacking.
 
#104 ·
Aches and Pains

I suffered a 4th degree (the AC and CC were completely torn) back in Spring of 09 and I still have the aches and pains. I am now at a point where I can do just about everything I could do before. The only holdups I have is doing heavy resistance stuff like pullups or pushing heavy weights in the gym. When things get heavy I can feel the ligaments pulling and don't wanna risk hurting it. But I still encounter soreness on a regular basis but never any real pain.

I do remember how wearing a backpack caused minor aches and soreness early on. This went away a few months ago. I would get tightness in my shoulder on the side of the injury. I would guess that will go away for you. Just stretch it out (I twist my back opposite of the injury and it helps).

I don't wear my brace often but i did just last month when I went snowboarding and while I never felt pain (I fell a lot :) I did experience soreness. Currently I mountain bike (absolutely 0 issues and I ride pretty hard), do triathlon (sometimes swimming will cause soreness) and run (13+ miles I feel that side fatigue quicker than the other but just soreness). I don't wear my brace through any of this.

The last two weeks I've started playing basketball which I was really worried about. I play pretty hard and I wasn't sure how my shoulder would hold up because the shoulder moves alot and has some sudden jolts quite often. There are times when a quick jolt will be uncomfortable (not painful) but no lingering pain, just moderate soreness.

So to answer your question (simply from my experience), the soreness hasn't gone away yet (I'm seeing it subside through time) but the functionality is all there and there is no pain. I just stretch it out and it feels much better. I did get a massage in summer and it was AWESOME! Just play it safe and don't push it too hard, let it heal.:thumbsup:
 
#105 ·
Damn... here I am .... 4 months nealry later and I can say it is sore everyday still... not as bad... I got range of motion .. but if I raise my hand straight up... I can do it.. but it hurts. I dont know if I should do it a lot and hopefully the pain will go away? I am sick of the sore ness.. cant wait...
I can mountain bike.. mainly road bike.... its sore but works
 
#106 ·
i got hit by a car one week ago today and landed directly on the shoulder. i didn't see a doctor because i hate going, it's bad for our companies worker's comp rates, and i knew they would try to make me stay off of it. and i'd rather work if i can. just in the last day or two the swelling in my shoulder went down enough that i could really clearly follow the clavicle and make sure it wasn't broken, but i figured it wasn't because i've had very little pain the whole way through. but i finally with internet research was able to self-diagnose as a level 2 or 3, probably 3 AC separation. i wish i'd known earlier, so i could have taped it for support during that vital first week of healing. i'll still tape it from now on. here are some pictures of the injury, one week after occurence.

https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00198.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00197.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00196.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00199.jpg

but the truth is... the shoulder locked up after about 20 minutes to where i couldn't lift the arm near shoulder length. by one or two days after, i could lift the arm above shoulder height again. of course with pain, but i could do it. the most painful things i've done is pulled up on the handlebars (no curb hops for me this week) and lifted something kind of heavy into the bed of a tall pickup (lifting up was fine, setting it back down in the truck a foot away from the body was what hurt). the second most painful thing i do is to swing my bike chain lock around behind me to catch it with the other hand. it's hard to switch hands with this habit, but switching helps enough to make it worth it. other than those things, i've used it pretty regularly already. so, i don't think i would consider surgery or even consultation because i've worked 9 hour days as a messenger, sometimes with up to 40lbs in the bag weighing on the shoulder, beginning about 30 minutes after the accident and through this whole week.

SO. with that long bit out, here is my final question though - after the injury does heal, what will a trauma incident to the same area do later? is there increased risk, or is there maybe decreased risk because significant scar tissue has formed and the joint isn't even there to break anymore?

p.s. the last picture is to show where my bag rests for work.
 
#1,307 ·
i got hit by a car one week ago today and landed directly on the shoulder. i didn't see a doctor because i hate going, it's bad for our companies worker's comp rates, and i knew they would try to make me stay off of it. and i'd rather work if i can. just in the last day or two the swelling in my shoulder went down enough that i could really clearly follow the clavicle and make sure it wasn't broken, but i figured it wasn't because i've had very little pain the whole way through. but i finally with internet research was able to self-diagnose as a level 2 or 3, probably 3 AC separation. i wish i'd known earlier, so i could have taped it for support during that vital first week of healing. i'll still tape it from now on. here are some pictures of the injury, one week after occurence.

https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00198.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00197.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00196.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00199.jpg

but the truth is... the shoulder locked up after about 20 minutes to where i couldn't lift the arm near shoulder length. by one or two days after, i could lift the arm above shoulder height again. of course with pain, but i could do it. the most painful things i've done is pulled up on the handlebars (no curb hops for me this week) and lifted something kind of heavy into the bed of a tall pickup (lifting up was fine, setting it back down in the truck a foot away from the body was what hurt). the second most painful thing i do is to swing my bike chain lock around behind me to catch it with the other hand. it's hard to switch hands with this habit, but switching helps enough to make it worth it. other than those things, i've used it pretty regularly already. so, i don't think i would consider surgery or even consultation because i've worked 9 hour days as a messenger, sometimes with up to 40lbs in the bag weighing on the shoulder, beginning about 30 minutes after the accident and through this whole week.

SO. with that long bit out, here is my final question though - after the injury does heal, what will a trauma incident to the same area do later? is there increased risk, or is there maybe decreased risk because significant scar tissue has formed and the joint isn't even there to break anymore?

p.s. the last picture is to show where my bag rests for work.
It can be tough to tell with an external picture versus an xray. Mine looked a lot like yours and I suspected a 3 but when I made no progress in 2 months and went to the doc it turned out to be a 2 based on xrays. 8 weeks of PT - mostly using those bizarre suction cups to encourage blood flow, did wonders. This was my 3rd time on this side and I'm back to about 99% after 6 months, but it did seem easier to injure this time.
 
#107 ·
Im not a doctor.. your bone sticks up more than mine. In fact I cand figure out why my bone doesnt stick up as much as others... but I have a little bigger neck muscle so mabe I cant see it sticking up so much because its hidden? I wrapped mine up for like 5 days really hard and kept it immobile.. I couldnt even hardly walk for 4 days the pain was so intents. i kept my forarm bent parralel to my body .. I needed help just goin to the bathroom for 3 days + and taking a shower by myself was almost impossible for a week. I try not to think of myself as a *****, but all I had was some mild muscle relaxers and liike ibubufferin . I sear I thought It would never heal... but 5 months later I am 90-95% back to normal. Some advised the operation, some advised it would be cool to heal normally. Id say go natural. But I had this butterflycolarbone brace thing I wore and wrapped my body up forcing teh bone down for a week-2 weeks. Maybe thats why it is not proturudign now? I wouldnt **** with anything or try to be macho about it it will only keep it from healing and stuff. But I am serious to say I had no ****ing choice.. it was very painful.

Good luck,
 
#108 ·
that's what is so wierd to me... the bone protrudes up as far as the model/textbook cases i find on medical sites... enough to definitely hint at a level3 separation. but the pain just hasn't been there for me. certain motions cause me to say "ooo" and retract from the movement quick, but nothing constant and nothing unbearable. so i do believe in trusting your body and its signals, and if it really really needed me to lay off it'd tell me so. but my mind simply thinks that i need to let it rest. so i might trade with a coworker biking for driving (he drives usually but would like to get a little time in the sun on the bike), maybe a week or so.
 
#109 ·
Dinsmore, congratulations, your the new owner of a AC seperation. Even though you are starting to regain strength and mobility, you should still get an x-ray to see if it's a grade 2 or 3 seperation.If it's a 3 then all ligaments are torn and you can't really do any more damage, but if it's a grade 2, then another hit to that shoulder could result in an increase in severity which might require surgery.I'm not a doctor, but to me your seperation looks like a grade 2.I injured mine about six months ago (grade 3)and it looks like a golf ball growing out the top of my shoulder and I have alot of upper body mass.You look pretty thin and with the injury being pretty new doesn't look to severe. Good luck brother.
 
#110 ·
thank you for the warning about protecting if it's level 2. for as much info on the injury as there is on the internet, i found nothing at all about the risks of repeat incidents.

and, yeah, based on the low pain level, only a half day or so of limited range of motion, and the not so bad bump, it's probably level 2 as you say.

do you think med students do free x-ray clinics like they do for some other procedures? ha.
 
#112 ·
dinsmore, the real danger to a repeat incident is that you don't know for certain what grade seperation you have. A grade 3, is that all ligaments are torn, a grade 2, to my understanding is not all ligaments are torn.There are 2 group of ligaments that stabilize the AC joint.
 
#114 ·
The AC joint seems a little over rated. I had a grade 3 sep 8 years ago. I ended up having the bone cut and AC repinned that year, so I wouldn't have the bone looking like it would burst through the skin at any moment. I never had any pain. I had some clicking and mashing of the bone through the muscle when doing shoulder presses or rows. I no longer do chin ups.

I'm happy I had the bone cut and the AC repaired. I brought my shoulder almost all the way back up to normal position. It was limited some my range of movement a little. My shoulder would get pretty sore if I was doing rowing and press type motions. It looked pretty funky to have my shoulder an inch lower on my left side with a protrusion popping up through my shirts. I have paid for a lot of insurance over the years. I'm glad I used it.

Be glad it was not a rotator cuff injury. Those don't have happy endings near as often.
 
#116 ·
LuckySomer - how soon after the injury did you have the Weaver-Dunn?

I did my AC 11 years ago. Level 4, pretty nasty, snowboarding. Hit a quarter wrong, came down on the shoulder. I popped all the ligaments. Had surgery 3 days after the accident but not really sure what was done. I live in Japan and back then my Japanese wasn't good. I know I had a large pin in my shoulder that was removed a month after surgery.

Anyhow, the surgery did nothing apart from taking me out for 3-4 months. As soon as the pinned was removed I felt the clavicle ping like it was on a spring. I can put a finger between the clavicle and shoulder blade. I can't do heavy weight training as the shoulder gets too sore. I'd love to put some muscle on the shoulder so the clavicle is not so pronounced but it just doesn't seem possible.

I'm now thinking about corrective surgery as I'm just sick of being deformed. The Weaver-Dunn procedure looks promising but I think finding a willing ortho doc here will be hard plus it is going to be pricey

I also do a lot of Aikido (I train every day) and some of the throws and locks twist up the shoulder. Sometimes I am simply incapacitated with pain. I'm 37 now and have a lot of active life ahead of and i really feel like the shoulder is holding me back. So I have the jutting out collar bone and nice scar plus vary degrees of pain, soreness and aching. I'd rather do what I do and take the pain though than not do it. But if I could get it fixed by corrective surgery that would be awesome.

Anyone heard of having this procedure done years after the event? I can also feel the onset of arthritis and heard this procedure can also help with that.

Oh, also, that "bump" you all got....well, be prepared for it to get BIGGER. Especially if you're active. Weight training definitely widened the gap by a good few millimetres and I'm sure Aikido has added more. Basically after 11 years and surgery the clavicle is 50% higher off the shoulder than it was after that fateful quarter pipe jump.
 
#117 ·
Update:
I am now 3 years and a few months out from my crash and my surgery using modified weaver dunn, (read my previous post and follow up post). Crash was on 12/26/06 and surgery on 12/28/06 for third degree separation.

My shoulder feels strong and my range of motion is nearly 100%. I can do most all the things I could do before, I choose not to do bench presses as I just don't think they are as functional as push ups. I am happy with the surgery and would not do anything different. My pin is still in, never had it removed.

Hope this helps any of you who are wondering what to do and good luck to you! If you have any questions feel free to PM me.
 
#118 ·
update on mine

Snowboard crash causing separation: 12-5-2009
Today 5-5-2010

The last month my shoulder has been getting worse in terms of pain.

Activity is pretty normal with the effected shoulder. Good range of motion. bump is bouncy and moves around when arm is moved. I am able to work out, but for every hour of working out, there is 3+ days of pain afterwards. Can't be out for multiple hours at a time, Example: denver auto show, after 2 hours of walking around pain was unbearable and had to go home. Normally starts out as a dull ache and escalates the longer I'm on my feet.

I am actually needing some input of those who have had surgery. I am planning on seeing an orthopedic. I hear surgery puts you out for 6 months. Is there supposed to be pain with conservative healing? will there be this pain after surgery?

Thanks for any input
 
#120 ·
I had a 3D+ separation (R) in 1998 and had it repaired. It took about 6 months to heal and get back on the bike. It was a drag but well worth it. My surgeon was able to get to 99% rotation and now I can throw a fastball better with my kids. Go figure. My left shoulder has been bruised a few times (just recently) but seemed to escape any serious injury. The right side has a little bump to match my normaly bumpy shoulders.
 
#122 ·
Just separated my shoulder last Wed. going down a chute on mt bike (done it before). Messed up on line and and next thing you know.... Have no insurance cus just got new job so 2 more months to go and hope they keep me. Should have rode conservatively cus could have been worse and no insurance.

From reading forums and researching web, I have a type 2 separation. Can't lay down on left side. Bump on shoulder is not too noticable. ROM improved from last week. The thing that bothers me is how my injured shoulder is not as wide as the normal one anymore. Looks like it dipped down at the edge so to speak. When I wear T-shirt the sleeve on the injured shoulder appears longer than the sleeve on the normal shoulder.

I know the bump will stay forever but mine is not that noticable, but will the shoulder ever look broad again or will it always be a 1/2 to an inch lower than normal?

Also, Do ligaments ever replace themself or once damaged its gone forever? Do the ligaments get replaced by new bone if ligament cant heal itself? What is the disadvantge if support is with other bone vs ligaments.
 
#123 ·
Grade 1, 2, and 3 separation are generally treated without surgery. Once the ligament is torn it stays that way unless surgically repaired. What ever your posture is now will stay that way. A separated shoulder can lead to other problems in the future. Just depends on how severe it is.

http://www.aafp.org/afp/980215ap/980215a.html

These are the types of exercises you need to strengthen your Rotator Cuff.
 
#124 ·
Sonoran_Flyer said:
Grade 1, 2, and 3 separation are generally treated without surgery. Once the ligament is torn it stays that way unless surgically repaired. What ever your posture is now will stay that way. A separated shoulder can lead to other problems in the future. Just depends on how severe it is.

http://www.aafp.org/afp/980215ap/980215a.html

These are the types of exercises you need to strengthen your Rotator Cuff.
Thanks. I'll probably wait one more week before I do that. Right now I'm just focusing on shoulder shrugs, raising arm up and down with the natural wait of my arm.

Just curious when you say problems in the future, do you mean things like arthritis? Can I choose to do surgery later so that ligaments are fixed. I read somewhere that surgery would have to be done with 3 days for ligaments to be fixed.

When I become permanent at my job and get insurance I will see an ortho just so I can get a better understanding of long term effects.
 
#125 ·
If its grade 1 or 2 probably no or minimal complications. Grade 3 or higher would be of concern. It is just the shoulder is out of its natural position and is using different muscles to support it. This can lead to Rotator Cuff issues 10 to 15 years later. In my case the clavical was just under the skin(punched thru muscle), which can lead to Necrosis (death of skin or infection).
 
#126 ·
I'm 2 weeks into a grade 2 separation that I suffered in the most ridiculous OTB scenario ever.

Usually I bounce back very quickly but this is different. The recovery process is much slower and I now believe my physio when he says "6 weeks" at least.

Trying my best not to lose fitness.

To all the other AC joint injury sufferers out there:

"GET WELL SOON & CHIN UP" :)
 
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