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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!!!
 
#819 ·
An update for the forum:

I am 2 years out from my Grade III from a high speed road bike crash and slide into a curb. No surgery was recommended and things are good, not 100%, but better than I expected. Overall I would say 95% recovered but I'm unlikely to ever get to 100% only because the scapula is not in the same place as it used to be and this provides for some weird sensations. Range of motion is 90%, only limit is touching my opposite shoulder blade. The bump certainly isn't going away and it's pretty weird to be able to move it by pressing on it.

Here are some details:
I was 37 2 years ago when I get hurt, so 39 now. Mostly I'm a rock climber who MTB and road bikes on the side, which if you climb you will understand the frustration with hurting yourself engaged in a non-climbing activity.
The Weill-Cornell surgeon group here in NYC did an MRI and diagnosed the grade 3 separation and suggested PT. I did 12 weeks of band, weight, hand cycle and table pushup PT, which was useful and kept me on a recovery schedule. I didn't continue with PT after the 12 weeks, but did light iron and ROM at the gym every week.

A return to climbing took 2 months, and there was still some pain and clicking with certain motions. After 2 years I am back to bouldering V6 and toproping 5.12 at the gym, though I won't even try certain shoulder intensive moves like steep gastons. Crack and vertical face climbing is OK.

It took a full year until I could sleep on my side without pain and a full year until I could pull up on MTB bars hard enough to clear larger obstacles larger than curbs. MTB seems 100% now, but I am much more cautious and that's less fun. Road biking is totally fine.

I can throw a baseball with no issues, swing the arm around, pump light iron at the gym, do pullups, and carry pretty heavy objects. Pushups don't feel great. But mostly I'm grateful to climb and bike with no pain.

Hiking with a heavy pack (45lbs) is a little challenging as the strap slips off my clavicle onto the AC joint and that kind of hurts. I still do it weekly because it's fun to hike with a toddler on your back. I run sometimes and can feel the shoulder then becuase of all the bouncing.

In summary, you can call me satisfied. The nagging clavicle 'sensations' and occasional clicks have gotten a lot less intrusive in year 2 and I can do what I want in sports. Once my kid gets older and doesn't need to be picked up every 5 minutes I would consider surgery if pain returned or there was some long-term deterioration happening.
 
#820 ·
Palmasi...Great to hear that you are back to somewhat of a good routine. I too am recovering, but I have some serious disdain for professionals who look at your lifestyle and tell you to go the conservative route. Im doing the same now. Yes, I have kiteboarded 3 times, but only at 1.3rd the capacity.... I wish dr's would've been honest with us in the beginning and told us that as athletic people, we will not recover without surgery. Post in 2 more years and let us know if you are in the same health as someone post op after 12 months.
 
#821 ·
This thread is giving me hope. Suffered a Grade 3 this past Friday. Sleeping is the worst. Clearly, time healing is the main factor. Being 63 y.o. and an apparently bad MTBer isn't the greatest combo. Too bad my otherwise awesome bike lacks air bags and a seat belt.
 
#823 ·
3+ last Wednesay.
First two days were bad.
Saw the Surgeon yesterday. She said I was lucky. No damage to the Rotator Cuff. Surgery probably not necessary.
Home PT and ice. Getting some ROM back. Pain is starting to lesson. (Only Motrin once in a while.) Also 60+ years old...

I'll check back in a week.

(Next, I'm going to check on some armour...)
 
#822 ·
5 weeks post crash (yesterday) and I have full range of motion and no pain. I would estimate the strength is somewhere between 30% and 65% of what it should be, depending on the type and direction of the exertion. I can see why many people pass through a Level 3 without any surgery.

However, my shoulder is very unstable (or at least I am very in tune with the instability) as the head of the humerus passes forward and under the clavicle with certain movements like hitting a ball off a racket. I also periodically pinch the clavicle and head of the humerus when I do simple mundane tasks like talk on the phone, which is moderately painful but painful enough for me to cut most calls short. I am a fairly active 44 year old in reasonable shape. Beyond biking in the summer/fall and skiing in the winter/spring, I want to be able to swing a baseball bat, through a softball, play golf, and be able to control a racket. As such, my doctor and I have concluded I am a good candidate for the surgery. While the published research of a controlled set of common every day tasks suggests there is no difference between surgical and non-surgical routes 2 years post, I believe there likely would be a difference between how two athletes (think rock climbers or baseball players) would report their rock climbing abilities two year post for the surgical and non-surgical routes.

Could I recover without the surgery; sure, I guess if I was content to give up or limit myself materially in many of the activities I love--but I don't think I am. Surgery is scheduled for August 13th, with the hope I will be fully cleared to start my ski season late December/early January.

The only reservation I have is the potential for re-injury in skiing and mountain biking in particular.....
 
#824 ·
My AC Separation Story

This threads usefulness has compelled me to also share my story. July 18th, Grade 3 separation from bad crash at mile 32 of the High Cascades 100. Managed to finish the race so was optimistic maybe I didn't do too much damage, Although the giant knob on my shoulder told me otherwise.

An ER visit along with the diagnosis of 3 different orthopedic doctors all confirmed a bad Grade 3. The uniform recommendation from all doctors was no surgery. This didn't sit well with me. Aside from the deformity, it seemed some effort should be made to fix the shoulder structurally.

I then began doing my own research as many above have done. One thing I noted was that you do have more options if you act in the acute stage of the injury (first 4weeks). So the advice that you lose nothing by waiting to see how it heals is not entirely correct.

I decided to have AC tightrope surgery arthroscopically. They surgery was performed 11 days from my injury so my own ligaments are expected to heal/reattach. I'm now 2 days post op and so relieved to be on the other side of this and to have the hope of a full recovery.

I'll update with my post surgery progress for the benefit of others who are trying to make the surgery / no surgery decision. Good healing thoughts go out to everyone who has had to deal with this injury.
 
#826 ·
I'm so glad to find this thread!

I dislocated and separated my shoulder last week falling off a stupid skills park obstacle. Crazy amounts of pain - taken to hospital in an ambulance and given truckloads of morphine.

I've had my gallbladder removed and given birth twice, and the pain from this was right up there.

One week later I have very little ROM and still crazy amounts of pain. Seeing the orthopaedic surgeon next week to look at options in terms of surgery vs non-surgery. GP wasn't sure of the separation/grade - definitely a 3+, maybe a 4 or 5.

Good to see some recovery stories. I just want to get back on the bike!

Medical radiography Joint X-ray Radiography Radiology
 
#827 ·
10 week post surgery update for Grade 3 suffered mid March 2015 at age 55.

My shoulder got infected with staph immediately after surgery that I was battling for 9 weeks before removing the infected hardware and will now let the shoulder heal naturally. The MD team did not catch the infection until 20 days after the surgery despite obvious symptoms of chills, fever, pain and swelling in the surgical area. I lost over 10 lbs in 10 days fighting this infection with 102+ fevers before finally getting on antibiotics. I never had staph and rarely get sick. Initially, I really did even pay attention to the chills and mild fevers. Just continued working, etc. thinking it’s all part of the healing process until later in the cycle when the fevers and pain got real bad.

I highly recommend that anyone considering surgery ensures their MD triples all the necessary precautions to prevent staph. That means pre/post opp antibiotics, testing you for staph (simple nasal test), etc. If artificial components are being used then make certain there are no natural alternatives from either a cadaver or harvested from your body. If the hardware (i.e. screws, etc) gets infected with staph you are screwed because the antibiotics can’t kill staph once it attaches to the hardware. Staph is everywhere: gyms, airplanes, on your skin, etc. Avoid any post surgery activities that generate sweat until the incision is completely healed.

Fortunately, my shoulder looks normal (i.e. no bump, even with my other shoulder) after the hardware removal and is very strong. I continued to do self-PT and run/bike during this entire ordeal: 3 surgeries (initial, cleanse/debridement, removal) and multiple antibiotic treatments (oral and IV). The surgery excised the tip of my clavicle so it longer digs into the deltoid/acromion area; a major annoyance when paddling, throwing, swimming. The hardware held the clavicle in place for 10 weeks allowing the scar tissue to develop and I am hopeful it will permanently hold this position. I will stick with a safe regiment of high cardio and PT exercises that do not pull the clavicle for at least 2 more months allowing the scar tissue to continue reinforcing this position.


Found this in a medical journal. Guidelines seem accurate based on my experience.

For Surgery

Youth (or middle agers like me who still think/act young cuz I have young athletes to raise)
Athletic pursuit—particularly throwing sports (mandatory as my kids play football, basketball and baseball)
Manual occupation (nope)
Dominant side (?? - type A? then perhaps)
Joint very unstable anteroposteriorly and vertically (yes particularly with high frequency overhead motion like swimming, paddling, etc.)
Clavicle lying subcutaneously (yep, thin skinned)
Prefer a scar (vs a bump??? - no brainer!)
Thin patient (yep)
Reliable enough to take part in postoperative program (overly active - how I got the injury in the first place)

Against Surgery

Age
Nonathletic
Sedentary life-style
Nondominant side
Joint relatively stable
Overlying muscle
Prefer a bump
Thick subcutaneous fat
Unreliable patient (alchohol, drugs, mental subnormaliry)
 
#830 ·
I figured I would provide an update for anyone else, who like me is following recovery stories and trying to decide between surgical and non-surgical routes for a Level 3 separation. I was scheduled for surgery for August 13th, which was ~9 weeks post crash. After consulting with with another orthopedic friend of mine, and my bike mechanic, I came away with the feeling that I will be completely fine and perhaps better off going the non-surgical route. My decision to "indefinitely post-pone" surgery was based on the following:
- My orthpedic (hip specialty) friend informed me that surgery comes with risks (i.e. nerve damage, infection, allograft rejection, etc), albeit small
- Full recovery would take 4 to 6 months with significant physical limitations for 8 weeks
- Orthopedic friend's brother-in-law suffered a level 3 playing hockey 6 months ahead of me and recovered 100%
- Risk of re-injury is relatively high, given my active lifestyle. Re-injury could be problematic because the clavicle bone is weakened by the holes drilled in it.
- My bike mechanic had the same injury about 10 years ago and is totally fine, except for the cosmetic lump
- The bike mechanic has gone back down on the same shoulder without sustaining major re-injury--the tears were slightly worse as a result, recovery was quick, functionality is full
- While I can't confirm the statistic, I heard that ~70% of NHL players have had an AC separation and ~0% have had surgery to repair it
- Studies suggest that surgical and non-surgical cases experience the same rebound in functionality and outcome (although I personally believe this may be misleading because it doesn't control for "all" activities. i.e. I would want to see a study comparing groups rock climbers, tennis players, athletes in general at their respective sports)
- My functionality continues to improve, any pain is very manageable, and I can do virtually anything I want to do. Throwing a ball (ie. baseball, softball, football) are all possible, but probably only back to ~65% of what I was able to do before)

There is a significant part of me that wishes I had forced the surgical route immediately, so as to avoid the "double" recovery periods. However, I would still be very concerned about the risks of re-injury, especially given the clavicle would be compromised. Changing out the lump for a scar [immediately] after the injury and likely having functionality that would be at least as good, if not better, than the non-surgical route may have been a preferable path.

If you're new to the level 3 injury and in the very early days post injury, I suggest researching the potential complications of re-injury post surgical route. If you can get comfortable with those risks, the surgical route may leave you with less 2nd guessing. At this point, I can attest that I probably don't "need" the surgery, and if I knew at the time of the injury what I know now, I would focus on the re-injury risk. If I were able to get comfortable with that, I would most likely have the surgery.
 
#831 ·
Hi guys and gals
I have just been told i have a grade 2 AC seperation, typing in asling now and seeing specialist on Tuesday.
My question is regarding after it gets better and im back on the bike, im concerned with loss of confidence and reinjuring even from a minor tumble.
anyone had experience with some sort of shoulder protection, don't want Armour as i only do trail riding. anyone used these or something similar do you think they would help with minor bumps etc Exo Ss Jacket - Black - Bike
 
#832 ·
I had a somewhat bad fall 2 weeks ago where my shoulder and cheekbone hit what I think was a rock. (I didn't really take notice as I got right up and shook it off, continued riding for a few hours without any issues.

After a week of healing up the swelling I noticed that I couldn't even complete a single pushup, just staying in the top position of the move would hurt so much that I had to immediately get off my bad side.

My swelling is gone, as is the bruising, but whatever has gone wrong in there persists. The clavicle feels fine, but at the end of the clavicle; just about where the AC joint sits there's a tiny lump that's sore to the touch.

The movement of my arm isn't limited at all, I can do supported biceps curls, pullups (!), various rowing excercises and lat pulldowns. But benching, flies and rear delt work is all but impossible.

Any ideas what I hurt?
From researching online it's either a rotator cuff injury or the ac joint.

Going to the doc tomorrow to request a checkup and xrays either way so this is just me being curious.
 
#833 ·
Sounds like a minor separation, mine was initially thought to be a grade 2 but after seeing a specialists and more scans it's now a 1 which is ok but it's been a month and can't MTB ride yet as pulling on the bars hurts. I would recommend not aggravating it and requesting a weighted X-ray to show how much separation ther is. Seeing a sports physio has helped and regular taping to him it altogether helps a lot. Take time and get it right no matter how much it sucks not being able to ride or exercise.
 
#834 ·
Hey guys, from my understanding is when you get a grade 3 or higher separation, isn't your collar bone not anchored down anymore by the ligaments?

Since ligaments can't regrow, once they're separated they are gone, how do you guys expect to ever get good functionality back?

I ask because I think I may have lucked out with just a collar bone break, but it broke real close to the ligaments and I'm worried if I lost some of the ligaments.
 
#835 ·
Hey Speeder, the good news is that even with the ligaments ripped out and my collar bone floating where it used to connect to the AC Joint, there is enough stabilization in the area to make it a non-issue. I ripped it out back in 2012, Grade 3, no surgery.....and I'm good. I can still do pushups, ride/jump my mountain bike, surf, standup paddle, etc just fine. Arguably not as strong with overhead lifts and bench press but at 55 I don't care about that stuff anymore anyway. ;)
 
#837 ·
I think most people that have grade 3 or less end up fine on their own. I had a grade 2/3 a little over a year ago and don't notice it anymore. I was off the bike for 6 weeks to be safe, then a couple weeks of road riding and back on the MTB after 2 months. The orthopedic specialist said as long as I didn't impact it while it was healing I was good to go. I do know a couple of people that had separations and put their arm in a sling and they feel like they ended up worse off for recovery because they immobilized it for too long.
 
#838 ·
Grade 3, open surgery dogbone procedure w/distal clavicle excision. I'm 1 month post op and all is going well so far. Doc wants 4 more weeks in a sling then PT.

Anyone have any insight on the following; Many times when looking in the mirror, it somewhat looks like my injured shoulder is narrower than the non-injured side...ie closer to my body. Today I actually measured, and was blown away to see that it was actually up to an inch more narrow. This was with both arms relaxed hanging straight down. Anyone else notice this with your separation injuries/surgeries?

It doesn't look like muscle atrophy or something like that, it just looks like my shoulder is shoved up in there more so than the good side. The only thing I can think of is it might be just a side effect of having my arm in a sling nearly 24/7, and once I start PT everything will loosen up and straighten out.

Any thoughts or previous experience?
 
#840 ·
David,
I too had a grade 3 and had the same procedure this past May. I wore a sling for 6 weeks post op, but I also noticed my shoulder was significantly smaller than the non injured shoulder. What I noticed more was my bicep and pec on the injured side lost its muscle tone, but it was from wearing the sling for 6 weeks. I also waited 4 weeks to have the surgery so I wore a sling for roughly 9 weeks. My PT told me that my shoulder blade was out of place, but with pt for 4 weeks and keeping up with the regime they gave me everything has gone back to normal, mostly. I can't work out like I used to, but I did start riding after 2 months post op and now I am riding like before with no issues. The only problems I have is doing certain exercises in the gym, I have been avoiding workouts that strain the shoulders. Like you stated though once you start PT everything will start getting better. Good luck with everything, it gets better.
 
#841 ·
thanks for that, good to hear. I also have noticed that with both arms hanging down and trying to be relaxed as possible my injured shoulder is higher as well as narrower. I'm looking forward to ditching the sling and started PT to get everything back to normal. I'm thinking some chiropractic massage will be very beneficial as part of my PT.

Was your surgery arthroscopic? interesting that the dog bone procedure was invented to do arthroscopically but my surgeon still did open. Oh well, scars not too bad.
 
#842 ·
Mine was open surgery, I had some pretty bad tissue damage around the area so they had to do some graphing. It took me a while to actually get the surgeon to tell me the exact procedure he did. He briefed me before surgery but my wife and I were clueless as to what he did until later. I had read a lot about AC joint surgery and read mixed reviews on how long the recovery time would be, which made me worry. I feel no pain unless I work out now but then its only temporary while I am exercising, it goes away after. My surgery was 4 months ago so I think I am doing pretty good so far. My PT had said that since I was in good shape prior to the surgery that it shouldn't take that long to recover, but both my PT and Dr. told me to avoid Dips and Pull ups mainly body weight workouts for 6 month or more after surgery. Its been 4 months and I can do push ups but they are pretty uncomfortable. I would just recommend you keep up with the workouts that the PT gives you, I was doing them more than I should but at the end of 4 weeks I was able to use light weights during therapy instead of the bands. Good luck with PT and your recovery. Oh and my scar is crazy looking maybe close to 2.5 inches long and close to a 1/4 inch thick lol.
 
#843 · (Edited)
AC Seperation Grade IV

I have found most of the messages this thread to helpful to my situation, so I thought I would share my experience. I have had surgery a week ago.

How it happened
Snowboarding. I was going across the hill when another snowboarder who was going way to fast collided directly into my right shoulder. We went to the ground, I remember hearing a ringing in my head and everything going dark for a second before seeing stars, as I tried to get up by pushing up using my arms I felt a sharp pain in my shoulder and I knew something was wrong. I take off my bindings and grab my board and walk all the way down to a nearby cafe to get help.
On my way down I rubbed my right shoulder and I could feel a deformity. This was confirmed by a ski patrol aid, who suspected I had separated my AC joint. After checking me for signs of a concussion she helped me get to a clinic.
At the clinic, I had to wait a while before being seen and I think the adrenaline had worn off because the pain got pretty sharp. The clinic had me take xrays and they were looked over by the emergency doc over there. He thought it was a grade 3 separation and even showed me a bump on his shoulder as he also had separated his AC joint. He said that I would most likely not be needing surgery and will be able to get back to normal after rehab.

Process to surgery
I saw a physical therapist a couple of days later who after looking at my xrays instantly recommended I see a surgeon. I got booked in a couple of weeks later. During this time I kept my arm in a sling for a week and weened off it on week 2 post injury. The bump on the shoulder was not even sticking out that much and was hardly noticeable.
The surgeon examined me and sent me to get more Xrays done. He said that he highly recommends surgery as he believed I had a grade IV and he though I would have problems getting back to MTB and snowboarding. His notes mentioned that I had a 200% greater than normal displacement and my bone had been mildly displaced posteriorly. I agreed to go ahead with the surgery and asked him to place an ACC claim for it (I live in New Zealand healthcare is free).
I did some research on the surgeon and he seemed like one of the best I could get.
I had to wait another 4 weeks for ACC to approve my surgery and another 2 weeks to get a surgery booked in. Therefore, my surgery was 7 weeks post injury.
At the time just before surgery. I had gotten about 80% of my ROM back with about 50% strength. The surgeon was going to tie down my clavicle using some sort of super strong polymer rope and connect my CC ligaments back up but he was going to let the AC scar up on its own.

Surgery Experience
I was really scared of the surgery as this was the first major thing I had done to myself. However the experience of the surgery was not painful at all. Only pain I felt was the IV drip going in. Other than that they give you stuff to make you calm and you wake up at the other end of it feeling like you have had a nap. The pain from surgery was minimal as they drug you up. I had to stay overnight and had a pleasant experience at the hospital, given what it was.
I stopped taking all drugs 4 days post op. Started showering whilst avoiding the wound in a sling. And I do have a dull ache which is to be expected.

1 week post OP
I am one week post OP atm. To be in a sling for 6 weeks. I return to work in another week as I can choose to work from a desk.
I am going to see the surgeon in another week to have a progress check. Will update after week 2.

Concerns I have atm:
-Man i hope i can get back to MTB and snowboarding
-Ive got a backpacking trip to Japan 11 weeks post op which i hope ill be ok for. (doc says will be allgood)

Hope that helps. :)

3 weeks post OP Update
I am currently sitting at 20 days post op. to be in a sling for 3 more weeks. I have returned to work and feel fine other than minimal stiffness and pain sleeping well too.
Went to see the surgeon for a check up and got some sort of bad news. According to the xray taken my clavicle is not sitting as its supposed to post op. it is still a bit higher than its supposed to be. It had been lowered down a lot and bought forward since it was a type 4, however, not according to the xray it looks like a type 3. the doc thinks the repair might have stretched. I have been religious with the sling and have been following instructions. It was disappointing to hear this.
The doc palpated the site and there was no pain which was a good sight. I expressed my concerns regarding the outcome and he said that they got it down good when they did the surgery. He also thinks that I will still turn out all right. Guess I gotta keep going and let the chips fall where they may.
 
#844 ·
I have found most of the messages this thread to helpful to my situation, so I thought I would share my experience. I have had surgery a week ago.

How it happened
Snowboarding. I was going across the hill when another snowboarder who was going way to fast collided directly into my right shoulder. We went to the ground, I remember hearing a ringing in my head and everything going dark for a second before seeing stars, as I tried to get up by pushing up using my arms I felt a sharp pain in my shoulder and I knew something was wrong. I take off my bindings and grab my board and walk all the way down to a nearby cafe to get help.
On my way down I rubbed my right shoulder and I could feel a deformity. This was confirmed by a ski patrol aid, who suspected I had separated my AC joint. After checking me for signs of a concussion she helped me get to a clinic.
At the clinic, I had to wait a while before being seen and I think the adrenaline had worn off because the pain got pretty sharp. The clinic had me take xrays and they were looked over by the emergency doc over there. He thought it was a grade 3 separation and even showed me a bump on his shoulder as he also had separated his AC joint. He said that I would most likely not be needing surgery and will be able to get back to normal after rehab.

Process to surgery
I saw a physical therapist a couple of days later who after looking at my xrays instantly recommended I see a surgeon. I got booked in a couple of weeks later. During this time I kept my arm in a sling for a week and weened off it on week 2 post injury. The bump on the shoulder was not even sticking out that much and was hardly noticeable.
The surgeon examined me and sent me to get more Xrays done. He said that he highly recommends surgery as he believed I had a grade IV and he though I would have problems getting back to MTB and snowboarding. His notes mentioned that I had a 200% greater than normal displacement and my bone had been mildly displaced posteriorly. I agreed to go ahead with the surgery and asked him to place an ACC claim for it (I live in New Zealand healthcare is free).
I did some research on the surgeon and he seemed like one of the best I could get.
I had to wait another 4 weeks for ACC to approve my surgery and another 2 weeks to get a surgery booked in. Therefore, my surgery was 7 weeks post injury.
At the time just before surgery. I had gotten about 80% of my ROM back with about 50% strength. The surgeon was going to tie down my clavicle using some sort of super strong polymer rope and connect my CC ligaments back up but he was going to let the AC scar up on its own.

Surgery Experience
I was really scared of the surgery as this was the first major thing I had done to myself. However the experience of the surgery was not painful at all. Only pain I felt was the IV drip going in. Other than that they give you stuff to make you calm and you wake up at the other end of it feeling like you have had a nap. The pain from surgery was minimal as they drug you up. I had to stay overnight and had a pleasant experience at the hospital, given what it was.
I stopped taking all drugs 4 days post op. Started showering whilst avoiding the wound in a sling. And I do have a dull ache which is to be expected.

1 week post OP
I am one week post OP atm. To be in a sling for 6 weeks. I return to work in another week as I can choose to work from a desk.
I am going to see the surgeon in another week to have a progress check. Will update after week 2.

Concerns I have atm:
-Man i hope i can get back to MTB and snowboarding
-Ive got a backpacking trip to Japan 11 weeks post op which i hope ill be ok for. (doc says will be allgood)

Hope that helps. :)
You'll be fine mate! I had surgery the middle of May and was back riding on the road the end of June. I weened myself out of the sling after about a month...I still was careful with the arm of my injured side...I'd keep finger looped in jeans belt loop most of the time...but the sling was just so uncomfortable that after I was really on the mend I ditched it ASAP.
I'm now 5 months post surgery (level III) and have what I'd consider 100% use of shoulder: Push-ups without pain, full range of motion, no limits on any physical activities I do, etc...
You'll be great to go on your trip to Japan. ;-)
 
#845 ·
I joined the club about 7 weeks ago, grade 3 separation diagnosis to my dominant side. Yesterday I had my follow up with the Ortho surgeon. Before he even examined me he said that I need to decide whether I want surgery or not based on how happy I am where my shoulder is now as it will only improve another 10% from here. That sucks because I feel I am at 50%, where I now have 90% full range of motion but still lack strength, experience pain and instability with the arm raised above shoulder and crossed in front, of chest. I have ben out on the trail bike 3 times in the last 2 weeks and any big hits, drops, lifting the front causes a shot of pain. The joint does not feel stable and certain movements result in a feeling of grinding between the rotator and the AC.
I wanted to ask you guys how much improvement you saw from week 7 to 15 in comparison to week 2 to 7?
I really was hoping to avoid surgery
 
#846 ·
Thanks to all who contributed to this thread. Super helpful to see what others have been through.

My story, and what i learned

High level

AC separation, grade 2 or grade 3 depending on how you look at it. In either case, surgery is not necessary, and I opted not to have it. The more I read, the more happy I am about not opting for surgery. Recovery time (measured as being able to ride again legitimately): 13 weeks.

Here's a bunch of detail

Measuring whether it was a grade 2 or grade 3
The traditional way is to look at the distance from the tip of the clavicle (where the AC, or acromioclavicular ligament sits) and the acromion on an x-ray. The more reliable way, according to my ortho, is to measure from the middle (not the tip) of the clavicle to the coracoid process, where the trapezoid / conoid ligaments sit. If that distance is between 110-160% of what it should be (using the other shoulder as a comparison), then it's a grade 3 ... you know you have a good ortho if they spend the time trying to figure this out ... also, I am going off of memory here, so I might've gotten the ranges slightly wrong.

Implications of grade 2 or grade 3
No surgery for grade 2. Grade 3 is a grey area. The majority of orthos that I spoke to cite the same research when it comes to deciding whether to have surgery or not. The research followed hockey players, who have a high incidence of AC sep, crashing into barriers and such. They found that for grade 3, the prognosis is the same whether you have surgery or not. The ortho will likely say something like "you can choose between a bump (the clavicle sticking out a bit) or a scar (from the surgery)". It seems like a rationale reason for the surgery is if you care about how you shoulder look (e.g. you are a young lady). For me, I didn't see any benefit and a lot of downside: pain (apparently shoulder surgeries are quite uncomfortable to recover from), longer recovery time, and risk of infection etc... . So no surgery for me.

Recovery process
The day of, it hurt like a *****, and having no concept of AC separations, I was really worried that it was the end of my riding, tennis, golf and everything else days. I had a minor concussion, felt nausea, heart was racing, I was sweating like a dog ... I calmed down when they stuck me with morphine at the hospital. I was surprised at how much strength i still had in my arm when they tested it various ways at various angles. They sent me home that night, which I was also surprised with as I thought I would be admitted for some sort of surgery. Interesting side note ... every single medical professional I met had had an AC sep (ER nurse, ER doctor, Ortho Nurse, Ortho Doctor, Physio). I guess that's how they roll in San Diego!

Week 1: I took the prescription painkillers for the entire week, and stayed home the first 2 days, though was able to work (conference calls, writing one handed emails etc...). I took a lot of naps, and could sleep ok, but not great, on my good side. The pain was dull and constant, and I wasn't able to do much of anything with my shoulder. I also had flesh wounds, which my wife helped me with. Generally I was using 1 hand for most if not all of my activities. My wife drove me around, I had to sit in the backseat on the side where I could put the seatbelt over the good shoulder. Whenever the car went over a bump, I could really feel the instability in my shoulder ... it was quite uncomfortable. I also had to wear a sling. It caused pain on the other shoulder, partly from carrying the weight of the arm. It was all a big pain in the ass.

Week 2: Still wearing a sling. Switched from the prescription painkillers to over the counter, though had to go back on a couple of occasions because I needed the pain to go away. I was back at work every day, and still being driven. I could do a little typing on the computer with the bad hand, but it got tired quickly. I used voice recognition software a lot, which is not as much of a time saver as I thought.

Weeks 3-4: Ditched the sling, started driving myself around. tried to cut down on OTC meds ... generally succeeded ... started physio. once I found a PT I liked (the difference between an average and good PT is shocking), i was very aggressive ... twice a day, 15-20mins min per session. Most of the exercises were trying to get the neck and shoulder muscles to relax (they freeze after trauma, for protection). Still in some occasional pain, limited arm movement, couldn't lift my arm above my head, couldn't shave with that hand, had to wear button down shirts so I didn't have to bend my shoulder into a t-shirt. Generally was getting worried that recovery was going to take forever, given the incredibly slow pace of improvement.

Week 5: saw a step change improvement the day after being in the pool for an hour or so. Shoulder and neck muscles seemed more relaxed, and was able to do quite a bit more. Arm still got tired easily. At work, I always looked for ways to rest my arm on something (arm rest, table).

Week 6-8: gradual improvements, but no step changes as observed in week 5. Continued aggressive PT ... could raise arm above my head by walking fingers up a wall. Now back typing on a computer, almost normally, though was getting tired easily. Taking occasional OTC pain killers. Can only sleep on good side or on back. Still couldn't use my arm to shave my head, because of awkward reaching back motion.

Week 9-12: Rapid progress being made over these weeks. Was finally able to put my hands behind my head. Able to put on a t-shirt without screaming. I could hold planks legitimately (more of a week 11-12 thing), ventured out on the bike week 11, though on the road. Lifting the front tire to get on/off the sidewalk was a little painful, but manageable. Arm tired easily, and I took painkillers after the ride.

Week 13: Did my first legit mountain bike ride. Still a little soreness at the tip of the clavicle, but good amount of strength. I walked the bike on harder segments ... no point in taking risks this early. Confidence is certainly lower than before, but I expect it will come back as I put the miles on. Had to take pain meds the next day.

Week 14: Did a bunch of riding, and it all felt solid. I am also swinging a racket, and hitting a ball with good strength. Taking pain meds the next day about 50% of the time after physical activity. Wished I had done some exercising throughout this ordeal as I lost a lot of fitness (I've seen others say the same thing), but it's coming back. Graduated from PT, though I continue the exercises. I just recently was able to shave my head with no discomfort from the awkward reaching. A lot less instability inside the shoulder ... but I still can't sleep on my side, and there's no way that I can do a push up. I heard that takes 6 months to 1 year.

In closing
I hope this helps others set expectations on how the recovery goes. For me, it was definitely a story of no noticeable change / no noticeable change / no noticeable change / big change / no noticeable change and so on.

One of the important aspects seems to get those muscles to relax ... I tried massage and that was very helpful ... being in the pool also helped, so recommend all that. Be patient with the recovery, do the PT and try to get some exercise in.

Good luck and see you on the trails soon!

Note: I had to go off memory for a bunch of this stuff, so consider this directional, and thanks in advance for any corrections (primarily on the medical explanations!)
 
#847 ·
Grade 2 seperation here. Occurred 2 days ago, on the last quarter mile of a 9 mile ride. At least I was close to the car.

Got it X-Rayed and diagnosed right away, nd it was put it in a sling and I was told to see an othopedist. Went to the orthopedist Ive seen for other injuries(sports ortho), and he immediately told me to take off the sling and keep it off. He said use it and move it to the extent I can when I can. Gave me exercises to do in a few days that essentially entail me pulling the injured arm through range of motion movements using the other arm, using a towel, a broomstick etc. Essentially to make sure it doesn't heal "stiff" as he said that will slow things up. He said moving through low-med pain is OK, extreme pain no, so that's what I'm starting to do.

Thing is I have a lot of pain in the shoulder, but also alot in the whole region around the shoulder; through the rib cage front and back etc. Pain if I take a deep breath, sniff, basically do anything that tightens the muscles in that region. For example, I got a peanut caught in my throat earlier and started coughing....the pain from coughing was so intense, I wasn't sure if I should be laughing or crying. I've had several breaks, cuts muscle tears etc, but this might be the most painful injury I've had to date.

The ortho said he expects in 1-2 weeks I will feel substantially better, as a grade 2 seperation should heal fast, but if the pain isn't much better in 2 weeks, I likely have something else going on that the xray didn't pick up and they'll need to explore further, via MRI I assume. It's so painful I kind of expect I have something else going on. Then again, maybe I'm just getting sissified in my old age.

Reading this thread has helped though. I didn't realize this was such a common injury for cyclists. I surf, and I'm more concerned about the range of motion I need for paddling on a surfboard.
 
#848 ·
Grade 2 seperation here. Occurred 2 days ago, on the last quarter mile of a 9 mile ride. At least I was close to the car.

Got it X-Rayed and diagnosed right away, nd it was put it in a sling and I was told to see an othopedist. Went to the orthopedist Ive seen for other injuries(sports ortho), and he immediately told me to take off the sling and keep it off. He said use it and move it to the extent I can when I can. Gave me exercises to do in a few days that essentially entail me pulling the injured arm through range of motion movements using the other arm, using a towel, a broomstick etc. Essentially to make sure it doesn't heal "stiff" as he said that will slow things up. He said moving through low-med pain is OK, extreme pain no, so that's what I'm starting to do.

Thing is I have a lot of pain in the shoulder, but also alot in the whole region around the shoulder; through the rib cage front and back etc. Pain if I take a deep breath, sniff, basically do anything that tightens the muscles in that region. For example, I got a peanut caught in my throat earlier and started coughing....the pain from coughing was so intense, I wasn't sure if I should be laughing or crying. I've had several breaks, cuts muscle tears etc, but this might be the most painful injury I've had to date.

The ortho said he expects in 1-2 weeks I will feel substantially better, as a grade 2 seperation should heal fast, but if the pain isn't much better in 2 weeks, I likely have something else going on that the xray didn't pick up and they'll need to explore further, via MRI I assume. It's so painful I kind of expect I have something else going on. Then again, maybe I'm just getting sissified in my old age.

Reading this thread has helped though. I didn't realize this was such a common injury for cyclists. I surf, and I'm more concerned about the range of motion I need for paddling on a surfboard.
The pain sounds strange as with a grade three I did not have extreme pain when at rest.
Are you sure you didn't break/bruise any ribs, what you are describing reminds me of that.
 
#852 ·
I am no doctor but I would not delay getting a second opinion especially with back problems.
I am kind of paranoid with ER diagnoses, when I broke my ribs I also punctured a lung, although I complained about shortness of breath they said I was fine, gave me pain killers and sent me home. Then at 3am I got a call from the doctor on staff who said I needed to come back in because they checked again and noticed I had a punctured lung.
Not fun.
 
#854 ·
Thanks guys. I probably will get a second opinion. I'm not very trusting of doctors in general, but I have a good one in my office. Nice perk of my company..very old school. Made them give me my X-rays on disc so I could bring them in to him. The ER nurse looked at me like I was nuts asking for the X-rays. I guess most people don't. A few years back I had a stress fracture in my leg. It was missed by the X-ray tech but the doc at my office caught it.

Although from what I know of bruised ribs, they don't really do anything for them anyway.
 
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