AC separation

[swinter]

I think the Training forum is the right place to post this.

I am 8 weeks post a grade 3 shoulder separation (in which I tore my AC ligaments in the right shoulder) after an accident in a group ride.

I've been back on the bike for a month now. No pain any more when I ride, but doesn't feel comfortable.

Saw the ortho today. We're going to give it another month and then see whether to leave it as is or go the surgery route.

So, my question is: This is a common biking injury. Any thoughts from anyone on their experience? Pointers? Suggestions?

I expect it will be a tough judgment call whether to just live (and ride) with the shoulder at less than 100% or go through the trouble of the reconstruction and rehab. So, any additional information will probably be helpful to my decisionmaking process.

Thanks.

[RollinOn27s]

I had a bad 2nd degree separation myself. I feel your pain, which I'm sure was excruciating. Far worse than breaking an arm, to me at least. This was in March of this year.

When it happened, I was given some exercises to do to regain some strength in my shoulder. I did them for a while and then they just sort of faded from my mind. It was probably 3-4 months before I could throw a football around without mind numbing pain.

Last week I was home for Thanksgiving break and my mom scheduled an appointment at the local health club, which is also one of the foremost sports medicine facilities in the area. The doctor saw that I still have a lot of differences between my two shoulders; for example, the injured shoulder, or rather the shoulder blade itself, can "pop out" of my back far more than the other shoulder. This is due to the shoulder blade not being anchored well, if at all, to my clavicle any more.

Upon seeing the X-rays, in conjunction with the physical exam, he concluded that I do not in fact need surgery but should continue to try to rebuild my shoulder through physical therapy exercises.

Hope this helps.

~Andy

[swinter]

Thanks for sharing your experience.

Even though a grade 3 should be worse than a grade 2, it sounds like your injury was worse. My shoulder blade is unaffected. And it sounds like you had more pain (though I haven't tried tossing a football, and can't do regular push ups yet).

I've been doing the exercises and my torn shoulder doesn't look too weird anymore --- though to the touch, you can feel the muscles in the right shoulder are getting bigger and stronger than the other to compensate.

My ortho treats the Detroit Tigers. He took care of Palanco's shoulder when he tore it this past summer.

Anyone have the surgery?

[wally318]

I did a class 2 just over 2 mos. ago broadsiding a van in a hit and run. It reinjured one that I did 3 yrs, previous. In both instance the bump on the shoulder hasn't and probably won't go away. Sleep was the hardest for 1-2 mos. I don't have pain anymore and full range of motion just have to work gaining back full stregth. Just in time for winter weight season. I suggest you do the same. If you have any experience at time trailing then you can handle the slight pain of rehab. and I'm quite positive that you'll get back to normal if nothing major is wrong.

[rockymtnway]

I'm in a class on diagnosis and treatment of athletic injuries and unfortunately, grade 3 AC separations almost always require surgery somewhere down the line. My prof said that in a lot of cases she's had athletes that wished they would have opted for surgery sooner rather than later since the waiting before surgery didn't get them any closer to getting back on the field.

Tough call, since surgery is always a scary proposition I try to avoid at all costs.

Good luck and best wishes for a full recovery.

[Recoverydoc]

I disagree with that assesment related to third degree ac seperations. It all depends on the rehab. Surgery will always take longer and will change the mechanics of that shoulder forever and to a greater extent then proper rehab. It comes down to pain and useful range of motion. You can gain all your strength back if you have pain free range of motion in that shoulder. so I would get in to see someone that does rehab for athelets and start you can also get a second opinion before surgery. Just my input

[fast700c]

Anyone have the surgery?

I had a complete dislocation of my right AC joint (not sure how that compares to a grade 3) about 8 years ago.

Initially I was simply put in a sling at the hospital and sent home with an out patients appointment for the next week. I consulted a Physiotherapist who stapped the shoulder in an atempt to immobilise it some more.

To cut a long story short after about three weeks of visits to the hospital as an outpatient I was finally seen by an Ortho Registrar instead of a trainee Doctor. I was booked in for surgery the next day!!

They preformed what I remember being called a Weaver/Dunn procedure (or something like that, I guess it was named after the surgeons who first performed it). It involved reducing the dislocation and then using resorbable sutures to lasso around the clavicle and underlying bone to hold it all in place while scar tissue grows around it all, and eventually keeps it in place. The sugeon said this procedure was better than pinning the AC joint as there is still some movement possible and is closer to a normal AC joint than one with a rigid pin in it.

My shoulder was immobilised for several weeks then started the Physiotherapy to get it all moving again. I now have full range of movement and my shoulder feels just as strong as the other side, although at times under certain loads it does feel different. I also still have a pronounced lump on my right shoulder.

If I had the same thing happen again I'd have the surgery straight away. I believe in my case it was the only way to reduce the dislocation to an adequate level. I guess your shoulder will always have to be immobilised for a time so there will always be need for re-hab afterwards, so I believe its a good idea to get the process underway as soon as possible.

I'd get a second or even third opinion and discuss with your sugeon all the options available as every case will be different.

Hope that helps give you some perspective on the sugery route, and all the best with your shoulder.

[swinter]

Thanks wally318, rockymtnway, Recoverydoc, and fast700c for sharing your experience and insight. I have some better questions to ask my doc when I see him next month.

It sounds to me, fast700c , that your dislocation was much worse than mine: My shoulder is close enough to the clavicle that it was able to form scar tissue and bind on it's own.

If I were to do the surgery, as I understand it they don't use a pin but take a tendon from elsewhere to take the place of the torn ligaments.

I am doing daily exercises for the shoulder (along with my regular exercises -- except full push ups, which I still can't do) and riding. (It got cold here, but tomorrow should be just warm enough to bundle up and ride.) Range of motion is good, and pain is minor. But I wouldn't want to have to pull on the bars in a hard climb!

[rockymtnway]

Swinter, You're right in your that the more you know the more intelligent and effective conversation you can have with your doc. It's hard to tell what degree of separation you have, but the big question point for surgery is at a grade 3 (graded 1-6). Anything more severe needs surgery, anything less doesn't. See if this article helps any. If nothing else, it should facilitate a better conversation with your doc.

[aerozy]

Hey guys! I'm 4 weeks into a type 3 AC shoulder separation. Was going 55km/h downhill when my front clincher blew and sent me over. Funny thing Is I ride tubulars 90% of the time. Was only riding clinchers as Im holidays and thought it would be more practical. Makes you think, doesnt it?

Anyways to the point. Today I went to a general sports doctor that has forwarded me to an orthopedist surgeon "friend" of his. He wants me to consider going under the knife. Ive done my research and seems like most doctors believe that as long as you regain your full range of motion and feel pain free no surgery should take place. 4 weeks in I believe that is my case. Of course I cant lift weights or pitch but riding my bike seems pretty ok. I do have a permament lump on my shoulder that looks pretty freaky and my right arm reaches 1cm further comparing to my left.

So questions are:
1) For those of you who have had type III AC separations did you go down the surgeory or PT route? How has your recovery been either way.
2) Im concerned that my bike fit may need some adjustement. Maybe I should move my right hood down a cm or so? Would you agree?
3) Are there any real life stories of famous professionals having gone through the same ordeal? How did their recovery look like?

Cheers, D

[RippedUp]

Hi all! Bringing this old topic back to life. Any more experiences with Type 3 AC separations? Would love to hear more.
I'm into my 3rd week post-injury. Going conservative.

[dtwolfen]

I've got a knob on my shoulder from a separation about 8 years ago. It does not effect riding much. I adjust fit a little but I am getting older. I do not think I have bought a piece of equipment exclusively to deal with the injury except maybe the handlebars. I moved to flat topped and wrapped to the center. Hope this helps you understand your injury. It does not hurt but does limit motion a little.

Sent from my LG-H700 using Tapatalk

[stoney]

I had a type 3 AC separation in 2008. I did not have surgery and 10 years on, at age 50, my shoulder still works fine. But, I lift weights weekly to keep the muscles in the shoulder strong. If I stop lifting for awhile, then my shoulder starts aching and bothering me. My weight routine doesn't take 10 minutes two times per week to keep the shoulder strong and pain free.

[glepore]

I'll age myself. 3rd degree in maybe 1990. Ugly bump. No pain. Can't lift overhead, but not due to that, paralyzed my traps more or less in a m/c accident, lucky I can walk.

YMMV. If it gets bad, they just whack the end of the clavicle off.