Shoulder separation injury

I received a shoulder injury May 7th. This is from what I understand fairly common amongst dirt bikers & mountain bikers, so I was wondering if anyone here's had a similar injury & whether or not they opted for surgery.

I have a level 3 ac separation - the ligaments connecting the clavicle to the scapula are completely torn. This is a very frustrating injury because there is no concensus as to whether surgery is worthwhile. The ortho surgeon said it's up to me. Seems counterintuitive to me to not reconnect things, but apparently none-operative treatment works. Downside to surgery is, according to some but not all, limited range of motion, as well as risk of failure & complications. Benefits to surgery: more secure stability & support for the shoulder. (Without surgery some support & stability is provided by scarring & muscle compensation.

As I was a work out fiend up to the injury, this is extremely frustrating & depressing.

Anyone here face this decision, & if so what were the results?

 

In my view, surgery should be considered only if you cannot continue on in a reasonable manner. My understanding is that once you have dislocated a shoulder, you are prone to this injury. I suspect same holds true with ribs cause I have popped one 5 or 6 times. Last time took the life out of be and they thought it was a punctured lung.

I also pushed for definitive action on a back injury I sustained in 1978. I have had three since and meds have been part of my life since. If I had the luxury to go back, I would not have had the surgery, at least at that time. You say you are a work out fanatic. That is good and bad. You think you know best on how to exercise and in fact you very likely do not. They are expensive, but go see a Rehabilitation Kinesiologist and have him/her go over your injury and develop a plan of action that you should follow MATICULOUSLY. You can always elect surgery later. Good luck.

BTW. I also had what the doc said was a partial dislocation of the shoulder about 5 years ago now. Didn't know that could happen but I am told it went out then back in on its own immediately. So they say. It took a long time to settle down, but to be honest, I can't remember if it was my left or right now.

 

Thanks Randy, I do plan on seeing a physiotherapist if I don't do surgery.

Just to specify - I don't have a dislocated shoulder (in which the joint is out of the socket) but rather, the collar bone is seperated from the shoulder blade.

The depressing thing is there's all sorts of contradictory views re: surgery...it's driving me nuts.

 

with surgery your recovery time might drop...less time in rehab....if your a work out fiend, this might be better route for you

 

I had a pretty severe separation in 2006. I opted for surgery after about 6 months because of the discomfort and because of the shoulder was about 2 inches lower than the other one. Recovery took a while and I had to have physical therepy for a few months and it took about a year to feel normal again, but I feel as though I made the right decision for me. I have only one side effect. Because of the severity of mine(doc said the usually don't see a tear as bad as mine), I do have some rubbing of the scapula on a rib from time to time, but not enough to be that big a deal. In my case, they did a pegusus graft, which means they used a piece of heart tissue from a horse to repair mine. I chose that instead of having a piece of a cadaver in me. Too creepy. All in all I don't regret it one bit. Plus I have a pretty cool scar.

 

Hi Billygoat,
A level 3 (or grade 3) AC joint injury usually means complete or near complete tearing of the ligaments that hold the collarbone (clavicle) down on the shoulderblade (scapula). IMO The problem with not having it operated on is not a loss of range of motion or severe pain as the muscles around the area step up to help stabilise it. The problems that I see are the shoulder blade will always hang alot lower and the clavicle alot higher (cosmetic). But it can often lead to pain elsewhere due to the supporting muscle fatigue and pulling on the neck. Is the shoulder strength weaker than it used to be? Cause if the joint isnt sitting tight the shoulder is often weaker. I'm a sports Chiro and I often see these, mainly Level 1 and two, and level 3 every now and then. The 1 & 2's respond really quickly to mobilisation, strapping. Type 3 respond well pain-wise and improved strength, but the joint doesnt cosmetically change much, due to the loss of ligaments. IMO surgery is always the last option and only if it is affecting you life (which it sounds like). It isnt a big operation compared to shoulder surgery. they are really just replacing the torn ligaments with a suitable replacement. 6 weeks ago I started treating a guy who had just had an Anterior Cruciate Ligament (knee) replacement. He started unable to straighten his leg and on crutches and now he is back at work (not playing soccer yet). That is only a small bit to do with me and more to do with the success of the surgery (which was keyhole). Sorry for long winded reply but I
Hope this bit of info helps mate and you feel better. Any questions, let me know.

 

Thanks for the advice all....

I'm at week 6 and am still feeling some pain & discomfort...maybe pushing myself too much exercise wise, but can't help but wonder if it's an indicator for surgery....

 

sMark sound FAR more qualified than I am but I still do stand by my advise to not over do the exercise until the injury has had a time to heal. Most men are not good at that taking the macho role saying I will handle it. Take the advise of the professionals.

I am stepping out to Physio right now and stand by that process for what I am dealing with now. But where I find that they are less successful, is that one therapist is looking after several people virtually at the same time when it comes to exercise. And technique of the exercise is what makes it work. That is why I would suggest a one on one with a Kinesiologist who specializes in injury re-hab. I went for a year courtesy of the Mounties and he had me in the best shape of my life at 47 years of age, and he had me more flexible than I had ever been. I am sure he can give me a referral to someone in your area if you are interested. Just PM me and I will find out.

 

Thanks Randy...in fact, I spoke with a phsyiotherapist yesterday - the spouse of a S/Sgt. at work, seemed very knowledgeable. Whether or not I get surgery I will certainly be seeing the pt and following her instructions.

After a week of driving myself crazy trying to make a decision on surgery, this morning I called the surgeon's office & left a message advising that if it wasn't too late for effective surgery at 6 weeks post injury, I want the procedure. At the end of the day I had to go with my instinct - based here on the totality of factors: deformity from the clavicle sticking up, lack of stability for my shoulder & clavicle, the general sense that leaving parts unconnected is just counter-intuitive, and realizing that if I didn't get the surgery I'd probably drive myself bonkers constantly wondering if things would have been better if I had gotten it. As soon as I made that call, I felt at peace and knew I had made the right call.

And if it's too late, then so be it. I am pissed at the delay it took in seeing the surgeon in the first place, but that's all out of my hands. Either way, I'll definitely ease back on my regular aggressiviness with workouts and follow the instructions of the P.T.

Alea iacta est.

 

Billygoat,
I also am 6 weeks out from a grade 3 separation.(bike accident) I am also a physician (primary care) and have researched the issue pretty thoroughly.
I have elected to not have surgery as the functional outcomes do not appear to be better for most people. I have a fairly large deformity as separations go. I rested for 4 weeks and began PT 2 weeks ago. I rode my bicycle 3 times this week and felt pretty good. My experience is that that I do fairly well with below the shoulder activities but have a much tough time with above the shoulder activities. Washing my hair is the worst and I can't lift weight above my shoulders yet. My PT guy hasn't even begun any above the shoulder exercises yet and states he will do so in a few weeks and hopefully by 12 weeks out i will be fully recovered. I don't know about you but the shoulder feels like it's moving in a "bag of marbles" with many above the shoulder movements. The crunching and crepitus is worse than the pain but I'm told that will gradually improve. So, my recommendation would be not to have surgery and to wait at least 12 weeks with patient(slow) rehab and then decide if it is affecting your normal lifestyle. Are you feeling similar thing to myself?

 

Hi BKL,

I can lift my arm above my head, but in fact in the past several days it's become a bit harder. There's been a new pain along the side of my neck (injured side) which must be from the muscles trying to compensate.

I fear that the muscle compensation on the injured side will over the years cause problems - some sites suggest potential problems to the rotator cuff (see: Shoulder Separation and Dislocation: An Overview - Conditions and Treatments - HSS ); and I'm guessing at back problems. I often get a real pain in the shoulder blade area...side closer to the spine as opposed to shoulder side.

I sometimes feel that weird "crunching" sensation. I have a sense that things have gotten a bit worse...possibly subjective, but perhaps I over did it trying to get back to exercising. I realize now I have to consult with a PT and surrender to their instructions.

I know a guy from work who had the surgery soon after his injury - from the same ortho surgeon I'm dealing with. He was very pleased and had nothing but good things to say about this surgeon. My brother is a radiologist in town and also confirms this is the surgeon who does the most of these types of procedures. That's why I'm willing to take the risk. The surgeon is not pushing for surgery but is willing to do it.

Also: I'm sure you've checked out the mountain bike forums...I get the impression that people with the surgery can get back to weights more easily...or with more confidence.

 

I also overdid the rehab initially (trying to do over the shoulder exercises) You need to be very slow and begin with ROM and below the shoulder rehab. I feel much better after 2 weeks of doing this. I was surprised I was able to get back to riding in 6 weeks. I will take weeks 8-12 to finish the over the shoulder rehab and feel good it will go well.
My ortho guy told me there would be no problem with doing surgery at that time if I want to proceed with that route. My PT said he's treated about 10 3rd degrees and all with good outcomes except 0ne who required surgery and he was an electrician who required a lot of over the head work for his job.
Whatever way you go, best of luck - it's certainly a personal decision.

 

Well, I'm getting surgery next Wednesday. Will post how it went down the road.

 

BG
I'm very interested to hear how it goes. I'll let you know how the 4 more weeks of PT goes. Hopefully I won't be considering surgery at that time but if so I'll definately ask some more detailed questions. Hope the surgery and rehab go well.

 

Hi Billygoat,
Best of luck with it mate.
Talk to you on the other side.

 

2nd day post op. Worst part about the surgery for me is the anesthetic - makes me sick. I was nautious for 24 hours.

Pain in shoulder is getting intense but is controlled effectively with Tylenol 3's. I have some oxycodone but am trying to avoid them if possible.

Could be psychological, but I have the impression that things are back where they should be as far as my shoulder goes. The awkward feeling I had before - that my collarbone was sticking out and my shoulder was not where it shoud be - is gone.

Am feeling confidant so far. Have to see the surgeon in 2 weeks to get sutures removed. Will have a better assessment at that point.

In 3 months I have to get 2nd surgery to remove the screws.

 

i have been in a wheelchair 30 years now both my shoulder in the last 5 years have been worked on with ops 2 on left 1 on right the last was 6 mths back much better now but the first ones i had on both shoulder blades was for more that 5 years see it did not last that long hope the last 2 do anyhelp
regards johnrebel

 

Hi Billygoat,
I'm glad to hear you are feeling okay after surgery.

 

Thanks Mark,

I removed the dressing today. It wasn’t stitches, it was staples they used. Whatever, doesn’t matter to me. The protrusion from my collar bone is COMPLETELY gone – awesome! I’ll take the scar over that anytime. My wife’s happy about it too.

Stapled area seems fine – no excessive redness, no swelling, no leakage.

Did some crunches and sit-ups today as well – my 1st exercise since surgery (other than slow walks around the block, which I’ve done the past 2 days).

Will nevertheless absolutely keep my arm slinged as long as they tell me. Will go to physiotherapy once I’m at that point and do what I’m told. I am determined to regain strength & range of motion, but in a cautious manner – don’t want to re-injur myself in any way.

Hopefully I can get some fall rides in on the bike! But am maintaining a long term approach to recovery.

 

good on you, how all goes according to the plan