Shoulder separation - down the track

[Mitch243]

Hi, looking to get some advice. Typing with one hand so bear with me.

Tore my AC - type 3 shoulder separation. I'm in Canada right now, doc reckoned it was about as bad as they come without immediately requiring surgery (type 4+).
For physical severity, currently my shoulder is about 35mm lower than it should be.
I fly back to Aus in 2 weeks. I'll have it re-assessed and xrayed when I get back.
I will probably start seeing a physio as well.

For those that have had type 3 separations, how did recovery go? Any issues down the track (months/years)?
Slumped shoulder, immobility, weak?
Anything you wished you'd done?
e.g. you can have elective surgery to have holes drilled into the bones and have them held in place by cables while the soft tissue connections regrow.

 

[oliosky]

Hi, looking to get some advice. Typing with one hand so bear with me.

Tore my AC - type 3 shoulder separation. I'm in Canada right now, doc reckoned it was about as bad as they come without immediately requiring surgery (type 4+).
For physical severity, currently my shoulder is about 35mm lower than it should be.
I fly back to Aus in 2 weeks. I'll have it re-assessed and xrayed when I get back.
I will probably start seeing a physio as well.

For those that have had type 3 separations, how did recovery go? Any issues down the track (months/years)?
Slumped shoulder, immobility, weak?
Anything you wished you'd done?
e.g. you can have elective surgery to have holes drilled into the bones and have them held in place by cables while the soft tissue connections regrow.

- recovery/rehab/physio post initial sepreation was a waste of time. Seperated again around 5-10 times in the next couple of years.

- it eventually came out so much that putting a seatbelt on popped it out

- had surgery in 2003

- no major issues since, apart from my tennis serve and throw is rubbish. Riding is fine.

 

[dontfeelcold]

I did the same about 4-5 years ago. Got surgery and was back into gymnastics after 6 months. Was riding a bike on the bike path after 3 weeks and back in the bush after 4 months, $3500 well spent.

 

[jrewing]

Do you even lift bro? Cause you won't anymore, unless you love clunking.... Push-ups, bench press are no good.

The only other side affect is when you get massages, they work the tight muscles around the back of the shoulder...then you start clunking again. Need to tell them to work on another tight muscle!

Been 3-4 yrs now.

 

[teK--]

- recovery/rehab/physio post initial sepreation was a waste of time. Seperated again around 5-10 times in the next couple of years.

- it eventually came out so much that putting a seatbelt on popped it out

- had surgery in 2003

- no major issues since, apart from my tennis serve and throw is rubbish. Riding is fine.

Are you referring to a shoulder dislocation? Because that is different from a shoulder separation. Once your shoulder is separated it cannot separate again (unless you have surgery which fails).

I did the same about 4-5 years ago. Got surgery and was back into gymnastics after 6 months. Was riding a bike on the bike path after 3 weeks and back in the bush after 4 months, $3500 well spent.

Was that through private health insurance and was a gap payment? Which procedure did you get?


To the OP:

I have a grade 3 from just over a year ago although not as bad as yours my drop is about 8-10mm.

Opted to have no surgery as I didn't have private health at the time and would have had to wait ages for the public system. Took out private health right away in the hope that if I changed my mind I could wait the 12 months exclusion period.

Started physio at about 8 weeks and I was back on MTB in about 11 weeks (albeit being super careful). After about 16 weeks I was back to my usual weights training but starting on light weights, and 6 months later up to now I am pushing about 3/4 the weight as I was prior to injury.

Mobility and stability is very good (but not as good as before), and occasionally there is a click in my shoulder but there is no pain. On the physio's advice I avoid doing heavy weights with deadlifts and shoulder presses now. If I work the shoulder hard for an extended period of time it does get a dull ache/soreness but nothing bad.

I've crashed a few times involving sideways shunts and the typical hands out OTB crash and thankfully shoulder has been fine.

Upon reflection I wouldn't have done anything different but in future if it starts bothering me and I can fit in a recovery period I might opt to get surgery to restore full stability and strength as well as mitigate any arthritis which is otherwise inevitable if left uncorrected.

I researched all the different procedures available and the most modern/successful seems to be the kevlar rope and pin technique which has quickest recovery and least chance of infection. In saying that, any surgery of the shoulder or close to the head is inherently more risky than elsewhere in body.

Good luck with the recovery let us know how you go.

 

[pink poodle]

I blew my shoulder up in 2010. Doctors couldn't decide if it was a grade 3 or 4 and settled on 3. I followed the doctor's instructions and have experienced very little issues.

Their was pretty simple...sling for a bit (annoying much??? But do it), rest it for about 6-8 weeks (ie no riding or other macho stuff and definitely no wanking marathons), resume life as normal gradually.

I've not had any physio or similar and was never (saw doctors about it 3 different times) recommended surgery etc. I do apply a variety of mobility exercises to it when I remember that were recommended to me by an OT when I last had a desk job.

Issues:
- isn't noticeable to he initiated, but when you look close the shoulder sits higher at the collar bone and the distance from my neck to the outside of my shoulder is shorter than the "good side". This hurts my feelings as I was once a beautiful beast of perfect symmetry!

- on the rare occasion I get laid I can't be all spooney love the cuddle bandit all night as the arm goes funny if I sleep on it for too long thus I toss and turn in my sleep. Not an issue to me, but seems to annoy females.

- can't do more than about 10 chin ups in a row anymore, could do about 20 before the crash. Similar with push ups as well, can't do more than about 15 without a rest. Both put a lot of pressure on the joint.

- carrying heavy shit for a long time gets a bit achey as well.

- I also broke the collarbone on the same side about 4 months after I tore the ac. If you do this the bone can go all kinds of fucked! Mine has a made bump in it. Doctor wouldn't operate on he break as it didn't go right through etc even though it looked like I had a golf ball under my skin.

Not to shit on too long...but I broke the collar bone and tore the ac on the other side in a separate accident a in 2008. This was a pretty big bust up so when they pinned me back together they hooked the ac back into place as well. Shoulder looks perfect, works mostly perfect, can't spoon on that side for shit either.

That's about it. Out of interest I've got a buddy who scored a grade 2 and it was a perpetual pain in the are. As the joint never severed it was always healing and then popping then healing then popping etc. Also have a buddy that had a grade 4 reconstructed. Took 2 goes to get it right and a lot of time off the bike.

Do what to doctor says. Care for it sensibly. You'll be fine, just not so good at spooning.

 

[ctguru]

Grade 3-4 right acj subluxation in about 1995, no surgery. Still ride fine today, fractured left clavicle twice, now has 13 hole plate in it. Stacked a number of times, most recently big over the bars with lots of skin off. Shoulders are fine though. I found when wearing a back pack and reaching down for the water bottle my clavicle moved on my acj injury side which was painful. Camelback now so no issue

 

[NUMBER5]

Did a grade 3 along with some ribs and a sternum about 5-6 yrs ago. At the time I was referred to a very good sports specialist. I still remember one of the first questions I asked him was "can I still ride and what happens if I come down on that shoulder again?". The response was a blazay "You've got nothing to tear there anymore,,,,, so yes".

I was given the option of surgery or not. The stats were that 15% of people with no surgery reported continued problems while (if I recall correctly) 5-10% of people who did the surgery reported problems. I was also told that I could do the surgery at anytime but the surgery that was done at a later date was different to the one done immediately.

I went the no surgery route. Saw rehab specialist and did the rubber band thingy, pole over the head, side to side etc. So far the shoulder's been pretty good. Prob lost about 10% movement, touch weaker and on the rare occasion can ache with some pings here n there. Even the bone sticking out of the middle of it has settled down so it's barely noticeable....haha. Oh, carrying a heavy back pack or a 15kg plus toddler on your shoulder for extended periods of time can also make it ache. At the end of the day I generally don't notice it and it doesn't stop me from doing anything. Who gives a shit if one shoulder is higher than the other and one arm is slightly longer than the other?? hahaha.

Good luck with the recovery mate

Now my left shoulder..... oh boy..hahaha

 

[dontfeelcold]

Was that through private health insurance and was a gap payment? Which procedure did you get?

Yep, that was through private health cover. It covered most of the hospital stay and barely any of the surgery. Medicare gave heaps back on the surgery.

I have a stud holding the ligament onto the joint. Over time the ligament reattaches to the bone.

The only thing I find uncomfortable is having people or heavy objects putting pressure on that joint. Not because of the joint being sore but because the head of the stud is facing up and cops all the load.

 

[Linga]

both my shoulders are blown and the right is the worst. Clavicle pops in and out easily.
Worst part is, that the docs help very little.
My Physio was disgusted when he saw it weeks later, it was too late to help.
Get to a physio and get it properly strapped into place as soon as you can. this will minimise the damage and give your body the best chance of resetting.
If you are in Perth I can give you his number, but I'd be getting it strapped by someone in Canada.
Goodluck mate.

 

[CourseOut]

Howdy

I separated my left shoulder in 2012, I believe it was a grade 3 also, although it doesn't sound quite as bad as yours. Crashed racing bmx, direct hit on the shoulder.

I saw a physio ASAP (I think it was a couple days after the crash). Had it in a sling for about a week, have an office job so not too bad really. Went to the physio maybe 4 times, he gave me some strength building exercises, as well as dry needling and massage to help the muscle relax and go back where they are supposed to be. Basically did super light weights (movement was kind of like starting a lawnmower), then started doing incline push ups (i.e. standing against a wall) and slowly worked my way toward doing them on the flat again. There were other exercises using resistance bands, but I can't remember them off hand.

Surgery was never suggested for me, but it did take quite a few weeks for me to recover. I think I was back on a bike in maybe 4 weeks, but only riding around. Was about a week before I could drive a manual again. Now I still have a good 20mm drop on my left shoulder, and I do get some discomfort if I overdo it weight training. It also seems to put extra strain on my neck, but physio seems to think that's unrelated. I do notice it if I don't do weight training for a bit - strength seems to go faster than it used to in that arm.

Short term definitely keep it in a sling, and get yourself to a physio ASAP

 

[redbruce]

Hi, looking to get some advice. Typing with one hand so bear with me.

Tore my AC - type 3 shoulder separation. I'm in Canada right now, doc reckoned it was about as bad as they come without immediately requiring surgery (type 4+).
For physical severity, currently my shoulder is about 35mm lower than it should be.
I fly back to Aus in 2 weeks. I'll have it re-assessed and xrayed when I get back.
I will probably start seeing a physio as well.

For those that have had type 3 separations, how did recovery go? Any issues down the track (months/years)?
Slumped shoulder, immobility, weak?
Anything you wished you'd done?
e.g. you can have elective surgery to have holes drilled into the bones and have them held in place by cables while the soft tissue connections regrow.

Hmmm, Deja vu. Wind back 12 months and I also had grade 3+ AC separation. Unlike most on this forum though, I'm 57.

I ended up at a public hospital, so saw a public funded ortho.

He saw my occupation and assumed I had been on the net (and rightly so - I'm a research scientist by profession), so discussed options with me, him erring on the side of lets give it 6 weeks and see.

Two weeks later I'm going nuts. Cant drive (well you can according to VicRoads, but you open yourself to insurance legal challenge re capability in event of accident - work wouldn't allow me to drive as consequence), cant ride motorbike, nor pushies, longer walks are uncomfortable, along with sleeping and decided to see my long term physio for advice.

He looked at my 25-35mm shoulder drop, explained the physiology of the complex joint (3 ligaments involved, all of which I had separated) and suggested I needed a second opinion. My (young but switched on) GP concurred.

I have private health insurance so saw another ortho (well known in AFL circles as shoulder/knee specialist in Melbourne). Similar discussion (but more facts, like 15% (across all ages) who don't have initial surgery have to have significant remedial surgery, along with an anticipated recovery time blowout from 10 months to 24 months: fitness helps but age against me - there is only a 6 week window for a critical ligament to repair (just doesn't without surgery), etc so, while not keen on odds really not keen on extent (my risk management approach) and decided on hook plate surgery (also has a synthetic mesh installed between scapula and acromium) . Once I made decision he then offered his basic rule: "if I can see the drop through a T shirt, recommend surgery".

So, once recovered from surgery (and recognising there are attendant risks, some of which befell me) I'm back in the car straight away, on the motorbike in three weeks, and MTB in 5.

12 weeks later plate comes out and I regress slightly until next level physio kicks in. Still a bit frustrated by recovery to some extent but have learn't shoulder stability is both muscle and ligament, so working on improving muscle memory and strength.

10 months later, I'm back to motorcyling, MTB, bushwalking and kayaking @ 90% of previous capacity, but with perhaps only 70% mental confidence.

Lessons:
1. Always, always get second (even third) opinion on stuff that has long term consequences (there is just more at stake) for you (be aware it can also have consequences for future employment).
2. A basic sling is useless. If going down that path get an orthopedic one designed for the specific injury (unfortunately ~$300 in AUS)
3. Age is a significant factor (despite being 57 and fitter and more active than most 40 yo). Was watching TeK's comment, with some frustration, on his experience at the time (he opted for no surgery) and discussing with my physio. Age means young have more time and capacity to develop muscle response to mitigate the inherent weakness in the ligaments (ie compensate for the irretrievable loss of the clavicle- coracoid ligament stability as consequence of no surgery). Fine but need to recognise ongoing stability relies on maintaining fitness of muscles involved.
4. As usual, no one size fits all. Choice of surgery or not requires information from a number of sources (and probably least of all the great unwashed unqualified and based on relatively short term experiences). See a range of qualified people to inform decision.

 

[anthonyma]

I'm also in the grade 3 separation club. I had various scans in the week after the injury and was told that surgery was an option but wasn't guaranteed to be a better outcome long term compared to if the ligaments healed naturally, but obviously surgery would be more expensive. I had follow-up scans in subsequent weeks to confirm the ligaments were healing (if they weren't then surgery would have been the only option for reasonable results).

I spent 6 weeks in a sling and sleeping in an upright lounge chair, then about another 6 of restricted movement including exercises to restore movement to the joint as the time in the sling means the joint doesn't move freely afterwards. During the second 6 weeks I could gradually increase the amount of load I put through the joint, moving up to standing push-ups ie against a wall.

I was told it would be 6 months until it felt "ok" and probably 18 months before it felt "normal" and that was about right. I was back on the bike in about 3 months but only easy riding with an upright ride position and back to riding normally at about the 6 month mark. I took the cues from by body and avoided anything that caused pain discomfort.

I don't notice any residual effects in terms of strength or mobility. I think a key factor in the full recovery was following the advice of the doctors and not trying to push things too far too early.

 

[rowdyflat]

I 've had several AC tears including complete had surgery was privately insured ,was about 45 yo then had great result.
Since then bad fractured clavicle surgery was fine.
If you are in the public system + not insured you wont get the optimum treatment unfortunately.
Most of these injuries will heal eventually with time if nothing is done.
Did you have travel insurance?

 

[Mitch243]

Thanks for the replies all.
I didn't have travel insurance per se, but I did have international medical cover via Bupa.
They still owe me a few thou, but hopefully that comes through this week.

I ended up flying back to Australia (for additional reasons) and having surgery.
I got two extra opinions beforehand and both agreed on it - it was a bad separation.

I guess it was a different surgery to others since I've got a shoulder immobilizer on for 6 weeks.
Doc reckons the ligament should heal by late May and I can start physio/rehab after that.
He's fairly optimistic, more so than me for sure.

Time will tell.

 

[pharmaboy]

Glad to hear . Incidentally, I read between the lines on Bruce s post, that the recomendation of a second opinion was to get him out of the public system. These are the sort of injuries you need to have private health for. The public system has delays built in and they greatly effect the outcome - ligament injuries have long been the province of private orthopaedic surgeons, because the public system just doesn't value the injury as important enough

 

[GDonehue]

So many fellow shoulder folk...
I was kind of lucky that I did mine at work doing a selection course (at least that is what I am telling them... Turns out drilling a tree 20 years back and crushing my AC leaving a small piece of bone floating about, that we hae called peanut and now sits on my bedside table, had little to do with it). Mine went on 26 May. I thought inhad dislocated it so kept doing the exercise one armed hoping it would pop back in (18 mth prep for selection course - a dislocated shoulder was not going to stop me). Taken to hospital and told I was stuffed. Physiotherapy said I'd never do push ups again. Opted for second and third opinion and ended up with surgery by Eugene Ek. He rocked. Back at work in five weeks, back to fully operational in under ten. I am now back to full training, pumping out 80 - 100 push ups and getting back into heavy weights. It all came down to putting myself through pain of rehab and doing everything I was told by physio.