Sorry to hear about your accident. The Same thing happened to me about 3 years agon (around this very same time of year!).

I'd advise against the surgery. You can always get it later if there are complications, but once you get it, that's it. You could end up with arthritis or something else from the surgery, especially with the endurance athlete lifestyle. I went without and it's fine. I have to do strengthening exercises almost everyday, but would probably have to do the same thing otherwise. I mostly do them out of habit now. Running was the last thing I could do during recovery, but swimming was about 3 weeks. I actually have a much better pull on my right side than left (right side is separated) because of the extra range of motion.

On a side note, you can scare the crap out of kids at the beach. "OH MY GOD MY ARM!!!!"

I separated mine (grade 3) 3 years ago. While I've managed to get back to doing everything I used to without surgery, I still have significant discomfort with day to day activities now and then. Swimming's not too bad, but mountain biking and skiing can be quite problematic. Kinda wish I had bit the bullett and got it fixed when it happened. I suspect that I will have to get it done at some point. And yes, people point and stare at the pool.

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MAO Elite Team
http://www.markallenonline.com

Sorry to hear about the injury. Mine was right shoulder Grade 2, 13 months ago. No surgery, since the surgeon said there were slightly more possible risks than benefits in my case. My PT said no swimming for several months, and anything resembling a swimming motion was quite uncomfortable. I could bike, run, and even XC ski (a surprise, this last one) as hard as I wanted, just no swimming.

I did the prescribed exercises every day and was able to race IM this year, but it's still more fragile and injury-prone than the left.
Best of luck in your recovery.

Chris

Sorry to hear about your accident, I separated mine last year (class 3) on a mountain bike ride. I opted to not get surgery and i have not looked back since. It took a couple of months to probably get full range of motion back and if you can live with a bump on your shoulder you will be fine. I am over 40 so the cosmetics did not bother me like it would have if i was 20, and remember "chicks dig scars". You will have to do some rehab to learn some good exercises to get your shoulder stronger but i would recommend not getting surgery.

Congrats. welcome to the club :)

I got my Grade III (ortho said verging on IV) on 2/5 of this year, 10 weeks out from IMAZ. I was pretty aggressive with ROM exercises (pendulum), and physical therapy. Used the sling on and off for 3 days then got rid of it. My doc said the ligaments were gone, I couldn't do any more damage, so my only limitation was pain management. In that respect, better than a 2 since I could continue to train


I was back in the pool within 5 days (kicking and one armed swim only), and was back to 3K + workouts in 2 weeks. I was sore at the end, but I got through it. Other than a little "crunchiness" in the shoulder and a bump, no lingering effects.

I was on the trainer in 3 days, and running within a week. Actually, running was the worst long term, as those ligaments that were formerly holding up the scapula aren't there any more, and I could feel my whole shoulder blade sagging after about 8 miles, got pretty sore. PT on the areas as well as kinesio tape helped, and that's pretty much gone.

Cycling, hurt moving from hoods to bullhorns or aero bars, but once in position, was OK. Did 70+ 10 days after my crash, but a couple big bumps HURT.

Made it to the start line of IMAZ with my swimming stronger than ever. And as someone else said, I have been told my stroke actually improved.

Ortho said surgery may or may not work (there's various methods), and I'd be trading a scar for a bump, plus recovery time. Could be done at any time. He recommended against it unless I had to do overhead lifting or throwing.

Only time it bothers me is if I sleep too long on it, in the night it will hurt

Just went and bought a suit, the tailor noticed and had to put a pad in the shoulder since it's a bit droopy. And yeah, people will stare at it, it just shows how tough you are :)

Non-op, if as described.

It sounds like many others have had prolonged issues...my youngest brother had a grade III, we decided to treat non-op, and he was swimming in less than 2 wks.

He is around 3 years post injury and doing fine...except for the unsightly bump on his shoulder.

Best of luck.

Jeff

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Jeff Shilt
__________________________
www.mdotdoc@blogspot.com
twitter @MdotDoc

I would like to thank everyone for the posts, the imput from this forum is quite valuable since we are into the same activities. I do not want to make a bad decision on top of an injury. The orthopedic doctors seem on the fence on this injury, I cerainly do not want advise from someone making money or the insurance company saving money. I guess time will tell, at least they can go in and fix things down the road if it is bad.

Thanks again for the imput and the personal stories. I am probably 90% on letting it heal as it is.

Don

Ya Bro. Let it go. It's the end of the season. You'll have time to rehab. For what its worth I had a grade 3 years ago. I raced that next season. And, set a IM PR this year. The deformity is still there but it's more than functional for a Triathlete.

2 1/2 yrs ago grade 3-4 ac separation. trauma hosp. docs said i would need surgery. 2 days later met with dan buss, twins and vikings shoulder guy. he said no way - rehab and the shoulder would find its way back. did a tri 2mos later. keep working it and you should be ok. you'll just get a lot of cred when you walk into your lbs. long live the bump!!!

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I got grade III three years ago. Chose not to have surgery and except for my wife making fun of my "funny bone" sticking out, I have not had any issues whatsoever. The doctor told me that the only constraint would be that I will not be able to lift heavy things above my head - So I just don't do it.

I was also told that surgery later down the road is just as effective as right after.

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Dog fighting is not a sport. Real heroes do not fight dogs!

grade 2 or 3 as a kid (HS athletic trainer sucked- no rec for doc or anything; this is a best guess based on symptoms recently learned and the 1/2" bump on L shoulder), grade 2 MTB crash early 20's. 31 now, some ROM gone forever; strength is good, but that is from many years of lifting. If it's a 50/50, go non-invasive. Be an animal with therapy, and you can see some good results. Stay in close contact w/ your ortho.

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If I don't, who will? -Me
It's like being bipolar in opinion is a requirement around here. -TripleThreat

I separated my left shoulder four years ago last month. It involved a borrowed bike, a sidewalk, a broom handle, and a light pole. Please do not ask…

Dr. said it was a level 5. No ligaments left.

Like others have mentioned…. The damage was done, pain was the limiting factor, and I could either have the surgery then, (I was 31), or later in life. Odds of success were the same. He was talking about moving ligaments from here to there, attaching them with screws, and LOTS of PT. I elected to not have surgery.

I loved Vicodin for a short time, and had some pretty serious clunks for a while. For a couple of years I had some pain from time to time, but was functional.

2 years ago I started to work out, and the stronger I got, the better my shoulder felt. I still cannot do upright rows, shoulder press, anything above my head, or anything heavy without pain. Mountain biking, road biking, running, and swimming can all be done without any pain. I have a BIG bump. Overall I am happy with my decision to skip the surgery.

Right now I would gladly trade my plantar fasciitis for another separated shoulder…

I'd say skip it.

I had a nasty crash 28 months ago, for which I spent 3 days in the ICU. I had a concussion, broken ribs, a broken sternum, collapsed lung (necessitating a chest tube) along with a grade 3 AC separation. My biggest limiters were the chest injuries, which caused me a lot of pain doing anything for 6 weeks.
I saw a local ortho and a second opinion with a shoulder guy at USC. both said that they would not recommend repair, and that repair would keep me out of training for 6 months).

From what I've read, if you are not doing heavy weights or throwing for a living, it's not necessary.

After a few weeks of riding the recumbent lifecycle at the gym (try that for 2+hours--ugh!) , then riding on my beater bike on the trainer (with the front elevated a foot, holding on with my good arm), I was able to run at 6 weeks, without undue rib pain.

For the swim, I started out doing Doug Stern's (well his as described here) sewing machine drill in a pool, then open water for a week or so, I was able to swim a few laps for real after 7 weeks. I was able to ride on the road after 2 months. I did some serious PT, where I worked my butt off in the meantime. Among many other things, he had me on one of those Chuck Norris/Christy Brinkley gym things doing freestyle (well????) sort of. That really helped the shoulder recover for the pool.

With a little help (well, it was a lot of help) from Francois, I won my AG at Big Kahuna at 4 months, a local Oly at 4.5 months and finished second in my AG at SOMA at 5.5 months, first in AG in IMAZ in 11 months and 12th AG at Kona 6 months after that. My shoulder was a little tired at the end of the swim at Kahuna, but otherwise no problems.

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Dick

Take everything I say with a grain of salt. I know nothing.

I did mine in April, also grade III.

The advice I got from my orthopaedist (who is also the long time surgeon for the local Big12 university athletic teams) was that there was nothing to lose from not doing surgery and coming back to it 6 or 12 months later if I wasn't happy with the rehab. Also, I was told that there was approximately a 1/3 failure rate of the surgery. Since my injury was in the preseason and the rehab for conservative treatment is generally faster than it is for surgery, all signals pointed to going conservative first.

My progression was ellipticals to cycling to running to swimming. Did a half marathon within a month of the injury and Oly about 7 weeks out. I had a successful season for me. My swimming in workout time trials never got back down to what I was doing just before I hurt myself, but my results in races were faster than last year. So, yes, there was a deficit, but not overwhelming. As always, your mileage can and will vary.

Like others, I still have some residual discomfort from time to time and in certain motions. I've never been hugely strong, and I'm still lifting less weight than I was doing before the accident (in shoulder related exercises) and doing fewer pullups.

I've been comfortable with my decision. Choose what makes most sense to you after some more research and maybe a couple more conversations with the doc (or another one!). It's disappointing how many medical things really are a tossup.

William

11 years ago -- car accident. At least yours was a "war" injury mine was just being a dumbass driver.

I did not have surgery and I notice no difference with my shoulder motion or strength. Btw it is my strong/primary shoulder if that makes a difference.

The hump was only a problem when I was being "hit on" by another guy in the men's whirlpool. He thought I should have it fixed, while I was just more interested in not continuing the conversation...

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Swim - Bike - Run the rest is just clothing changes.

I also suffered a grade 3. I did a ton of research and found that those who opted for the surgery mainly did it bc they just wanted to get rid of the "bump" but if you read through all the research, you will see that there is not a perfect procedure for this type of injury. I've read cases where athletes had the surgery and wake up in the night in pain with the clavical popping back up again. A high percentage of those surgeries are not successful. i tore mine in july 07. I had to take about a month off from swimming. i tried a few times within that month, but my shoulder would just retaliate and leave me in alot of pain. I found training on the vasa was a helpful way to get back into swimming bc i would swim with an underwater recovery to minimize stress to the shoulder. I was able to start swimming 4 weeks after the crash and start more serious swim training in sept. and was able to race an ironman 3 months after the crash. Its definitely not a healthy shoulder. I have to be careful with pull paddle sets, ramping up swim volume too quickly, have trouble playing ball with my lab (can only throw sidearm), still hurts to sleep on my right side.... but my recovery back to training and racing was only about 2 months. Much less than the time i would have lost due to surgery and rehab. I can stilll swim 18-20,000 M /week as long as i build up slowly. I would definitely pass on the surgery. Good Luck!

I did the same thing last summer in July getting ready for IMFL. My ortho said to give it a month and see how I did. The pain was awful for the first two weeks and after that it was managable. After the month I went back and had a good range of motion to the side and out the back but could not lift my arm out to shake hands.

I decided that I'd like to be able to use my arm again so I opted for surgery. Man did it suck. Mine was an open procedure (no scope) and utilized a cadavor tendon with bio screws. Anyway post-op the doc told me it looked like a bomb had gone off in my shoulder and that he was amazed that I had had as much movement out of it as I did before the surgery. I believe the technical term was 'completely shreaded AC and CC ligaments with massive trauma to the Clavicular miniscus (which had to me removed)

Several months in a sling, obvioulsy no IMFL, 25lbs and lots of frustration. PT was a snap, I had no issues and only needed about three sessions of streching to go from 95% mobility to 99%. They sent me home to do the rest of the strenghtening on my own.

a year later and the shoulder is still not perfect, but that is mostly due to my lack of PT streghening once I got full normal use back. I can sim with no problems, lift heavy object above my head, etc. I still have a sloppy collar bone and it does hurt from time to time.

I have a wicked scar, and the bone still leaves a 'bump' on my shoulder, although not nearly what it was.

Wait to see if the shoulder will come back without the surgery, alot of them do and the surgery is a massive trauma to the shoulder that takes along time to heal. The good news though is that the new technique utilizes human tissue that will actually be replaced by your own over the course of a year, and will get stronger and stronger just like everything else.

Good luck, that is a sucky injury.

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This is your life, and it's ending one minute at a time. - Fight Club
Industry Brat.

curious as to what you decided to do? I once again pushed my shoulder over the edge and have to take some time off from swimming now!

Well, I decided to just let it heal, things had been progressing nicely until an incident with my dog this last Wednesday. The ligaments tore a bit more and set me back at least 4-5 days. The clavicle is higher now than it was before the dog, and muscles in the area were quite sore and tight for several days. The re-tearing was more painful than the initial damage. I have quite a bit of strength in certain positions and full range of motion as far as I can tell if I move slowly. I have a tough time above shoulder height and cannot make fast or reactive movements at all. I figure it may be at least another 2 weeks before I get in the pool, running is ok, riding is uncomfortable but possible. Best of luck.

Ditto everyone else...

I had a grade 2 about 6 years ago... it took about a year to get more or less back to normal (at age 48 then..)

My surgeon said the same... see what happens, you can always get surgery later if you need to.

At this point all that's left is the bump ...

Just suffered a grade III shoulder separation last week after a pretty nasty crash on my bike. It has been very helpful to read the responses of others who have dealt with this problem in the past. It has been difficult to find much good feedback from people who have opted to have the surgery. I noticed a post from Ti T'war whose outcome seems to be pretty good other than the painful recovery. I am most concerned about being limited in overhead lifting and throwing. I play a fair amount of volleyball and have 5 kids that are certainly going to expect some baseball time with dad. I have been leaning towards having the surgery, but after reading some of the posts here I may decide to put that decision off for a few more weeks. The doctor says I could go either way. He indicated that the right shoulder is actually shorter now than the left side as a result of the accident. He would need to remove a small portion of the bone and then use either a cadaver tendon or a graft from my hamstring to secure the clavicle in place. The doctor and a couple therapists I've talked with seem to think that the end result would be better after surgery than it would if I let it heal naturally. Tough decision.

I had a grade 3 about 10 years ago and it took about 18 months to get to 90% without surgery and I don't think I can get it back to 100%. It still wants to collapse from time to time when lifting heavy objects. It just isn't totally stable, but it doesn't limit me much athletically. If I was still into lifting it would get very frustrating and I while I can still whip a pill (baseball) around pretty well, I have lost some arm strength. The one thing I absolutely cannot do is spike a volleyball, but at 5'6" that isn't much of a problem.

Before you go through with that particular surgery I would get a second opinion, my first doc said the surgery would involve pins and or screws to hold the bone down while the ligaments were sutured and allowed to heal, he also said there is no fix later if I let it heal on my own. The second doc is in sports medicine and gave the same surgery option, but also said the same surgery could be done months or even years later if it was not working out. There was no guarantee either way.

I was in the pool for the third time last night and although it feels like there is a golf ball on/in my shoulder, I was finally able to get some decent pull. My shoulder fatigued a bit more than usual and I only swam for 15 minutes. I am pleased with the progress. As far as I can tell the main motion that does not have its former strength is lifting my arm while it is across my body, and the main position that can be painfull is arm down and behind my back. (taking off a jacket) I think throwing will come back with some shoulder excercises. Parts of your shoulder will go back at least partially to where they belong as they heal.

Best wishes for a good recovery.

amigos and amigas,

all of your comments, suggestions and quips have given me great relief, chuckles and even some tears! i separated my shoulder grade III in March while snowboarding in mammoth. i am not exactly a tri-athelete, but i am an avid mountain biker, fly fisher, surfer, etc, and it's been a struggle to accept and live with the hump! i am 38.

i am hoping that there are some advocates of doing the surgery. there are plenty of opinions not to do it, and maybe they are right. Dr. Ryu here in Santa Barbara does not recommend it, but he could be convinced. i think he does a re-construction type of surgery where he uses cadaver ligaments to create new ligaments. i have been struggling with the decision.

the reason i want to re-consider it is that long term i worry about the discomfort. it's healed up pretty good, and i probably have 95% of my strength, but it does start to ache after several hours of backpacking, child carrying, fly fishing, etc. Sleeping is a choir, as it hurts or pokes out regardless of which side i sleep on.

why not get the surgery, recup, and have a new shoulder? any post-op success stories out for a grade iii?

thanks all
blu

I did a class 3 sep while skiiing 7 months ago. Chose not to do the surgery. My ortho said he could do the surgery later if I didnt like the outcome without it.

Except for the bump, I've been satisfied. I'm 41. I play basketball at a high level, and slowly got my jumpshot back, as well as the ability to use the arm of the injured shoulder in positions above my head. There is no pain with it anymore. It does feel weaker, but not enough for me to care about it. I like to carry a shoulder bag on that shoulder- it pushes the bump down..

If I was 20 yrs younger, I would probably roll the dice on the surgery thought, only for the cosmetic reasons. A younger friend of mine had the same injury and got the surgery and is pleased with it. It is a roll of the dice. Surgery will give you a scar, expose you to infection, and then possibly not hold the clavicle down enough to reduce the bump totally. So for me, it wasnt worth the risk. Plus I think it delays the recovery by at least a few months longer than would occur without surgery.

Bullsh-t to all those who say you can get it later.

My sports residency included a 1 year placement with an upper extremity orthopaedic surgeon.

I've seen the conservative route, the immediate surgery route, and the late surgery route.

Most success came with the immediate surgery route and those that pulled the trigger early were the most likely cases to heal with no dysfunction.

For some, a hook plate was used alone and others used a combination of a hook plate and reconstruction of the coracoclavicular ligaments. In both instances, the hook plate was eventually removed but again, those that pulled the trigger early had a higher likelihood of success.

I cannot say the same for your situation as I do not know the full clinical history, but the above is what I saw and also falls in line with the current research.

So no recommendations from my end other than to base your decision from QUALIFIED opinions rather the lay population....especially if it has to do with a knife and some thread/string

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JC
Twitter: http://twitter.com/jeffcubos
Website: http://www.jeffcubos.com

For what its worth, in my "clinical" opinion, what you do in the first 3-4 weeks post injury is crucial to what the prognosis will be.

Immobilizing the joint in a sling to prevent gravity from pushing down on the acromion is key. Secondly, taping down that AC joint with leukotape IMMEDIATELY following the injury also goes a long way.

It may be too late for your case but if anyone else reads this, hopefully I can help someone in the future.

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JC
Twitter: http://twitter.com/jeffcubos
Website: http://www.jeffcubos.com

My suggestion is to get two opinions. I've separated both shoulders and had surgery on one. I opted for surgery a year after my accident and I wish I didn't wait so long.

Get all the information you can, then make a decision. I'd recommend to do it very quickly because stuff starts healing quickly and shit starts fusing together that isn't supposed to (at least that's what happened to me).

You guys do realize this is a post pulled up from over a year ago right?

Would be interesting if the OP actually responded with what he chose and how it worked.

I had a grade 3 separation in 2002 (AC joint), did not do surgery, and other the the cosmetic issues, have very minor problems. My shoulder hurts after long runs (3 hours plus) and after hard swim workouts. It also clicks some when you rotate it, but no pain except after prolonged activity. I do feel I have lost a very small amount of range of motion, but it is very small.

I am certainly not questioning "qboss" expertise, he has medical experience, and this is just my personal experience, I am sure it differs for everyone, but I am personally glad i did not have the surgery. I was told by my ortho that it could go either way, and that I could wait, so I decided to see what happened. It worked in MY case, may not be the best option for someone else. I was not into triathlon at the time, so wasn't as concerned with swimming, but if the same thing happened now, I would get several QUALIFIED MEDICAL opinions. Seems like this one is not at all cut and dried.

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Disclaimer: This poster is a sales rep in the bicycle industry

3+ years out. No problems except the bump.

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Dick

Take everything I say with a grain of salt. I know nothing.

I had a grade III shoulder separation about 5 years ago from a crash in a criterium at Superweek. I chose not to have surgery. I did my rehab exercises, got a lot of massage, ART, and accupuncture (to help with the surrounding muscles) and I was back riding on the road by 4 weeks after. I was on the trainer the day after the crash. I did my first criterium again 6 weeks after the crash. I didn't have any issues with range of motion or discomfort, other then the lump would sometimes get sore from my purse strap when I carried by purse on that shoulder. I wasn't racing tris at the time but I did do a lot of swimming in my off season for rehab and cross training and didn't have any issues from the shoulder. But I can't really speak to long term issues since I ended up breaking my collar bone on the same side a year later, which did require surgery, so my doctor joked that pretty much fixed the lump from the shoulder separation. :)

Well here we are, over a year later and part of me wishes I had just had the surgery right away. I still have a very large bump which is not a big deal, but the shoulder will hitch up on certain movements, which if repeated makes me a bit queasy. It still bothers me from time to time and affects my swimming. I noticed very early that I was actually a faster swimmer as I was forced into a better body position and stronger pull since it was quite uncomfortable to stretch out to glide. To this day the shoulder fatigues out quite fast (10 minutes race pace) I am sure I could extend or remove this through more swim training but after a few days of 15-20 minutes in the pool my shoulder will have a dull semi-nauseous feeling that only comes from inside pain type of ache for several days. I have not been able to get past this point yet.

I did not initially get the surgery because I wanted to have things heal up naturally since every doctor I saw said I could go either way. I also did not have the surgery because I would be looking at as much as three times the initial recovery, I never thought I would be still having trouble a year later. I may very well pay a long term price for the short term gains. Is it really a big deal, at this point in my life I guess not. I still debate getting it fixed, I am 34 now and time is ticking. I want to be able to throw a ball around with my son when he is older and I think I can do that if I work at it a bit even without the surgery. It is a very tough choice either way, it is more difficult when most doctors are on the fence.

Hope this helps, it may not be bright and cheery, but it is the truth.

Don

I'm 51 year old multi-sport athlete & I have a grade III separation post 2 weeks from a motorcross accident (helmuts do save lives). Saw a shoulder ortho and he Rx'd an MRI wihich I had an hour ago. I really doubt he will recommend surgery. Last week I though I would never use the shoulder again it was so painful and immobilized. This week has been amazing. Range of motion has improved dramaticlly without any formal therapy. I have done a couple of light upper body weightlifting, leg workouts and a spin seesion, this after reading stuff that I would be out 3-6 months. I've spent hours on the net reading about AC separation injuries, surgeries, and outcomes. The internet is a remarkable wealth of information. There are forums on AC separations on websites ranging from mountain biking, weightlifting, swimming, triathlons, bodybuilding, rugby, cycling, motorcross, kayaking, surfing, skiing, general medical info site, etc. After reading hours of forum discussions, I can say mountain bikers take the prize for sheer volume of shoulder separations (Rugby 2nd place). Their wisdom was "absolutely don't have surgery cause your just gonna separate it again and again" or "it's great not having to worry about separating your shoulder again man, you can fall on it over and over - no worries". Most everyone with a Grade III (which seems to be the overwhelming grade discussed in forums) wants to know a) should I have surgery & b) what is my long term prognosis with or without surgery. My unofficial and non-medical results from forums are:

Pro-surgery:
Possibly removes bump (collar bone protrusion) improving cosmetics
Possibly restores 100% strength in shoulder vs 80-90% strength left untreated
Restores full range of motion vs 90-95% ROM left untreated
Restores integrity of joint for repeated highly repetitve overhead function for sports, ie baseball, swimming, tennis
Possibly less long term pain from movement

Con-surgery:
Uncertian outcome of surgery, ie complications, infections, failed joint post surgery
Re-injury of joint vs, not having the joint there to be separated again
Possible arthritis in joint post surgical repair
extended recovery period
can postpone surgery to see how it does and opt for surgery later (although how much later is disputed)

The biggest factors in deciding whether or not to have surgery for most people are a) age - the younger the more likely to have surgery, b) sport - some sports require 100% ROM and strength in the shoulder, c) pain - not all grade III's are equal, some seem to be very painful for a long time, d) cosmetics - the bump is not natural, e) recovery period - most athletes want to get back to activity asap.

Thanks for those who have posted their stories. For me, the net result of reading all the forums is that I will end up not having surgery and will have a bump and maybe 10-15% less strength to do certain exercises, ie bench press, pull-ups, rowing.
Best of luck.
Steve

Hey, is this forum still active? I am seeking advise on a grade III. Will post my story.

So, I got a grade III (left shoulder) from a wave slamming me down while bodysurfing. The first month or two was hell. This happened in August of 2010 and is all healed up now. I am an avid swimmer who partakes in triathlon relays and open water swims. I also enjoy working out (lifting weights, etc..). I am completely able to do everything that I use to with left shoulder and have participated in several tris and open water swims since then. I did see a chiropractor and went through a treatment plan of his to perform necessary back, neck, and shoulder adjustments with the results being very positive and my ROM was fully restored. My concern is the appearance of my shoulder; I have a fairly large lump at the top of my AC joint. Def noticeable when wearing certain shirts and is rather unsightly. It is really freakin bothering me (from a cosmetic stand point) since I get my ass up at 5am and workout (swim/lift/whatever) for two hours before work five days a week and I take pride in what I eat and treat my body.

I also saw an orthopedic doctor about this and was asking him what my options were on getting the bump reduced/removed. His only suggestion is surgery (3-4 inch incision on the AC joint with a graft and a screw holding everything together initially with the screw being removed making the whole thing a 2 step process). He also told me that I would be in a sling for 6 weeks followed by 6 weeks of pt totaling 3 months from start to finish. I am finding that the bump would possibly not go away (the main reason I am doing this). So, if I can be assured that bump will go away, I will be willing to go through with it. If not, it’s a no go. Again, everything feels fine now, just the bump really bothers me. Does anyone have any suggestions on what I can do get rid or minimize the bump? Any suggestions will be greatly appreciated. Thanks.

I went ten years without surgery. Last year had it fixed, well tried to atleast. About 9 weeks in the ligament stretched and now I have no feeling in the shoulder and my last two fingers.

Unless you're a model, I wouldn't go through the surgery and long recovery for a questionable result. And I do have a grade 3+ from 2008, and a very large bump. Frankly, I never notice it until it shows up in photos or someone mentions it. I guess it looks pretty gnarly.

As my ortho told me, "it's not a guarantee and you're just trading a bump for a scar"

Sorry, I know you were looking for suggestions but it's either try the surgery or not. Only you can weigh your motivations for doing so

Good luck

Thanks Chris for your message. Yes, agreed, it would be a lot to go through for a questionable result.

Does anyone else have any other suggestions or experiences that they could share?

Dont need to have Op for a grade 3. Its optional, but I wouldn't advise. Rehab will get you there.
With a Grade 5 if you want any quality of life, its advisable to have repaired.
Good luck, mate

I don't know what grade I have because it happened back in the mid 1980s but I have a large hard lump and lots of pain running and swimming. I never had the surgery - never had it offered back then. I did no followup or PT - just the ambulance ER visit (bike vs car and shoulder vs windshield). Really wish I'd done PT but now reading surgery stories, maybe I'm glad I never had the surgery. It is only pain, I suppose. Lots of clicking on ROM but I think I might have full ROM (but it is painful)

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I had a real nice crash in early June total separation grade 3 and since I'm a firefighter haven't been back to work since because I don't have a light duty option, though after my PT I think I'm getting over the hump and should be back to work by October since I had to put off hernia repair til last week so I could do my 60 days of PT as the insurance doesn't allow for a day longer. Either way I think it just takes time. I actually swam last week before my surgery using an underwater recovery on the right side. Not the most efficient method but it works and I'm thinking I'll be able to do a half or hopefully another full iron by the end of next summer if I don't have to get cut again.

I just hope I can ride my tri bike again. I have been out on my MTB and Hybrid on smooth paved paths and an old tri bike on the trainer with an altered handlebar set up to ride more comfortably. I think I can get back to work and do my job as other's expect and I know I can do so I'm hoping to put off surgery. See the doc in 2 weeks for a determination on our next step.

From my research, reading various post online, and my surgeons experience the outcomes from PT or surgery are about the same. I really consider surgery a last resort as there's no one real proven method. Seems like a crap shoot.

Good luck.

I had a horse fall on me while training it to take a bit.I fractured my pubic bone in two places and my pelvic in one and did a type III shoulder separation as well as bruised up some ribs and banged up my left leg.That was June 21 of 2010.I spent a month mostly in a wheel chair and had to used my arms to get around the separation didn't hurt when it happened so I was able to run a wheel chair.I didn't have insurance that would pay much more than the three days in the hospital and the ER.The doctor wanted me to stay for a week,but I didn't feel I could aford it so they let me go home.After a month I was able to get around with a walker and crutches and later used a cane.
The whole time I used my arm and my Rom was good.I had lost some strength and my shoulder ground and cracked some but no big deal.I was back on my street bike shortly after Labor Day.
I did my own PT exercises that I found on the net and worked some with weights.I did use a chiropractor to get my left leg to working right.I had a lot of tight muscles in it and my back.Also lost some muscle mass in the left leg from not being able to use it.I started using light weights and worked slowly to build my strength back.I can walked and run again.My shoulder has a big bump on it.I seem to have most of the strength back in my arm.I do have some discomfort at times but no real pain.I started roofing houses and barns as well as other carpentry work this year in May.I figured that type of work would be good therapy and I could find out what my limitations are.Swinging a hammer works and I can work overhead as well.I can hang by one arm,climb ladders,We put up a pole building and I climbed rafters.I am careful about what I do until I am sure my shoulder will perform as it should.I think I get a little float in it.I can do push ups,pull ups and dips.I can bench press with a barbell.If I feel I need support to help keep the shoulder in place I have a evs harness that I can put on.I can't really say I am all that limited in doing the things I have done in the past.I turned 52 this summer,so I don't expect my body to do what it could do when I was 18.I try to eat right and get exercise and keep my muscles up.I had read that surgery can cause a loss of ROM and people who get the surgery may not be able to work as fast as someone with out it.For now I am taking my surgeons advice and leaving it the way it is.Maybe I can give my bump a name.Like Bob,Bill or even Betty.LOL.The biggest concern I had was if my rotator cuff muscles were in good condition as well as all the muscle involved in any physical activity.Give your injuries time to heal and don't over do to soon.Make note of what you can do this week and compare it to what you can do next week or next month.

FYI - I have a grade 3 from 2004. No Surgery. Aches at times, but can do most anything. Have done 10 or so IMs since, with all the training required. I swim daily.

Most all, listen to Dr. J above - he is a highly accomplished orthopedic surgeon and knows what he is talking about.

Best wishes,

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David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.

Thanks everyone for your responses and your stories.

After a lot of thought, I have decided not to go through the surgery. It is not worth the risk to me. Thanks again!

right shoulder grade III and left shoulder grade II.......neither had surgery, both are fine now. just lots of breast stroke as i couldn't lift my arm up. if it hurt (range of motion) i didn't do it until it didn't hurt.

granted these injuries were roughly 15 years ago and cause by snowboarding and not bicycles.

on a side note, push down on your clavicle that is sticking up....... it moves! great fun grossing people out with that one! mine don't move anymore so must be things are hooked back up the way they were supposed to.

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Tim

Hi Dr. J
I saw this string on shoulder separation and your comments and thought you might comment on my own situation. I also had a grade III in July 2009. It was not surgically repaired. I was back on the bike in 3 weeks and in the water in 4. I did PT and for the most part was back in business. However this past June I began having neck pain and general shoulder stiffness. I have returned to PT as well as periodic massage therapy and even accupuncture. Modest improvement. I saw my orthopedic today (same one as when injury occured) and he indicated from my account he thinks I have "scapular dyskinesia" and would be a good candidate given the demands I put on my shoulder for a surgical repair. I am not eager for this but persistent sorness and stiffness is not a happy prospect either. I love my sport and retain a 5-6 day a-week regimen and am actively competitive. Don't like the 5-8 month recovery period either but need to take the long view too.

General observations? If you like I can share my email address as well.

Many thanks.

Chicagoman:

Those would be unusual symptoms to be associated with AC sprain...all the studies report the long term consequences of a displaced AC joint are the bump (cosmetic), reduced neuromuscular endurance (no one I've treated complains of this), and some degenerative changes at the distal clavicle several years after the injury. Every one treats 1 & 2's non-operatively, type III's seem mildly controversial in the literature-most folks with any experience and certainly in my practice would treat non-op with a very rapid return to swimming/cycling/running, whereas type 4-6 get an operation. Those that are experiencing persistent symptoms with non op treatment likely have additional pathology.

Which brings us to your symptoms...I would be quick to look for causes originating in your neck with associated symptoms referred to your shoulder before settling on the AC joint as responsible.

Best of luck,
J

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Jeff Shilt
__________________________
www.mdotdoc@blogspot.com
twitter @MdotDoc

Thanks much for your quick response. I do also have achiness out on the edge of my shoulder and the upper deltoid area. Do you have a website I can consult or an email address or other contact information I can take advantage of?

Best!

Hi Tucker 1050, I had a grade 4 AC separation in Feb 2011 after getting run over by a "gorrila" outside my goal crease playing hockey. The surgeon carried out surgery in March 2011 and I had a screw inserted to keep the joint in place while it healed and two pins that were placed parallel to the shoulder and were situated on each side of the screw to keep that in alignment! The pins were removed (thankfully) 2 weeks later (just hand removed no local etc). I was told the screw would be removed after 8 - 12 weeks via a local freezing and incision - everything I read on line also gave this time frame for removal.

As to your question - the surgery did a 100% job as to leaving no "bump on my shoulder" and my therapy went very well and as instructed to do so. However, for whatever reason the surgeon said after my 12 week visit the screw was to remain in place for up to 1 year! Couldn't figure that out at all. Anyway, as I continued my therapy and gaining my range back I could feel a kind of restriction and a rubbing of sorts at the area of the incision. I also experienced some kind of "locking - up" at that point whenever I brought my arm back to a resting position after raising it etc and to me it seemd obvious the screw was hindering my progression as to therapy and further movement since it felt like I had hit a wall as to further extension of my arm and therapy. I was told by the surgeon this was not the case.

In late summer of 2011 I requested the screw be removed and again in October 2011 the same request and asked why they did not take x-rays at that time to see if anything had changed - I was told it was not necessary! My next appointment was not slated until the spring of 2012 but of late I had enough of the feelings inside my shoulder as mentioned previously and went to see the surgeon at the fracture clinic of the local hospital (he sees patients there in the afternoons) on Dec 5, 2011 and pretty well told them I want an x-ray and an appointment NOW! They managed to fit me in - took the x-rays and I saw the surgeon who said - " I don't like what I am seeing here on the x-rays" - duh! It was obvious the screw was not broken but the screw and washer had worn into the bone about 1/3 of the way or more - showed as a dark hollow spot on the x-ray and you could clearly see the screw and washer below the the surrounding surface of the bone it was holding in place. Obviously in my mind this was a result of the movement of the screw and washer during my everyday movements and therapy sessions - despite being told this was not happening. The only answer from the surgeon was it was not unusual to see and now general anesthetic and surgery again to remove the screw and washer (no local anesthetic surgery now since this has happend) and I guess time to fill back over the void/hollow spot now there in the bone.

Pretty long winded response to your post (sorry about that just wanted you to have the history on this). If I had to do it over again and having a buddy who did not have the surgery and seeing his restrictions (and the cosmetic results - huge bump) I would still definately go through with the surgery, however knowing what I know now I would insist on the screw removal after the max 12 weeks that I have read up on. Having this screw and washer in place for the almost 9 months now I fear has created a whole new issue for me. I am convinced however that once this is removed (week of the 19th Dec 2011) I will finally be rid of this "rubbing, locking up and wearing situation" that I was feeling daily for the last couple of months and finally get to where I should have been months ago.

I am really annoyed at having no real answers as to why the fixture (screw & washer) were left in for so long and it bothers me to have the doc telling me the feeling inside as to rubbing, restrictions etc can't be the screw but rather just the "healing process". Who knows what your feeling inside your body more than the person living with it! This whole thing just does not sit right with me at all. If anyone has had similar issues it would be great to hear from you - thanks for reading and best of luck to you Tucker 1050 (David) regardless of the choice you make.

Hey everyone I've read most of this thread and throw in my $0.02


I separated my right shoulder (Type III) on September 21st, 2011 while messing around playing rugby at my old college. Hurt pretty bad but did not do any research into the injury, nor see a specialist of any kind until 7 weeks later. The doctor I saw was surprised at my range of motion and capability, especially since I did not ice it regularly or wear a sling. He advised no surgery, but explained that a decision should (at that point) be put off another 7-8 weeks (was closing in on the Holidays). To make a long story short, I went to see him again in mid January with one main complaint.

I could do 1 set of pushups of about 40-50 depending on how bad I grit my teeth and beared the enormous amount of pain I was in. Id basically be crippled for hours after one set. I opted for the surgery and went under the knife on 2/17/2012. Well its coming up on 8 weeks later for that decision and I couldnt be happier. I do still appear to have a very small bump on my shoulder, but my muscle hasn't filled out yet. I did the all natural route with a grafted ligament and a resection of a ligament, no screws or wires. I am 24 years old. I do have a huge scar but I don't care about it.

For those too lazy to read my patchwork story, my advise is to have a very open conversation with a doctor about your goals and your life and what you want out of your surgery. If you are young and an athlete of any kind my personal advice is go for it.

I had an AC separation in February, and found hearing other people's stories on this thread to be hugely helpful when making a difficult decision whether to get surgery, so I promised myself I'd post on here about my experience for those who are interested in case it helps.

I separated my shoulder in mid-Feb when riding on some recently rained on roads... made a left turn, bike started to slide and then got caught on a grate, throwing me pretty violently to my right side where I landed on my shoulder (happened so quick I barely remember it). I got an x-ray and saw an ortho surgeon that I trust (aka he doesn't recommend surgery for everything - the old saying "if all you have is a hammer, everything looks like a nail" applies to most orthopedic surgeons). He said I had grade III/V, basically my collar bone was displaced a slight bit more than 100% (definition of grade V) but it hadn't broken through the peritoneum (I think that's the word he used), and so he felt it was more of a grade III. He said surgery was a definite option and a tough call, but "if you were my family member, I'd recommend against it". He mentioned that their were plenty of downsides to surgery as well, and I could potentially get back up to 90-95% without it. So I followed his advice.

Recovery was slow at first, and then got much better rather quickly. I had in my head that I was going to be different than most people and really get after my physical therapy and heal faster than others I had read about, etc. but in the end I think it was fairly similar to most of what I've read here. I was back running again after only 2-3 weeks, but I think that's because my running technique is relatively smooth and I don't hit with my heels, sparing some of the jarring motion that some people who run on their heels might get in their shoulder. The bike took about 4 weeks, and it didn't really feel good to ride a bike for about 7-8 weeks. Riding on smooth flat road was fine, but even the slightest bump would just go right into my shoulder and could be quite painful. Swimming was the longest... I found I could "swim" after 3-4 weeks by keeping my arm totally under water (so side stroke or breast stroke), but couldn't really lift it out of the water, and didn't have too much ability to really put force behind my stroke. At 6 weeks it felt alot better and I was able to swim somewhat normally with discomfort and sometime a little pain, but it was bearable. With all that in mind, I still decided to do the Galveston HIM on April 1, so about 6.5 weeks from the accident. Swimming was kind of painful (and I was in terrible cardio shape so that also didn't help). Biking in aero position was OK, but also painful once I got off, and running ended up being fine. Overall I was just under 5 hrs, and I say that only to show that I was clearly still able to race with my shoulder, even though I'm not sure I would recommend it to anyone (better to let it heal if you don't have a big race that you already paid for the flight and hotel and everything, and even then my decision was probably still stupid).

Now I'm a little over 3 months out. Running is totally fine, biking is totally fine. However, I still feel pinching in my shoulder while swimming... it's not a constant thing, but when I really stretch and reach out on the stroke I can feel it. I can't really do butterfly (thought I sometimes try), it's still painful because that pinching gets really bad when I'm rotating both my arms out of the water at the same time. That said, it hasn't affected my swimming training... I've pretty much continued my time improvement from before the accident. In life generally the shoulder is more or less fine, but I'm still aware of it. Because it didn't tear through the peritoneum, my bump isn't too terrible... kind of depends on the position I'm in. I can square my shoulders back and you can't see it at all, but if I relax them, it's pretty obvious and sits maybe an inch above the rest of my shoulder. Honestly I don't find it a big deal at all, and I never really get comments on it, most people don't really notice it until you point it out and they're like "oh yea, you're right!". I used to play squash, but haven't picked it up yet and not sure I will for another couple months. I'm hoping this pinching goes away over time, although I haven't noticed much, if any, improvement over the last 4 weeks. It's especially bad when I pull my right hand over the top of my head to the left side of my body, or when I make a really sudden jerk movement, like throwing a ball fast or catching myself if I trip or something.

Sorry for the 10 page essay, but just wanted to be as thorough as possible - really appreciate all the other people who posted about their experiences, and I hope this is at least somewhat helpful to someone else.

I had a posterior seperation. I avoided surgery for several years but it got to the point where it would come out if I waved at someone. I got it fixed. It works, but it will never be the same.

I''ll add my 2 cents to this thread since I don't see a whole lot of folks talking about the longer term with this injury. I had a grade 3 AC separation of my non throwing shoulder in 1998. I was told that I could go for the surgery if I wanted but there was a risk it would cause more pain than just letting it heal. I opted to skip the surgery and let it heal. I had a similar recovery experience to everyone else who has posted and my only issue has been cosmetic. The only real limitation I put on myself is no max bench press. Now that I am 14 years past the injury, I am happy that I opted not to do the surgery. However, I am a little concerned about the future. The last few years I have had a couple of issues with my rotator cuff. After a bad collision sliding into a base, I had a ton of pain and trouble raising my arm. It was resolved with a couple of months of PT, but I was told that with the previous separation my acromion sits lower against my rotator cuff and can cause problems. I now wonder if it is a ticking time bomb. With that said, I am still glad I skipped the surgery. I have gotten through ages 23-37, while playing a ton of sports, and had very few complaints. Plus, whenever people start talking about scars and other wounds I get to freak everyone out with my shoulder.

My original post is a few above this one. Quick post here. I got the surgery on 2/17/2012. Today is 5/24/2012. I feel great. Have a small bump, huge scar. Nearly back to 100% range of motion and will be moving on to strengthening it next week. I can't wait. The first 8 weeks are the toughest, (sling, lots of sitting around)....but the last four I feel normal again (minus not working out).

If you are young (I am 24) I say go for it. Its 6 months recovery time, and I deeply questioned my decision during the first 8 weeks. Now I am glad that I made it.

As we age the normal progression of the rotator cuff is degeneration, So in essence, it was born a ticking time bomb. We as humans were not meant to do activities over head. Your problems after sliding into a base were most likely from sliding. It sucks getting older :). I have had two grade 3's (from bike racing), one in 1993 and the other AC joint in 1997. I have never had a problem. Being in the medical field, I was informed by the orthopedic guys that I am better off NOT doing the surgery. The top upper extremity guy explained that the repair's usually will fail at some point in the future if you are a high level athlete.

Well I would like to add a few things now that some time has passed and this topic put a reply to your post in my inbox. I did live with the grade three separation an on a normal everyday basis it was not a big deal. It was painful to tread water and painful if I crossed over center on freestyle but my pull was stronger on that shoulder for some reason. It seems that grade definitions vary from doctor to doctor, my clavicle was over 100% out of position or in other terms is was more than its height out of position. It took some time to heal but I did in time recover most of the function, I was even able to throw again which was a concern because I want to be able to throw a ball around with my son. The decision to fix it was constantly on my mind since my backpack did not sit right and things were not the way they were. Then came an event that changed things once again.

Last August I was riding home from work and a car door opened right into me hitting my right shoulder at somewhere over 20mph, I was thrown into the street and run over by a Ford ranger truck. I spent ten weeks in the hospital and have had seven surgeries, I no longer have my L4-L5 vertebrae. My shoulder went to a grade V separation, as in there was nothing left holding the distal end of the clavicle in place. It poked up through the muscle and made a very large bump in the skin. It was not repaired for six months because of the other damage that was more important. The first reconstruction failed after two weeks because the strain on the graft was too great. So far the second graft is holding, it has been ten weeks. I know the shoulder surgeries would not have been so bad had I not had to deal with everything else but let me say that these two surgeries were extremely difficult and painful. I really believe that unless you are a world class athlete to let things heal naturally if they will, if not then you had better fix it right away before the body adapts to its new position. Both times it took the surgeon and two assistants to push the bone back down into place.

In short I just want to let everyone know that if you decided to let it heal I believe you made the right decision, live with it and do not look back. Whatever the reason for your accident know that although your shoulder will never be the same it is the way things will be from now on. A full reconstruction is not an easy surgery. If you do have the surgery make sure you do your research as not all methods are considered equal.

I know the rules, a picture or it did not happen. I will spare you the police scene photos. The right picture was pre surgery, middle post surgery, left after the graft failed. Now it is better than the middle photo. The bottom photos are of my lower back. Yes I get to keep my new hardware the rest of my life, at least it is Ti.

Here's what I said last time someone asked...

Post #10 of 16

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Civilize the mind, but make savage the body.

- Chinese proverb

Another grade III here, did not get surgery. Healed in a few weeks, have never had a problem or experienced with it since. Left a bump, but not a big deal. Gives me a good story to tell. :)

Anyone here with a grade 3 had any problems swimming after recovery?
I had a grade 3 about 6-7 weeks ago and just started swimming (took so long due to other injury).
Mainly interested if anyone was a "swimmer" and made it through a Grade 3 and returned to pre-separation swim levels?

Injured January 2010. I am over 50. AC sep + other broken bones. Opted out of surgery because doc said we can always do that later. 35 PT sessions in 2010. Zero in 2011, shoulder worse in 2012, lots and lots of snap crackle popping, weak, pain increased, so back to PT in 2012 another 15 times. I have a high deductible insurance so I pay $100 out of pocket every time I go.

The doc explained it this way to me why I need PT: If you are moving a couch and you have 4 normal people, 1 on each corner, no problem, easy to move. Now after the injury you only have 3 people to carry the couch, so I need 3 big strong people to carry the same couch. PT is hard on me, I don't enjoy it, it takes a lot of time and wipes me out. I do a ton of exercises. 1 goal is to get back to 30 pushups, I can do 12 now and it hurts and the shoulder always feels strained and weak. I can pull as much weight as I want, but can't seem to push the weight.

I keep thinking about the future, arthritis, more pain never ending PT. So lets say the pain gets so bad I opt-in for A-C surgery, can any of you tell me how much your AC separation surgery cost approximately?

I had a grad 4 separation, and my ortho said surgical intervention would only be cosmetic so I said forget it!! So i still have a bump, but no problems! the only time in 1.5 yrs since the accident it has hurt, was when i did some kick sets on my back and really really tried to get streamlined and it doesnt really wanna go that direction too much. Other than hat it was great! btw im 20 yrs old, so maybe my youth has some effect. plus i took my sling off the day after the accident so I could have as much range of motion as early as possible. Hope this helps!

I am a radiologist who also had a type III AC separation like yours 3 years ago.

I advise you to NOT have surgery. You can ride the trainer now. Wait about 4-6 weeks to run. Before then it will hurt your shoulder which may alter your gait and cause another injury. I started running right away after my injury and learned this lesson the hard way. Take at least 6 weeks off swimming.

It will be sore and achy for about a year. After that the soreness will fade away. You should have no disability or limitations long term. I lift weights above my head all the time.

There is an added benefit. Bone spurs from AC joint arthritis are very common and a major cause of rotator cuff problems especially in swimmers. A type III AC separation prevents this from happening because the clavicle is displaced superiority actually creating more space where the rotator cuff passes above the numeral head where tears and tendinitis occurs.

no idea what grade mine was but I took out the windshield of a car with my shoulder. Huge bump. Accident happened in early 80s, maybe 82 or 83? and I was a swimmer. Never got back to pre-separation swim levels. Now, at 52, definitely limited. Can't swim back-to-back days without chewing ibuprofen like candy. I'm going to try and test that this winter, however, by slowly increasing my weekly volume to see if I can handle same volume on more days. Good to read the last comment though. Looks like arthritis on that side should be decreased.

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

Mac I hope everything turns out alright for you. I had a grade 5 that required surgery. They even inserted a cadaver tendon due to the doc knew I was a triathlete. I have full range of motion after two years but I can tell you I know it will never be the same. It was my right shoulder which used to be my stronger side. No more, and this year I realized I will have to do some light strength training the rest of my life to keep it somewhat strong.

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"Sometimes you got to learn to hurt"

you should be taking advice from your orthopedic specialist that has SEEN and evaluated you. not from people on a triathlon forum who may or may not be qualified to give advice.

this is coming from me, dr. john.

john

Agreed, but don't come down so hard on people that are posting. Most people are just relating their own experience rather than giving advice. I had a grade 3 from bike crash in 2003. Doc said "probably" didn't need surgery so I've lived with it with some discomfort but no way to tell if it would have been better or worse with surgery.

sorry, not meant to sound harsh. just wanted to make sure the final advice he took was from a trained and qualified professional that has seen him. i could be anyone. i happen to have my doctorate in the field he is requesting information on, but i could just as easily be a 17 year old high school dropout.

Anyone that has had this surgery, how much will it cost? $10K $20K $30K or more?

Via car crash in 1997(age 25). Dominant hand side. NO SURGERY. Was a total non-athlete at the time and it has not inhibited picking up IM, ultrarunning, kayaking, or yoga. No shoulder pain, but a 1/2" hump which can spark conversations.

Only in some arm balance poses in yoga do I feel one arm is "crooked" and it makes the pose almost impossible for me.

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Swim - Bike - Run the rest is just clothing changes.

The PPO non provider cost at a surgery center at Newport beach was $2500 including the graft tendon, hardware and facility cost. The Dr. was paid by insurance but billed about $2000. My out of pocket was like $2800, PPO paid the rest. You will also have a brace to figure into that as well. I have a few if you need one.

Unless it is a problem for you in your everyday life I would avoid the surgery, it is alot more involved than you may think. Also be aware that the graft is weakest from 2-6 weeks after the surgery due to your body breaking it down before it rebuilds. My first graft tore two weeks after surgery. Take the nerve block if you can because it makes a significant difference as long as they get it right.

Did mine skiing in 81. No surgery. Small bump. No problems.

I had the same injury three years ago and did not have surgery. The ortho surgeon said studies indicated the same outcome with or without the surgery. My shoulder still looks like your x-ray. I have normal range of motion but some discomfort--it just feels strange, not really painful. There is some crepitus and the distal end of my clavicle protrudes, so it looks different. It doesn't interfere with swimming or any day to day activities.

If you elect surgery you should ask about possible complications and rehab. I recall being told that there would be a six week period of immobilization followed by physical therapy to regain ROM.

Good luck!

My injury became apparent in 2011 december. cause - cannot name it. It was not something that appeared all of a sudden but rather smth that evolved in time. But i blaming weightlifting and some martial arts.
I am not a prof athlete but i am fond of sports. Am 22 years old kow and a former obese child. That was what led me to sports. i was 117kg and now i'm 78kg.
I began this way because my story is long.
In dec 2011 an orthopedist said that i should stop all physical activites so i did. He gave meds as well. After 3 months i was better but not great. He said i sjould have surgery but did not mention the grade of the injury ( i live in romania and maybe we are a bit lacking a protocol jn ac separation). So i went to a recuperation doctor.
She said i should to underwater exercises about 2x week and swim if i could.
Notice that until know i have not mentioned anythjng about my symptoms. She asked me a question then:does it hinder my daily activites?i said i guess not. So i was kinda resolved that sports will be tough for me but i kept up my hopes.
7 mpnths have passed. And it hurts. I still cannot go backpacking,turning the driving wheel hurts and cannot rest my elbows on the table. Just saw the recup doc again and i am furious.
She said that i was not a prof athlete so that why she didnt put me to really hard PT and that i should try to enjoy life and not be bothered with my AC separation.
If i would be in the USA i would sue her. Not only did she disconsider my affectipn to sports she nearly openly insulted me suggesting that i am whimpy and just cannot take alittle daily pain.
The pain was okay at the beginning but now it is a rocky dry feeling that i feel. Range of motion i have and that is great. Strength has faded me a bit but it is okay as well. But i cannpt do daily chores cause little things set off a tendinitis inthe biceps.
I am really leaning towards surgery. The tip i leave to others is : speak to multiple doctors and do not have blind faith. I will be seeing an orthopedist soon. My discussion with my recup doc is over. From my point of view she messed up:
-not giving me my adequate PT
-procastinating my operation to 7 or more months (i will see)
-not taling me seriously.
I am 22 and i want to do lots of things but my doc treated me like a 60 year old. I think i will bite the bullet because 7 months have passed with episodes of tendinitis and pain (a tug of war) and i almost am where i started. So a year post-op but with the possibility of regaining normal daily use and possibly even sports seema a good deal to me.
Please write back.

how do you know that you have a ac separation? have you seen x-rays? ac separations are extreme. i am not sure how they can happen without a severe accident.

if you have had x-rays what class is the separation? 1, 2 or 3? there is also class IV and V, which are usually caused by bad car accidents, or extreme sports accidents.

for 1 or 2 class separation, i do believe surgery is optional, but you do need to do PT, and it will never be the same. that's the hardest part of a AC separation. it's basically permanent. it took me years to accept this. i still look like the hunchback of notredame, but i can't complain. i can do all the sports that i like pain free. sleeping still hurts.

B

I had a similar injury 2 years ago along with a broken humerus from the top of the bone. I elected to go without surgery and recovered well. However, I did not do all of the rehab that was involved. The result is a reduction in the ROM of my right shoulder. nothing terrible but it is noticeable.

i saw the x-ray and it is visible also on the echo.
so....imaging wise it doens't look severe but clinically it hurts. plus i cannot to terms with the fact that i'm only 22 years old and was treated like a 60 year old. i am furious with the doctor, she almost didn't tell me to think happy thoughts

- this is my x-ray. what i do not understand is that: if my separation would have been a grade 1 or 2 then it should have healed itself in 6 months time, right ?

I am happy I found this blog discussion – misery loves company! I separated my shoulder (grade 3) 3 months ago. Still very sore with any activity. As is the case with many of you, my doc and physio both advise against surgery and feel that I will recover and have excellent use of the shoulder. My recovery seems to be taking longer than many of you.

But here is the difference…. Only a couple of you have talked about constant clicking.
I have much clunking and clicking in the joint with almost any movement, due to the ligaments not holding the AC joint together. I am not so concerned with bump, but not very keen on the clicking as I am guessing it will continue to cause irritation to the muscles and the bones. It is also kind of freaky.

Do those of you with Grade 3 also have this constant clicking?
Any thoughts from the doctors in the blog?

I had the clicking for quite some time after my Grade III separation occurred. I was pretty aggressive with the rehab exercises and now it rarely occurs. Mostly happens if I try to do pull ups or bench press too much weight. Same as you, I hate to hear that clicking sound.

Yes I have the clicking and in certain positions get numbness down to my pinkie finger. The pull for my swimstroke is weaker and times are defintelty down.

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I had an AC3 separation about 14 years ago. I did not have surgery and went to PT for about four weeks. It took me about 3 months before I could start to swim, but was able to race triathlons within a year. There was a lot of popping and clicking for quite some time (2 years?). For the first couple of years it would fatigue more than the good shoulder . I've participated in over 10 IMs since the accident and the only compensation I've had to do was change the side of my breathing to put less stress on my right shoulder. Over training led to a nerve palsy on that side and the switch to breathing on right side help with reducing fatigue on my right side (I used to breathe to the left).


Long term side affects: very little on a day to day basis. I'm not able to pull ups/chin ups like I was able to do and every once in a while the bone sticking out actually bangs into something and smashes the skin -ouch.

Hi All,

It is comforting to now that you are not alone, so thanks to everyone for posting your experiances.

On the 16th of Decmeber I recieved a Grade III AC joint sepertion for my birthday. I am booked in to see a speciaist next week. Its 2 weeks to the day and the thought of going backwards and having surgery concerns me as I feel im making progress.

I must say I am a little confused with what to do. Lets see what the surgeon says, apparently thre is now key hole surgery that can be performed.
Willkeep you posted.

Grade III this past march - no surgery and full range of motion and swimming like before. Yeah I have a big bump in my shoulder, but its just something to brag about. My ortho dude said that the surgery has low success rate due to the nature of the shoulder. He also said grade III less pain - no bone on bone that grade I or II might.

Meet with the specialist, Its grade 4-5. Had to have surgery quickly. Had the hook plate method. The hook plate holds the bones togethere until the tendons heal. First 2 days after surgery are extremly painful especially the first night once the general wears off! 2 weeks on still need meds to sleep at night, pain during the day is managable without meds. 1 more op in 10 weeks to remove the plate. Looking forward to this as plate is uncomfortable. Doc says I will have 85% movement/function back in 3 months and 95-100% back in 12 months.

Hi people, i had a type 3 shoulder separation in 2012. i went to see my surgeon and she suggested the tight rope surgery, this was the first operation on my shoulder. I went back to work early and one day felt the synthetic band snap inside my shoulder; the bone became more prominent. I went back to my surgeon, this time she suggested the plate and hook procedure, which in her words would then be bomb proof! I went ahead and had the surgery and although the prominent bone has disappeared the recovery has been hell. I have been in so much pain, one evening I had to even go a&e and the doctor told me I had a type 1 infection! As the weeks have gone by it has got a bit easier but the whole process and been very hard to deal with; sleep deprivation couples with severe pain has been a struggle. I go back to hospital and have my plate out in 2weeks, the surgeon said the operation to take the plate out isn't as big as the last one. They have done a fantastic job with the scarring considering its already been opened up twice.

Hola Blu,
Researching this dilemma after a grade 3 separation (crashing on the snowboard on the infamous "last" run a couple of days ago). I'm writing because your situation sounds exactly like mine. Surfer,boarder,biker,etc...everything but the fly fishing,but I'm sure I'll eventually get to that. Just curious as to how you made out in the long run and if you recommend the surgery.Hopefully meeting with the orthopedics this week and leaning towards the surgery. Thanks! Kevin

Hi Kevin,

It's been 2.5 years since my surgery and I still think about my shoulder almost every day to some degree or the other. I don't doubt so much whether I should have had the surgery but rather the exact procedure, and how well the surgeon did, and if I got good guidance on the PT to do or not do. My bump was very pronounced, and it felt too awkward for me, as if it was pulling away from my body and only my skin was keeping it somewhat close. I still have a bump, but depending on my stress level and exercise/stretching it can range from acceptable to fairly pronounced, therefore I often wonder if the donor tendon was accepted by my body, but nevertheless I still have screws and wire in the shoulder holding it together, so I don't worry too much about it. My strength and range of motion are 100%, as far as I can tell. It sounds like you just had your fall so you probably have quite a lot of swelling, and it may be hard to determine just how it will be.

My biggest challenge these days is having my left shoulder hunch up, or "get tight". It seems to be mostly related to the soft tissue and muscles. My surgeon recommended extreme caution after the surgery, and I had to wait months before starting any PT. I literally did almost nothing except wear a sling for 3 months. I believe this caused a lot of excessive tightness in the whole region, and in fact, I have been left with a semi-permanent mega knot in my upper back on the left side underneath the shoulder blade, which seems to radiate through the area and cause neck pain, and tightness. I should have started very basic PT earlier (of course conservative PT) mostly focused on low profile stretching.

If your shoulder feels really awkward to you, and bony point sticks up high, my bottom line recommendation is to do the surgery and do it sooner rather than later. How long ago was your injury, just a few days ago? Another challenge I had was waiting 9 months for the surgery, so I went through the whole process of injury and recuperation twice in a 1 year period, which was brutal.

Hope this helps. Glad to provide any more insights. Every injury is different, and every shoulder is different. I think I will re-start PT focused on stretching out the shoulder/neck region to re-gain the limber.

One more note, you need to think just as much about the mental spiritual side, and staying positive, and accepting it. I fought the injury a lot because I just could not accept the finality of it. I think this may have led to some of the tightness and hunching I experience still today. You need to spend as much time sending good relaxing vibes to your shoulder, and breathing deep. Either way it takes time. It's a nasty bugger. Surgery or not, it will come back, and you will get back into all your favorite sports with very little noticeable effects on your performance.

Peace Out
Blu

Hey Blu,

Thank you so much for your swift,thorough,and eloquent reply.I'm lucky enough to have good insurance and was able to get an appointment this week with an orthopedic surgeon in Boston (Glen Ross) who has worked with the Celtics and comes highly recommended by a friend.The PA at the clinic on the mountain looked at the xray and told me it was "at least" a grade 3 separation and was fairly certain it would warrant surgery but I'm really anxious as to what they'll recommend in Boston on Thursday.It really sounds like the upside of doing the surgery immediately would be worth it to me,particularly because I have a lot of confidence in the skill of the surgeon.I'm also not thrilled with the prospect of walking around with this large bump on my shoulder and the surgery sounds like it may minimize that issue.Most importantly it sounds like the best chance to ultimately regain full functioning.Great advice also on addressing the mental aspect of this injury.I'm dealing with the pain easily without any drugs (although sleeping is a bit of a challenge),but was getting extremely anxious and somewhat depressed about the whole thing. Feeling much better now with somewhat of a plan of attack,even though things are still up in the air,so I thank you for the support! Glad to hear you haven't let this slow you down. I'll keep you posted on my progress (and will blame you if I lose the arm in surgery!) Thanks again, Kevin

Yo Kevin,

Sleeping totally gets better before and after surgery for me. I could not sleep even many months after the initial injury and all the way up to the surgery. But it seemed to only take about 5-6 months after the surgery when i could start sleeping on it some, which was nice. Today it does get a little sore/tight if I sleep hard on it, but it loosens up by mid-morning. Sometimes it doesn't even get sore.

Again good luck on this, but a good plan is peace of mind. One note some surgeons really try to dissuade you from this surgery. That's why I waited 9 months. After 2 visits he said I won't do it until you can't stand it anymore. And thats when I went back to him 9 months later.

Blu

I fell in 2008 and got grade 5 shoulder separation. had surgery with my own recycled ligament and seemed to work great. 8 weeks after the surgery i was still not allowed to make quick movements or lift. i was in a tanning bed (with help with the lid) and the glass fell out on me and i must have jerked to keep it off my face. within minutes the bone was sticking back up. had 2nd surgery 2 months later with cadaver ligament. within 10 days bone was starting to stick up again. gave up but had a lot of pain and also ended up with tears in elbow and was told my elbow was trying to take up the slack that my shoulder couldnt do. also had 2 rotator cuff tears. elected to have it one more time since now i have neck problems and doc said he thought the shoulder bones pulling could make neck worse and it doesnt seem like a lot but my bra strap falling off my shoulder or it in the groove of sensitive nerves under the skin constantly drove me nuts. i am actually still not sure what this doc did but know i have a plate and another cadaver ligament which we were not suppose to try again. as for nerve blocks, NEVER AGAIN. i was one of the people who had the reaction, throat swelled closed, paralized half my diaphram, throat and vocal cords and eye drooped all the way down. breathing was horrible and i couldnt get sound out at all hardly. they had to take it out within hours after surgery. i now am in a sling and cant use arm at all for 4 months!!! then surgery again to remove plate and then pt. at this point since i was not told this long i am VERY aggravated! i will be going from end of jan to end of june before i can use my arm at all, and thats not until the next surgery and then pt which could be july! i just hope this works, that would be the worst after going thru all this. my first surgery was 4.5 hours, 2nd the same and 3rd was 5 hours. i had 42 staples

I'm not a doctor and cannot give you any advice but I can share my experience. I was hesitating about getting a rotater cuff surgery as the option was given to me. My shoulder was bothering me and I took the gamble. My shoulder pain is now worst then before the surgery. I guess it's my fault, as I was warn by the doctor that this might happen. I took a gamble and lost. I'm sure the percentange of failure is really small, so I dont want to scare you.

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Formely stef32

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Hello! I just earned myself a type 3 shoulder separation a couple weeks ago. I had been snowboarding all day up at Mammoth and was tired... hauling ass on my last run to call it a day and basically fell for no reason (poor visibility) right onto my right shoulder.

I just took it out of the sling today and while I am getting some range of motion back, the whole shoulder is extremely tight and painful and lifting my arm up past chest level is impossible. I seem to be running into a 'bone meets bone' issue stopping me from moving it very well. I'm certainly not having the 'no big deal' experience that many on here claim to have had. I am a college student and I can barely write. I can't do my very simple job, taking care of plants at the school. I can kind of drive, but not really safely. I need drugs to sleep. I'm basically crippled. Fortunately, I am meeting with a surgeon next week to discuss options. In my current condition I can't even imagine NOT trying to fix it with surgery. The surgery horror stories I'm seeing here are a little disconcerting... I really hope mine goes smoothly.

Just thought I would share... since I'm still kind of freaking out about it. I'll update once a decision is made.

In the fall of 2006 I went over my handlebars in a hurry thanks to a driver who failed to yield the right away. A very pronounced "bump" (still) and massive amounts of pain for about three weeks if I remember right. Wore boots with long laces as I could tie them with my teeth and the other hand:-)
The surgeon told me that there was no one "recommended solution" due to the relatively high failure rate of the surgery. My physical therapist, who had the surgery himself (with the cadaver ligament) said the same. Also, in my case, given that I'm a little big bigger in the shoulders due to years of weight training, the surgeon said that actually helped to stabilize the joint and so he recommended holding off on surgery and seeing if the resulting scar tissue would work out. It did. My shoulder still clicks a lot when I do pullups and pushups and swim and I definitely lost some power, but I was swimming again in about four months and able to complete my first ironman distance event roughly a year after the accident. I remember doing a lot of rehab, especially with the rubber bands. Anyhow, I'm glad I was patient. I had done all the research as well and read the testimonials about the failed repairs and was not eager to go through all of the pain again. Good luck!

Other then my kids calling me quasi moto :0). Not much main 2 years later but still a little. Plus some nerve damage. When right side is in certain positions. Definetly some power lost in swim stroke also. But right now risks ( infection and failure of surgery) outweighs getting fixed.

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Your post makes me feel so much better. I just separated mine too (Grade 3) doctor told me the same thing about all the damage is done and I thought he was crazy because the shoulder looks so bad. Day 6 now after my snowboard halfpipe accident and I feel like I'm almost completely recovered other then just a little pain did kinda a small test and was able to lift a 400lb weight with both arms and little pain from it. Never would have believed you could live without your clavicle attached to anything until now. The only major concern I have is doing things over hand like throwing a baseball or pull ups. Still in too much pain to try those. I'm a power lineman so I work over my head A LOT.