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

---

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.

---

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.

---

"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.

---

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!