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!