Sorry to hear about your crash and the resulting injury. Last spring I had an AC separation after being hit by a car (although not as bad as your grade 3 case) and for me, surgery was not recommended. I couldn't swim for 6 weeks and when I returned to the pool, it was initially only for 10 minutes at a time at a very easy effort. My shoulder bugged me for the remainder of the triathlon season, although fortunately it gradually improved. I used kinesiology tape for my long workouts and races which seemed to help.

8 months on from the accident, it occasionally gives me bother. I can now swim without any issues and it's fine while cycling and running. However, I've become very aware of not stressing it, eg. I don't pick up heavy objects with my right arm and I haven't played golf or other sports that might cause shoulder discomfort. Even throwing a basketball hasn't been possible without discomfort.

I can't advise on what the course of action should be, but hopefully that gives you a slight insight into the recovery. Again, bare in mind that my injury was not as bad as yours, so I'd expect your rehab to be a longer process. Hopefully some others with valuable experience will chime in and share their stories. I wish you the best of luck.

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VALÄ’RE | YouTube

Thank you for your story.
Thats my concern. I'm afraid that i'll have to be real cautious doing anything on my right side.
I have spoken to a few athletes who have had a pretty successful recovery w/o surgery.
I'm interested in finding a few people who had the surgery and hear their experiences.

Thanks again.

I had a level 4 from racing motorcycles and the doc said its normal to let heal by itself. Besides if you keep racing you'll probably do it again and that's when we will do surgery. So I healed and raced motorcycles again with no problems. I just have a odd looking shoulder where the bone popped up and stayed there.

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What surgery are they suggesting? I think there are two ways to do it.

My wife separated her shoulder in a bike crash last May - same as you, grade 3 AC joint separation. She opted to have the surgery (took a tendon from her leg to replace the ligaments and attached a hook plate to her clavicle to hook under the acromion to keep the clavicle down). I just asked her if she would do it again and she said she wasn't sure since she doesn't know how it would compare to not having it done. After the surgery, she was in a lot of pain - it was way worse than the accident itself. The whole time the plate was in, it interfered with her shoulder function (ie. lifting a heavy cup, carrying a bag of groceries) and would aggravate easily. Physio tended to hurt a lot. She couldn't ride on the trainer for more than 10-15 mins without aggravating it. She wasn't a swimmer before so no comments on that.


She had the plate removed a few weeks ago and things have improved dramatically since then. She said it feels amazing now but would she go through the "7 months of hell" again? Undecided. She said it feels pretty damn close to normal now. My personal opinion as an outside observer is that it was the right choice for the long term but hard to know for sure.

Good luck with your decision, it's a tough one either way I think.

Edit to add: These blog links give an idea of what she went through (not her blog, just a similar description)

http://grinandbarrett.ca/...d-6-months-of-rehab/
http://grinandbarrett.ca/...date-one-year-later/

8 years ago. Bike crash. Grade 3, right shoulder. (~38 years old at the time)

I was 2 months out from Ironman. My health care program did not alllow (or made it very difficult) to see an outside specialist. I felt like I was getting the generic non-response responses... everyone is afraid to say anything for fear of lawsuits. I couldn't get a good answer regarding surgery, and they scoffed too quickly at the idea of an Ironman for me to believe they were considering anything beyond their own perspective.

I contancted a profesional acquaintance, a sports orthopedist--a running specialist, but he arranged for me see a fancy shoulder guy worked with many pro athletes, inlcuding with the pitchers for two national league baseball teams.

I saw the specialist/surgeon. I told him I was 2 months out from an Ironman. I didn't want to do any more damage, but worked too hard to give up without a medical-based understanding of why I shouldn't try. (note: I was still unable to move my arm at all. I was in a sling, and wearing a shoulder brace/suppport--often used for posture... straps that loop around your shoulders and pull gently back) I said I didn't have a clue as to surgery, and perhaps most importantly, I didn't want to live with the awful golf ball size lump on my shoulder for the rest of my life. ( I was willing to give up a limb, live partially crippled and suffer endless pain, as long as I looked good.)

He was an old guy, funny, no bullsh*t, and clearly used to people who depend on their bodies to make a living (certainly not me, but that was the approach I wanted). he looked at my x-rays and asked if i had done other IM races. (I had)

He said:

(I'm paraphrasing, of course)

--it was "a bad one"

--This is not really an injury you can "make worse". its basically going to heal the same way regardless. (the assumption being I don't crash my bike, get hit with a sledgehammer, etc) It's more a matter of pain at this point.

--don't swim for 2-3 weeks. then really take it slowly. try runnning in 1-2 weeks, might be more unfortable or painful than I expect. bike trainer is ok right now with an sling/immoblizer.

--After I get back in the pool for a couple weeks, then I could decide for myself on IM. I would suffer, but my shoulder wouldn't be any worse in the long run.

--His feeling was "no" on surgery... or rather, it's the same surgery now as it would be 5 years from now, so see how it goes. But the odds of the surgery helping/preventing anything were average at best.

--The attrocious lump should improve--it would always be there, but the worst of it was due to swelling. They could "shave" it down in surgery.


I got back into training, slowly. 8 weeks later did IM . It sucked. I hated every stroke and every step. It was a stupid thing to do. And I was so focused on my shoulder I overlooked the fact I basically missed all my peak training. ouch.

However, my shoulder was indeed no better or worse after a normal IM recovery.

In the race, the swim was only "uncomfortable"... being locked the aero position became increasingly painful, and then the jarring of running on pavement was awful. my neck, traps and shoulders cramped constantly.

It took a long time for the lump to go down. It's still noticible but no nearly as bad. There was a period where I would occasionally get a minor ache in that shoulder after a very long swim, and maybe still do. But everything aches now more now than it did. I swim, bike and run just as poorly now as I did before the accident. My shoulder, without surgery, simply never crosses my mind, and has not impacted any aspect of my life beyond that first 6-8 months.

Hope that helps. Best of luck!

Almost 3 years ago I crashed in a road race and ended up with a 5th degree shoulder separation. I met with two different orthopedics and both said the same thing and recommended the same surgical procedure. The both said if I don't do anything I would be limited and it would give me problems as I got older. I went into the surgery and what they did was used two titanium button like devices with some high grade "thread" and pulled my collar bone down by anchoring it to part of my shoulder blade. The thinking was that my natural ligaments would heal while the thread and buttons where talking the pressure off of it. This was done with a very small incision and a scope. Also at the same time he saw I had a Labrum tear (Drew Brees) and fixed that at the same time. I was in a sling for 1 month after then started just stretching for 2 months with only being able to pick up one pound the whole time. After 3 months from surgery I started PT with weights. At this point the whole thing fell apart and I was devastated The collar bone popped up back to where it was. Clearly my ligament was not able to heal itself and once the thread dissolved there was nothing left to hold it in place. This was clearly something to do with me. Another local guy I know had the same thing done 4 weeks after me and his is still holding to this day.


3 months later I try again with a different method. This time we are going to use a hook plate and a cadaver tendon. This time things were much better. He made an incision about 5 inched long. The hook plate screws into the collar bone and "hooks" under the shoulder blade. This thing is rock solid. I spent a month in the sling then a month stretching and then PT with weights. Everything felt great. After that I was free to do what I wanted but I had to have the plate out 6 months after surgery. This is mandatory as it can end up cracking the shoulder blade. They took the plate out in 6 months and now its been almost 2 years and everything is great. This is the way to go but it does require 2 surgeries. I can do anything I want now. I don't swim so I cant comment on that but I have tried just playing around in the pool and there is no pain.

there are already a couple threads on this. I have one but not sure what the grade was. Broke the windshield of a car after it hit me (on bike) with said shoulder. I have a huge lump on that side and if I ramp up swimming too fast I'll ache for many days - even running. The key is to ramp stuff up VERY slowly. I remember after the accident (in the early 1980s, like probably 81) not being able to use that arm for swimming the entire season - I'd swim one-armed. My coach would tape my wrist to my trunk. I was never offered surgery but it could be that I was clueless and honestly, I never followed up either (not sure if PT was even offered back then). Maybe with PT I'd be now much better off. Hard to say.

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I too had a grade 3 AC separation and can share some of my experiences with you.

AC separations are divided into 6 grades, 1-6 based on the extent of the separation of the AC (acromio-clavicular) and CC (coraco-clavicular) joints and ultimately the degree of damage to those ligaments. 1-2 are always managed conservatively with physical therapy. 4-6 are always managed operatively with therapy to follow. Grade 3 injuries are split on operative vs conservative approaches.

Immediately after my injury I saw an orthopedic physician who had worked for many years as the physician for several professional sports teams in a large city. His experience, even with those high performing athletes he rarely operates on the grade 3 injuries immediately and gives therapy an opportunity to improve function. He basically said it is a decision between a lump on the shoulder (the end of the clavicle sticking up) or a large scar from the surgery (which may or may not work in the long term). He also indicated that he hasn't operated on a grade 3 in over 5 years and sees over a hundred per year (the literature seems to support this as well)

I opted for the conservative approach with physical therapy and am now 6.5 months out from my injury. From your original post - I would say that you are probably going to have 6 months of therapy regardless of which approach you choose. For the first 4 months I was doing PT 2 times a week with a therapist and then several times a week on my own. I have now decreased to around 2 per month for more advanced exercises and intermittent stretching and continue the PT on my own at home. The PT is basically designed to initially regain range of motion and then strengthen all of the muscles around the shoulder to provide support. Honestly, the best advice I could give is to try to find a therapist who has experience with higher level performance, understands your goals of returning back to your performance standards. Then do the therapy, do therapy independently, & work on range of motion at home. I honestly feel as if it made a big difference.

I am running without difficulty, just spent the past week riding outdoors in the aero position and felt pretty comfortable on my bike, maybe a little achy at the end, and have been back into the pool a couple of times (honestly, I haven't been in a rush to get swimming again). The first time I swam I could feel clicking in every single stroke (it was aggravating . I have started to work on bilateral breathing as breathing to the side opposite of the injury seemed to make the pain a little worse. The next time I swam didn't have the clicking, just felt as if my shoulder was a little weaker from not having swam in 6 months.

On a day to day basis, intermittently I can feel clicking in my shoulder, sometimes it is achy, sometimes it feels totally fine. At this point I am looking forward to a good season, I might not be as fast in the swim as I have been, but I believe that I will be able to swim. I will be doing IM MOO in september and at least a half and another race or two before.

My story

Grade 3+ Feb 5, 2008 training for IMAZ April 08. Full tear.

Was diligent about ROM exercises, even before going to PT, and PT strengthening the complementary muscles

Ortho said it was a complete tear, so when I said I was doing IM in 8 or so weeks, he said as long as I could tolerate the pain, I could do what I wanted. Nothing I could do would make it worse. Re: surgery, he said there were several methods with varying degrees of success, and I would be trading a bump for a scar and months of rehab. Plus, I could do it now, 10 years, 20 years, didn't really matter. No surgery for me.

I was back swimming 4K masters sets by the end of February (icing afterwards as it got sore). Trainer within a week, biking outside within a couple weeks. Being in aero was fine, on hoods was fine, going from one to the other hurt like a bitch. as did bumps. Running within similar time period. Running beyond 8 miles or so actually was difficult, as my shoulder blade would start to sag as it wasn'tbeing held up by the collarbone. used K tape to help hold the shoulder up

Made it to the startline of IMAZ but had other issues that kept me from finishing. Went back in November and swam a :59.

Here, nearly 5 years later, only time I notice it is in the jacuzzi after masters and someone says "what the hell is that???" I swim 300K plus yards a year with no effects, even did a 10K swim last August. No ill effects running or riding. I do notice some weakness pulling out with that arm, i.e. pulling out a champagne cork is difficult. :) And the occasional crunching when I move it the wrong way. And suits fit funny because that side sort of "slopes down." Maybe someday I'll have to deal with an arthritis issue, but I'll cross that bridge then.

But on a day to day basis I don't notice it. Even looking in the mirror I've grown so used to the bump, I don't see it.

As you may see from the other post, there are several different scales. I was familiar with the 3 and 5 grade scales, and then a guy posted about a 6 grade scale. Make sure we are comparing apples to apples here.


I had a Grade 5 (on a 5 grade scale - complete separation) about 8 years ago. I am personal friends with two surgeons who specialize in this area. They STRONGLY advised me not to have surgery. I swam with 1 arm for about 14 weeks, and have been going strong ever since. I do keep the shoulder strong, and at times it does ache a little. I can't throw a ball as well as I used to, and I promptly lost 5 minutes on my IM swim time. BUT, it really does not bother me to swim, bike, or run.


The one thing that is happening in medicine is that technology is escalating so rapidly taht as long as you do no further harm and can take it, why not wait 'til there is a better procedure in the future if it is EVER needed.


Best wishes...it is a bummer to work through, and it hurts!

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* 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.

Guess I'll add my story to the the list. Last Valentines day I did and endo after having a bike cleat fail. I ended up with a grade 5 separation. After talking to a couple specialists I decided to try to go without the surgery. I was actually able to come back pretty quickly and did a full tri season last summer. This fall while training for a marathon things began to degrade and I was getting a lot of motion in the shoulder.

I headed up to the Steadman clinic in Vail (I highly recommend these guys) and surgery was recommended. One of the bones was now pushing into the back side of my delt (err something like that). I'm now 8 weeks out from surgery and things are improving. The recovery from the surgery, for me, is actually worse than recovering from the accident itself. With the accident one the acute swelling/bruising went down I progressed pretty quick. With the surgery I'm working to get mobility back in PT(I'm close to full ROM now).

Obviously I can't say at this point that surgery fixed everything but I thought I'd share that even if things get better in the short term, you might still end up with a set back later.

Grade 5 for me in August 2011 two weeks before IMMOO and went the surgery route. 3 weeks of complete rest post surgery. After the 3rd week I started PT and was able to get back on the trainer for short amounts of time. By the 6th or 7th week I was up to 75-90 minutes, mostly light spinning. Week 8 I was able to start running again. Week 13 I had the smart idea of trying to swim. Did a few 25's and knew it was going to take a while longer. Week 16 I was swimming, slowly, and very little volume. My weeks after that averaged just under 4k and my shoulder was definitely sore from time to time as PT came to an end. In Week 30 I raced Galveston 70.3 and my swim was marginally slower than the previous year. By Week 40, I was averaging close to 8k a week in the pool and a couple weeks later raced Challenge Roth.

Since then, I've definitely had ups and downs. My power on that side is noticeably less when doing one-armed drills, but it's coming around 16 months later. Range of motion is very good and doing strength work isn't an issue. Based on my results, I would definitely go through it again if I knew then what I know now. My biggest takeaway was to listen to the treatment plan and don't think you're going to recover like an Adrian Peterson.

Here's a copy and paste summary of my surgery from the report if you want to know what you're in for:

PREOPERATIVE DIAGNOSIS: Left shoulder acromioclavicular joint separation, grade 5.
POSTOPERATIVE DIAGNOSIS: Left shoulder acromioclavicular joint separation, grade 5.
OPERATION PERFORMED: Left shoulder acromioclavicular joint reconstruction using hamstring allograft.
DESCRIPTION OF PROCEDURE: A standard incision overlying the acromioclavicular joint extended toward the coracoid was made with a #15 blade. Subcutaneous tissue was incised along the line of incision. The deltotrapezial fascia overlying the distal end of the clavicle was split, anterior-posterior flaps were elevated. Patient had evidence of a grade 5 separation with complete detachment of the coracoacromial ligament. At this time 8 mm of distal clavicle was excised and drill holes were placed both medial and lateral in the clavicle. These were 6 mm in diameter. A hamstring allograft was obtained, appropriately thawed and then tagged with Ethibond sutures and then brought around the base of the coracoid along with a fiber tape. The allograft was brought into the medial tunnel then secured using a PEEK tenodesis screw. Through the screw was one limb of the fiber tape. The fiber tape and allograft were then brought through the lateral based drill hole in the clavicle. The clavicle was reduced into an anatomic position and then the graft was secured into the lateral tunnel using a PEEK tenodesis screw. Intraoperative fluoroscopy confirmed anatomic reduction of the acromioclavicular joint. The fiber tape was brough through both tendoesis screws was then placed over the superior aspect of the clavicle working as a further fixation.

grade 4 seperation here. funny enough i think i loosened it up taking a drunken 50 yard run at someone and tackling them. i was told it was the best tackle some have ever seen. Dude (coworker) went flying 15'.......it was a pay back lol. any way fast forword to 8 years later bike accident a bam I am where you are. no surgery but PT and chiro for 6months. I have numbness now going down to my right pinky finger every now and then and it still aches after a hard run or swim. I will probably get the operation when I hit 20 years on my job. I was told 8-10 months rehab. ey could not do it at time of accident because there was no skin to sew up. it was all road rash. I do wonder though with a plate in that has to be removed later which equals 2 operations will make it worse for arthritis later on??? just something to think about. I am thinking maybe it aint to bad having my kids call me quasie moto :0)

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I had a grade 3 separation in May of '06. (I also had a concussion, pneumothorax, rib and sternal fractures......)
I saw my regular ortho and got a second opinion from a shoulder guy at USC. Both recommended no surgery.
I was in the water in 6 weeks, and with a little help from Francois, won my AG at Big Kahuna in September. Won AG in a smaller OD a few weeks later and second at SOMA (late October?) (I actually lost in trans, not while moving.) Won my AG at IMAZ that next April.

The PT worked my butt off starting a few weeks after the injury.

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Dick

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

Thank you all for your stories, and I wish all of you a healthy/upright season!

I have a lead on a possible second opinion, and may look into scheduling an appointment in this upcoming week.
For those who chose for "no surgery" and are left with our ever so recognizable bump, my bigger concern falls more on the residual pain and discomfort down the road. I am willing to be in more discomfort for the short term than deal with longterm nagging aches.

I plan to rest up another week and wait to hear what doc says on improvements. I see him on Feb 15th in Walnut Creek, CA.
The one thing that the doctor did mention was that if I chose surgery within the first few weeks from accident, then it would be more scoping than the plates and cutting that a few post spoke on. However, if I wait after 6 weeks then doc was talking about adding a cadaver ligament to the equation.

Please keep the stories coming. It is nice to feel that I'm not alone.

Again, I cant thank you all enough.

I had a bike crash in March of '12. Grade III sep. No surgery.
Of course, still have the bump there but not a big deal. Doc said that if I was 20 yrs old could think about fixing it, but it was only for aesthetics. And, he said the fix fails much of the time due to the nature of the shoulder.

My rehab was swimming. I had (and still have) almost no pain (after the initial few weeks where it hurt like hell).
My ortho told me due to the fact that a grade 3 the bones are not rubbing together (can happen with a 1 or a 2).

By swimming, I have been able to get most of my ROM back and the strength is good. No problems in the pool. No problems with bike and run either.

Broke my hand in the same fall. Grip strength not back to 100% yet.

I had a grade 3 separation in 2004. 2 docs recommended non-surgical route, so that's what I did. 1 year of pain 24/7. I could swim, bike and run, but it hurt all the time. Realized during the Soma Half Iron swim, that the affected arm really wasn't doing me any good. Going thru the motion, but effectively I was swimming 1 armed. By then I had lost half the muscle mass in my arm and shoulder. Found an orthopedic surgeon. He agreed to do the surgery. No pins - it was all done with a heavy "suture" and a few drilled holes. Rehab the first 6 months was hellish, but at the end of the 1st year, I was swimming pain free. Best decision I ever made. The only decision that would have been better would be to get the surgery right away and hope they could reattach the tendons.

Good luck.

For sure, that is the hard question for the Grade 3 separation. Did you have any other associated injuries such as labral tear or rotator cuff tear? If no other reasons for surgery, the nonoperative rehab is usually tried first for grade 3 because of potential surgical complications. Either way, plan on at least 6 months before return to normal swimming. Achieving symmetry in shoulder ROM and strength is the major rehab challenge. Without surgery you may be limited in some shoulder movements requiring near-maximal strength like the bench press.

 The choice I made was to end up having surgery to the Grade 3 AC Tear. The procedure was arthroscopic and took place this past Wednesday - Feb 6, 2013. The surgeon performed a maneuver in which he took some fibrous string and "lasso'ed" the collarbone down. He then tied it off and done.
I just removed the bandages this morning and found 3 minimal incisions. Pain has been tolerable and was never as bad as from original injury. I've been taking 800mg Ibuprofen twice a day and a Vicodin only at night to help sleep.
The Orthopedic also had me purchase a Kodiak PolarCare Cooling machine for help with icing. It was a little pricy, but it works AMAZINGLY. Constant cold temperature on shoulder/arm without any dripping or freezer burning.

The reason why I opted for surgery was because I was really looking for the long term benefit. The sooner the surgery the less invasive it would be. I do not have any big races I needed to jump back into quick training for, so a little time off wasn't going to hurt me.

If I had to make the decision again, I would still opt toward surgery because I'm 33, and look to be an active man for a many more years to come.

Again, thank you all for your honest stories. They have definitely me feel that I am not alone out there. I hope the best recoveries for all of you and the least amount of pain on that gradual road back.

Stay safe and upright!

how long is recovery with your surgery?

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  I'll be in a sling for 6 weeks. It is more for precaution to not use it or have it bumped by people. Today, was the first day I got to remove the bandages and take a shower.
My post op follow up is on Feb 19 to decide when to start rehab. I was told that it will be about 6 months to recover full strength and rotation in shoulder.
The pain I have right now is not at all as the discomfort I was in during the first 3-4 days of initial separation. I'm already lowering the frequency of pain med use. I found a couple button up shirts which I slip around the arm, and feel great!
Each day there is an improvement in sleep, pain scale, and comfort.

Thanks!!glad you are showing quick signs of improvement. I could not get mine fixed because there was no skin to sew up after bike accident. Dr. Said see how it is because you will already be 3-4 weeks before we can operate anyway. I am a firefighter and use my shoulders a lot for work and now the right fatigues very easily so I am looking for options soon after season. Right now he said I would be out close to a year with cadaver or synthetic ligaments.

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Best wishes for an optimal functional outcome down the road!


Have you heard of cross-limb transfer of strength? In other words, resistance training of the healthy limb may help reduce the loss of activation (which leads to muscle atrophy) in the injured opposite limb. Such unilateral strength training (of your left arm) could counteract the brain's inhibitory effect on the activation of muscles in your right arm while you are in the protection phase of rehab. Mental imagery of moving your right arm with the left might further help. Read this abstract and discuss it with your ortho or PT:
http://www.ncbi.nlm.nih.gov/pubmed/19230754