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Advise on grade III shoulder separation, surgery or not?

 

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Race4LV

Sep 16, 08 14:09

Post #1 of 97 (32023 views)
Advise on grade III shoulder separation, surgery or not? Quote | Reply

So, I was lucky enough to crash on my shoulder over the weekend and receive a grade III shoulder separation. It boils down to tears in the AC and CC ligaments which allowed the clavicle to raise about 3/4 of an inch out of the joint. Orthopedic surgeon says I could go either way on this one. It should heal up fine if not repaired surgically, but could have discomfort and range of motion issues that could be worked on later. Does anyone here have experience with this injury (with or without surgery) as it relates to swimming post recovery. It seems that all of my researching leads me a 50/50 split on how people have dealt with it vs how they recovered.


Thanks
Don

Here is a picture since I know it really did not happen without a picture.



(This post was edited by Race4LV on Sep 16, 08 21:42)


TomkR

Sep 16, 08 14:18

Post #2 of 97 (32016 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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!!!!"


Mikey G

Sep 16, 08 14:36

Post #3 of 97 (32007 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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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chrisesposito

Sep 16, 08 14:54

Post #4 of 97 (31996 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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


georgehooterbkr

Sep 16, 08 14:56

Post #5 of 97 (31995 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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.


ChrisM

Sep 16, 08 15:11

Post #6 of 97 (31985 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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 :)


(This post was edited by ChrisM on Sep 16, 08 15:12)


Dr. J

Sep 16, 08 15:14

Post #7 of 97 (31978 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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

Jeff Shilt
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Race4LV

Sep 16, 08 15:21

Post #8 of 97 (31971 views)
Re: Advise on grade III shoulder separation, surgery or not? [ChrisM] [In reply to] Quote | Reply

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


irodetoday

Sep 16, 08 17:48

Post #9 of 97 (31947 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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.


madz

Sep 16, 08 18:51

Post #10 of 97 (31938 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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!!!



-------------------------------------------------------------


MyBailey07

Sep 16, 08 19:29

Post #11 of 97 (31920 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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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lunchbox

Sep 16, 08 19:31

Post #12 of 97 (31920 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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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It's like being bipolar in opinion is a requirement around here. -TripleThreat


nemjay

Sep 16, 08 20:47

Post #13 of 97 (31906 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply


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…


docfuel

Sep 16, 08 22:10

Post #14 of 97 (31892 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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


wsjinames

Sep 16, 08 22:37

Post #15 of 97 (31884 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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


linhardt

Sep 17, 08 5:21

Post #16 of 97 (31865 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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...


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


TDOG

Sep 17, 08 5:32

Post #17 of 97 (31863 views)
Re: Advise on grade III shoulder separation, surgery or not? [nemjay] [In reply to] Quote | Reply

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!


Ti T'war

Sep 17, 08 6:00

Post #18 of 97 (31857 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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.

It's T'war like 'car'
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TDOG

Sep 28, 08 13:55

Post #19 of 97 (31807 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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!


Race4LV

Sep 28, 08 21:23

Post #20 of 97 (31777 views)
Re: Advise on grade III shoulder separation, surgery or not? [TDOG] [In reply to] Quote | Reply

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.


sl@enposte.net

Sep 29, 08 19:56

Post #21 of 97 (31741 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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 ...


scottinaz

Oct 14, 08 18:28

Post #22 of 97 (31622 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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.


saltman

Oct 14, 08 19:02

Post #23 of 97 (31614 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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.


Race4LV

Oct 15, 08 6:38

Post #24 of 97 (31592 views)
Re: Advise on grade III shoulder separation, surgery or not? [scottinaz] [In reply to] Quote | Reply

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.


bluatwood

Jul 20, 09 14:38

Post #25 of 97 (30732 views)
Re: Advise on grade III shoulder separation, surgery or not? [Race4LV] [In reply to] Quote | Reply

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

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