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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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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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

I know this is late, but I can share my experience with a grade 3 AC separation from a MTB accident. I'm only a part time sprint distance "triathlete," but I am also very active. I'm a 4.5 USTA tennis player, wakeboard and waterski, MTB, road bike, etc..., also my wife is a RN who works in a surgical unit. Right after my accident, she got me in to see one of the surgeons on her unit, an orthopedic who specialized in shoulders, he also said that the shoulder would heal, but my tennis would suffer tremendously, and any other overhead sport would be a problem. It was his suggestion that I schedule surgery ASAP to take advantage of the ligaments that were still present to help bond to the cadaver donor he would insert for the repair.

Long story short, we went for the surgery repair. Good thing as he also found a lot of existing damage from my tennis, "shredded bicep tendon," torn labrum, etc...PT sucked for me, as it took awhile to get my range of motion back, and the PT's had to really work me over to get the motion back in the shoulder. It took over 8 months before I could really play tennis or swim, and riding a bike was a little painful, EVERYTHING I did related to upper body made the shoulder sore.

I'm now ~1.5 years after the procedure, and still occasionally have a sore shoulder, but my range of motion is good, and the shoulder is still getting stronger. I can swim, play tennis (although I had to modify my service motion), riding the bike is no problem, wakeboarding and water skiing present no problems. Sooo, end of long story, the procedure and resultant PT were worth it for me.

I would say, make sure you can get it to a sports ortho, preferably one with a good reputation as it relates to shoulders and see what they say...

Good luck.

Hi. Miljack, I found your post interesting as I am also a tennis player of the same ranking and had my surgery 6 weeks ago today (4th May 2013). So, this is my A.C story.....Came off my bike 24th November 2012, straight to A.E where I was examined by a fracture specialist( though not a shoulder expert) who missed diagnosed the grade of the separation and told me it would be fine in 4 weeks. After 4 weeks my shoulder was still a pathetic mess, so I eventually made it to see a top sports surgeon who specializes in shoulders here in London who took one look at it and told me it was grade 4/5 and if i wanted to hit any more fuzzy yellow balls surgery was needed.. My surgery was cancelled twice due to terrible luck on my part but eventually took place on the 4th May.

The procedure involved the Nottingham surgilig with an added ligament attachment everything went well and no more pointy shoulder.. Like yourself the Doc found alot of extra damage to my labrum probably due to tennis so he kindly fixed that up while he was routing around in there. Post-op shoulder geometry felt instantly better and more stable. Started PT 4 weeks post-op and have been doing it for 2 weeks, range of motion has gone from about 30% to 95%. Found the PT very tough and painful for the first few days but it became easier. Also spent the last few weeks resting up and watching the French Open grrrrrrrr.. so desperate to get back hitting though Doc's orders are no tennis for 6 months, should hopefully be ale to start running in 4 weeks.

Reading your post gave me some encouragement that i'll be able to return to a decent level of tennis though maybe without serving my old flat bombs lol Feeling really positive about my shoulder now, feels better everyday and today being my last day in the sling YES! Looking forward to starting some strength PT this week and I feel the worst is over and there is finally some light at the end of the tunnel.

Good luck to all those others with the same injury....Chin up!

You should probably consult your doctor.

I wanted to provide you with an update on my progress:

My surgery was performed on February 6, 2013 to repair and reattach a Grade 3 AC Separation.
It has only been 4 months post-op, and I am feeling really good about the recovery process. Currently, I go to Physical Therapy twice a week, which was cut down from three times. The major discomfort I feel is a knot in the back of my shoulder deep in between my lats and shoulder. They informed me that this was due to the immobilization, and it will just take time to work that out.

I am back to riding, running, and swimming. The strength is still not fully back, and I can only endure minimal volumes at a time. However, two weeks ago I rode 55 miles on the bike and this past Saturday I ran 14 miles with 4,000ft elevation gained. There was minimal discomfort in the injured shoulder, as in nothing more than what normally may be felt.

My advice is to be patient with the recovery process, and find a solid Physical Therapy facility. Another thing to do once your complete surgery, is to try and work in a massage every few weeks to try and work out those knots created by having your arm in the sling.

I was very pleased with the decision of surgery. I feel like I'll be back to normal with continued PT.

Good luck and I wish you the best!

I had a grade 3 as well back in 2001, i went to several doctors and listened to what they had to say.... in the end i went through with the surgery 4 years later.. My quality of life is so much better now and i don't look like i'm trying to grow a wing out of my shoulder anymore. Get it done, you won't regret it.

Hi All,
I suffered a grade 3 AC joint separation in my right shoulder 21 November 2012. First doctor said non-surgical approach. Wore a clavical brace for 4 weeks then started PT. Went back to almost all full activities after 8 weeks post injury. Ended up making it worse over the next 2 months, made it into a grade 5. Saw Second doctor in Louisiana where I go to school. Recommended surgery, being 21 years old with an athletic lifestyle. Couldn't do it at school needed to wait till the summer back home in NY where I am covered. Found a doctor who performed AC joint surgery on 24 May 2012 using a hamstring graft. Successful recovery thus far. Deemed it to be a true grade 4 during the operation.

~ 4 weeks - No activity/very light motion movements sling most of the time.
~ 6 weeks - out of sling, can resume moderate motions with the operated arm/cardio exercise resumed.
** I have done my best to not use the operated arm until now, mainly been doing beach frisbee workouts one-handed with running. Most everything else just doing it one handed.

So, its currently been 10 1/2 weeks post-op. I go to the doc tomorrow morning. Will find out more but wanted to put some questions out to those who have gone through a similar experience how the 12-24 week post op period varies in what you can and cannot do.
16 Aug will be my 12 week mark.
Would love to get back in the pool and ocean at this time and work on my strength through swimming exercise. In addition I surf and would like to resume that activity as well.
Played mostly ice hockey/basketball in high school and in college its really only basketball now. Basketball is semi-contact and I know the popular advisory is wait 6 months for contact sports but can I play after 3. Thanks to anyone who can shed some light on this sort of situation. Cheers.

Ted

Your wife and I had the same exact surgery! My ac grade was 3, I was in a rollover accident on May 2nd 2013. and since I'm a photographer and love to golf I just decided to do the surgery. I'm not sure if not doing the surgery was the best choice or not because I just went with the surgery. My experience with surgery:: my surgery was June 10th. They fixed my ligaments, and they put a hook plate in to hold down my collar bone (I do not know the medical terms haha) I just scheduled my next surgery for the plate removal on August 21st. Pain was excruciating at first. Still hurts constantly but now I'm used to the pain tolerance. It eased up a bit now thou. I can't do daily activities that well because the hook plate makes your range of motion very little. Can't really do my hair, putting it in a pony is redick, washing my hair I'm so use to with one hand now but you can't believe how much I'm gonna scrub my head when this comes out! Haha getting dressed is a task. You don't really realize how much you use both your arms until you can only use one. Haha now I think when this hardware comes out I am going to be one happy mama!! And I'm probly going to be happy that I went with the surgery because I will have my full range of motion back and be ready to shoot photos and swing clubs (obvi I will take my time for a couple months)

Question for your wife or anyone that has had the hook plate.. How long after the plate removal surgery were you able to go back to doing daily activities and maybe swimming and such? I'm just wondering so I don't do the wrong thing and mess it up!

I cannot waiiiiiiiitttt till I can lift both my arms up!! Haha

Hi mlm, would you mind giving me an idea of how the pain progressed after plate insertion? I had a hook plate put in 3 days ago, soon enough after the accident for the original ligaments to heal. First day after the op, pain was severe, next day quite mild, but now it is hurting a lot again. Painkillers that I can take every 6 hours are only effective for 1.5-2 hours, and I have a feeling the pain is so much worse when it returns that I may be better off doing without. If it stays like it is for much longer I probably need to make some arrangements for assistance, but if it's likely to improve noticeably in the next few days I can survive till then, so any info on how yours progressed would be useful.

Seems I may have solved the pain problem. In hospital they gave me Diclofenac, Paracetamol and Codeine. The pain was pretty minor when I left, around 30 hours after the operation, but they sent me away with only P&C, no Diclofenac. The pain then got a lot worse, so I thought perhaps the Diclofenac had been a major factor, and perhaps Ibuprofen would help, also being a NSAID. Popped a couple of Ibuprofen, and wow, huge improvement in the pain, barely any pain at all now while sitting still.

Hi,
I had a nasty fall from my bike last fridat and after xrays was told i have a GRADE II shoulder seperation. I am 29yrs old & my ortho surgen suggested surgery as i am a dancer but my gen.physician begged to differ.According to him I can recover without any probem if i rest it for 6 weeks and take the required treatment. I really dont know what to do..I am guessing the ligament is totally useless and Im not comfortable with the idea that i could b doing lifts and drops with a shoulder like that..I am afraid if i take a non OP treatment i cud have problems with my dance training which for me wud b a tragedy. can someone advice what can be done?

Surgery is not recommended for a Grade II. It is not recommended for a Grade III unless it is still giving you problems after recovering. Only > 4 is surgery the default option. I have "the worst looking grade III separation" the docs at my work have seen yet 7 months after it happened I did IMLP and it gave me zero issues. I just look like a freak. Let your's heal and then see what it needs.

As you unfortunately discovered, whether to choose conservative treatment is debatable in Grade II AC separation because the prognosis (functional outcome) is not certain. Further confusing the issue is the question: Is it really Grade II and not III? About 80% of athletes with Grade II are satisfied with their conservative treatment outcome. However, AC separations are not common among male ballet dancers. Cycling is the usual culprit.

There's no rush to decide for or against operative treatment, but you could ask to be placed on the surgeon's schedule, maybe at 3-4 weeks post-injury. At about that phase of healing, you will get an idea of function based on the amount of visible separation ("step deformity") and pain and crunch ("crepitus") during arm movements that strain the AC joint: 1. placing arm behind and across low back, 2. moving the straight arm across the front of chest to opposite side, 3. raising straight arm forward and directly overhead. Use caution not to extend the sprain with power movements like the bench press and military press until after complete healing (6-8 weeks).

well..mine is very small..not so obvious...but yes it looks like a mini bump n my shoulder...

thank you guys..that helps

I am going through the same ordeal. Grade 3 dislocation from a cycling crash. Had the tightrope surgery and it failed about 2 months later thus leaving a significant bump on the shoulder. This was 2008. It has since worsened the bump is larger and the pain, clicking and rubbing have increased. Have been to see a high end sports ortho who specializes in these types of injuries. Glad to hear that there is a fix.

Hello Simply_Miller

I suffered an endo on a mtn bike on December 28. Grade V sep, complete tear of all connective ligaments. Had surgery 3 weeks ago as I was not given a choice if I ever wanted to do another IM. My ortho basically told me I would never be happy with my shoulder if I didn't get it fixed.

My surgery was outpatient. He used my semitendenosis and made a "figure 8" around my coracoid process and sutured it around my clavicle. I am told the repair will be permanent after 6 months of Pt and healing. Just as a reference point, I was off pain meds in 3 days and to be honest, the surgery was exponentially better than what I thought it would be from a pain perspective. Kodak polar car 24x7 for two full weeks. Best invention ever. It was pricey but soooo worth it.

The background was for anyone considering surgery/ non surgery. My question is how are you doing now 1 year post op? Would you do anything differently? Any residual issues?

Thanks in advance

I am sorry to hear about your accident on the mountain bike. Choosing the surgery was definitely the right choice to go for your repair.

In my experience, I actually felt better every single day post operation. The procedure that my Ortho performed was with a special type of string. He went in arthroscopicly and wrapped the string around the top of my clavicle and then cinched it down somewhere in my shoulder. I also had all 3 ligaments severed. Even though I was on drugs, it just felt more comfortable as if my body could relax now that things were back to where they were suppose to be.

I was off the heavy pain meds after 3-4 days, but stayed on the lighter stuff for another few weeks. Even if you are not in a ton of discomfort, the pain medication will actually allow your body to repair faster because there is less stress on the body because of the meds. It may sound strange but it's true. I, too, had some polar ice machine that was strapped to my shoulder 24/7. I ran it for 8 hours on then off for 1 hour. I kept that repeated for atleast the first 4-5 days. That machine worked miracles!!

The doctor cleared me in August of 2013 (6months) to get back to whatever I wanted to get back to doing. It just so happened that there was a sprint triathlon that weekend, so I went for it. It was not very smooth, but I was just happy to be back.

The few residuals I experienced since November was waking up and my shoulder being stiff and achey. There was a bit of atrophy in the back of my shoulder muscles, so I found it difficult to perform the negatives on pull-ups and push-ups. I had to go slow and really take my time building back up the strength.

I celebrated my one year about one week ago. I feel really good. My strength is getting back to a level where I can really push myself in all 3 legs of the sport. I can sleep on my right side all night and not feel achey at all in the morning. My push ups and pull ups are getting better and much less discomfort performing them.

My surgeon gave me strict orders to be patient and focus on the longterm and not to be too anxious to get out there too soon. So, my answer is NO, I would take exactly the same path again and again. I was in my sling til April 19th (2.5 months)

I will be competing at Vineman 70.3 this July. I am fully capable of racing an IM distance this year. But, I'm choosing to focus on a few other things than doing that long training. Plus, there is a rebuilding period, I feel, from all the immobilization and look to take my time with everything.

It sounds like you are on a great road to recovery. All I can say is be patient with the return. The only exercise I was allowed to do was stationary recumbent bike until May. Swimming will take some time to rebuild the strength of your pull. You'll feel some pain at first while running because of the jarring and gravity pulling down on the arm. That'll take a few weeks. Just go slow.

Good luck with your recovery, your rehab, and your return to the sport!

Cheers,

Simply_miller

After I tore my rotator cuff it was vineman for a few years, as you only need to make 300m -400m before you can touch ground again, in case something goes really wrong.

THANK YOU! That is really helpful and greatly appreciated. Congrats on the one year post op! It sounds like although the surgical techniques differ (I understand there have been over 60 methods) I am on a similar path. I am finding hurry up and get better means keep the shoulder 100% immobile. The surgeon even has ne wearing my basic cotton sling that the ER gave me in the shower for 6 weeks.

Thanks again and continued success!

Just because I know a lot of fellow athletes use this thread to weigh surgival options and correctly most do not need surgery. I want to add some info for those that dont have much of a choice.

My only advice for anyone getting the surgery is to ask a lot of questions about the specific method the surgeon plans on using and be sure you are comfortable with it. Here are some links that I found helpful. They discuss surgical techniques, hamstring strength / morbidity of the tendon donor site, rehab studies, tendon to bone strength studies etc.... I hope they are helpful.

http://www.oudshoornbv.com/...ig%20Paper%20OPN.pdf
http://en.wikipedia.org/wiki/Gracilis_muscle (typicallyused in the repair)
http://en.wikipedia.org/wiki/Semitendinosus (typically used in the repair)
http://depts.washington.edu/...rgical-Technique.pdf
http://www.ncbi.nlm.nih.gov/pubmed/7761511
http://www.udel.edu/...0al%20rehab%20AC.pdf
http://www.ncbi.nlm.nih.gov/pubmed/8258550
http://ajs.sagepub.com/...nt/34/2/236.abstract
http://www.sgsu.co.uk/...cj-stabilisation.pdf

I had the same thing and done. My pain schedule was just like yours. However after about 6 weeks with almost full motion back I reached out to push open a door. When I pushed on the door ....pop... all the work done was tore up. Pay attention to the doc I proved the healing inside the shoulder does take longer.

That is terrible! Any insight on the method the Doc used? where are you in recovery now?

It sounds like the same surgery as yours the first time. They went back in and put a plate and screws in to hold it. Nothing was left to try reattach or wrap the second time. It was a yesr ago so things are good.

Sorry to hear about your wreck. I had a Grade III (or 5 - complete separation) 10 years ago from a bike wreck. It hurts like heck at the time! My Harvard trained buddy recommended no surgery (he examined again this summer and still agrees). Note that the AC joint is the only injury I have there . . . no other shoulder involvement.

I started swimming 1 armed after 5 days, running in two weeks and the trainer at about the same time. Every now and then it aches, and I can't throw a football as well, but I do pretty well. I have done 11 IMs since then. My swim has migrated from the high 50s to 1.07-8, but that may be age/life.

The clavicle is completely loose and bobs around. I do keep it very strong.

I wish you the best.

---

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.

To add my experience to the thread:

Grade 3 AC joint separation, had a clavicle hook plate inserted just over 3 weeks after the accident. No moving of any tendons etc from anywhere else, he just put the plate in which holds the clavicle in place and said the ligaments will all heal back together. He said this has to be done no later than 4 weeks after accident, ideally 2-3 weeks, or the ligaments have changed too much to be able to heal. The plate was supposed to stay in for 3 months, but ended up being taken out after 9 weeks due to infection, fortunately this was long enough for everything to be reasonably well healed.

These are the x-rays:


The hook plate procedure is described here:
http://www.shoulderdoc.co.uk/...es_clavicle_hook.pdf

It's now 4 months after the plate came out and I have close to normal function in the shoulder. I can swim all strokes including butterfly, and my times are similar to what they were before the accident. Loss of fitness hasn't been an issue for swimming because I wasn't particularly fit for swimming before the accident. I'm still around 40W down on my pre-accident cycling power due to being unable to do any cycling while the hook plate was in.

Hi I am new to this forum and have been reading these threads with great interest. My heart goes out to everyone who has been through this injury whether it has been through conservative treatment or the surgical route(and its many variations). My story is similar to many on these threads but I am looking for a bit of advice.
I suffered a grade 3 last August after a cycling accident. It was on my dominant right shoulder and I am a very keen sports person including squash,golf,cycling,running etc. I went to see a consultant who advised that it should be treated conservatively, so after wearing a sling for a week I started PT and over the next 4-6weeks it improved immensely. At that point I tentatively returned to squash which initially went well but after the 8 week mark I started getting pain in the acromial area. To cut a long story short I had an MRI in november which showed some impingement, a cortisone injection in january into that area which did little to reduce the pain and have now stopped PT as I feel I cannot increase the weights for the exercises. I have full ROM, but am weak in certain directions (mainly doing push ups), the shoulder cracks loudly a lot, and has a ratchet like feel to it. I have seen 2 further consultants to get second opinions and both differed in opinion.
Consultant 1 - Hook plate and my own ligament
Consultant 2 - Carry out distal clavicle excision initially, if this does not cure it the modified weaver dunn
Consultant 3 - Dog bone technique including modified weaver dunn (grafting CA ligament onto distal clavicle end)

I am extremely confused as to what to do now but have pencilled in an operation at the end of the month with Consultant 3. His procedure involves using fibre wires with a 'dog bone' tool to hold the clavicle down to the corocoid bone (explanation can be seen here https://www.arthrex.com/...c-dog-bone-technique)
My question is has anybody undergone this technique before (I believe its relatively new), I would really appreciate your experiences in rehab.
Thanks to all previous posts they have already given me great hope and as always stay upright!!

I had that done. About 8 weeks after, I was pushing open a door and it broke (hurt more then when I crashed). They then had to go in and do the hook plate procedure. Mine by the way was cat 4.

Thats not great, I hope the hook plate worked out as I believe it can be quite painful until it comes out. What are you allowed to do in the first few weeks with your arm in a sling. Is it advised to not leave the house??Or can you get out and walk etc I am looking to drive (obviously not me) 250 miles on a holiday and take it easy. Cheers

I was on a bike in two weeks. You cant hurt it unless you fall. Assuming you are not waiting for ligaments to heal. I wasn't just had some soft tissue to heal and the screws to set.

I haven't and cant have mine removed. I think some people have the plate removed when their ligaments heal. All my ligaments were to badly damaged and unrepairable. Without the plate the clavical migrates behind my shoulder

You could look into Surgilig, which seems to be called LockDown in the US:
http://lockdown.uk.com/usa/

Surgilig is what I was offered as an alternative to early fixation with the hook plate. I.e. the option I went with was to have the hook plate put in 3 weeks after the accident, which was early enough for the ligaments to heal and the hook plate to be removed. But there was an option to complete the competitive season first, by which time it would have been too late for the ligaments to heal, and instead have a Surgilig reconstruction.

Unfortunately, there seems to be no free lunch with these things, there is a trade off between robustness and disruption to the body. The dog bone button looks like it would require smaller incisions than a surgilig or hook plate, but it sounds like it may be less robust. I wouldn't personally want a hook plate in my body long term, I couldn't wait to get mine out, but apparently some people aren't bothered too much by its presence. The surgeons I talked to were more keen on robust solutions, they wouldn't do tightrope or modified Weaver-Dunn because they failed too often for their liking.

I had a Grade 3 tear in the AC joint. Still have it, massive step in my shoulder. (collar bone sticks out and looks like a step from my collar bone to my shoulder.)

Never had surgery, was informed that lots of them never work quite perfectly and that was from a respectable clinic out in Vail Colorado. I have some issues with my shoulder without the surgery and can definitely feel a difference between the two sides and it occasionally pops and hurts.

Why I didn't have surgery:
1. I didn't have pain after 4 weeks
2. My range of motion came back quickly
3. Surgery could be done anytime after, if I had surgery it couldn't be undone
4. I was told that any surgery done would probably still lead to pain and differences between the two sides.

I'm a terrible swimmer but my shoulder doesn't hurt when I swim, I also now have something to blame for my terrible swimming.

Sometimes I consider having surgery done but this is only when I do something stupid like try to lift a 200lb snowblower, thanks winter. Also there may have been advances in the surgery since about 5 years ago. Ask your surgeon about the likelihood of success of your surgery. I was told about 50% chance I would feel better than without surgery 45% about the same as without surgery and 5% chance I'd feel worse than without surgery.

Mine started off as a grade 2 but I have made it into a 4. My consultant here says that the 'dog bone' technique is his preferred method and has had little issues with it over the last 2 years other than the odd infection. He has used it on professional rugby players and tells me that after 4 months I can return to full contact sports. Initially however I would be waiting for the ligament to heal onto the clavicle hence the need for it to be immobilised. At present my scapula rotates forward and under the clavicle causing loud popping and graunching. Its also affected my lower back and I seem to have a stiff neck daily. Another consultant had advised that a distal clavicle excision might do the trick and would be less invasive than full modified weaver dunn. The latest consultant strongly advised against this procedure as it would not cure the instability. Thanks for your replies, I know there is no easy fix but it would be helpful if the consultants actually agreed.

Had an accident last year (my left shoulder), went to see the doctor in the Hospital (government owned) and a BS treatment done on me, then I went to see a specialist, the doctor just looked at it and proceeded to be done w/ his exam, then I started telling him about a tingling feeling in my spine, left side of body feels lower and right side is higher, a funny feeling as well in the left leg like tired, I felt my arm bone trying to rise while the shoulder wanted to go down, and felt my left side of my body trying to take up space of my right side of the body. After hearing what i felt, he decided to do an X-ray, then when we were done, he said look let's give it a month and if you feel like I should operate then will do that and if not then that's ok too (while you could feel in his voice he just did not care and said it nonchalantly). Reason i'm telling you this is that you should see more than 1 doctor.
The 3rd doctor that i went to see, he was more proactive, get the X-ray and report from the hospital that saw you from the time of the accident. When I went to see the Doc he was like yeah i could see you're shoulder is way lower then a typical shoulder separation, the bone should only be 1/2" up not 1 1/4", he move my arm around told him what i felt, he said ok let's do an MRI. After the MRI got back, he said that a surgery in the only to get you body back somewhat close to being centered again, base on what you are describing to me. A good 2 months passed till I had the surgery done, as of now i'm in my last month of recovery, I can't tell you yet what the outcome is till I get PT done, sorry to be continued.

Base on my research and what i have read, is that Grade 3 is somewhat a 50/50 situation, I know this is not what you want to hear it's either yes or no, but it varies on the situation. For me if I did not feel what I was describing to the doctor, I would probably had not have the surgery done.

Base on what i read, some complained about the 2 hour a night sleep for the next few weeks because of the pain. As for me I had none, unless I moved my arm.
One more thing, I hope you have good insurance, as the bill came close to $20,000.

Sounds a lot like the experience I had with doctors.

Mine happened last Tuesday, car hit my bike after turning into my path. A&E referred me to the fracture clinic, saw one consultant who said it was a grade 3 and thought I could do with surgery and referred me to his colleague. Who kept me waiting for 2 hours after my appt time and was just in an obvious massive hurry. He thought I didn't need surgery but the whole appt was over in 30 seconds. Found the whole experience so demoralising I've made an appointment to see someone privately.

Glad I found this thread, it's been reassuring in a lot of ways. One question - do you get used to the bump/wonky shoulder? I dunno whether it's vanity but it really bothers me. After a long time of being pretty inactive I was finally starting to get a decent level of fitness and I really liked my shoulders - not any more!

Hey guys, 2.5 weeks out from a grade 3. The first couple of weeks are rough but it slowly starts to get better. At almost 3 weeks I am just now able to put my arm over my head with some pain. My case is rather specific of course, being that I have an overlap of the clavicle and the scapula. This will cause my conservative treatment to be more difficult, but still possibly successful. I am optimistic of course, I would rather not have the surgery due to the invasiveness of it all, along with other complications. I can get over the bump. Once the ROM is in check, strength training and muscle building should help cover the bump. I saw a pretty renowned specialist that stated that acute surgery is not any more successful than surgery later down the road. This injury is tricky in terms of recovery, but I say if you sustained a grade 3 and not any higher (but possibly higher) then at least try conservative methods until you feel that it is not for you. Give it maybe 6-8 weeks to start, and if things are progressing, aim for a few more months. The muscles learn to compensate, and you can avoid a longer recovery time (along with other negatives). Don't get me wrong, I am no expert, but I feel that the body is strong enough to overcome a lot.. so why not give it a chance?

Hey how is your shoulder these days? I had a grade 3-4 separation. I got surgery 4days after the injury and is on my second postoperative day now. I also got this hook with screws. Seems you recovered pretty good?

It has actually gone a bit downhill. Bear in mind I didn't have the plate in for as long as it should have been in, due to infection, so this would be expected to not allow everything to heal as strongly as it would have done with more time. The bone has gradually moved further out of place, and I'm not sure it's all that strongly connected as if I swim I quite quickly feel like I'm going to rip it apart. I think I'd need further surgery if I wanted to compete at swimming again.

My view now is that surgilig/lockdown is probably a better solution as it is designed to be left inside the body, so you don't need a 2nd operation to remove it, and it doesn't interfere with movement like the hook plate does, so recovery should be much quicker, plus it provides zero scope for the bone to move back out of place. Having said that, apparently many people have much better movement with the hook plate in than I had. I pretty much wasn't able to do anything at all while I had it in, by which I mean I could barely sleep, and I was in agony after about 10 minutes if I tried to walk somewhere. If you have good pain free shoulder movement with it in, so it can be left in for plenty of time, and it doesn't limit your activity much while it's in, it will probably work out much better for you than it has for me. It doesn't really impact my cycling, I'm able to ride in the TT position okay, but I might be less aero than pre-accident due to the bone protruding.

Thank you for answering, I'm sorry to hear that it's unstable. Reading a lot of the entry's here and seems like there is individual differences/injury mechanism that has more impact of recovery, than actual surgery or Conservative approach. I will update my status here as time goes. Good luck if you choose the new surgery.:)

I've got a grade 4 dislocation and consultants initially ruled out any surgery due to the scaring on my back. It's 6 weeks since it happened and I would say I have nearly 95% movement back but in a controlled manner and significantly reduced strength. Recently saw consultant and she said to go for physio and come back in 3 months for a check-up. She kept highlighting the risks of surgery (LARS ligament technique) and I think she was pleased with the movement I had regained. I said my goal was to get back to swimming competitively to which she didn't really respond. It's been a hassle booking the physio sessions, I've only seen them once and now he's on holiday for 2 weeks. Booked a private physio who specialises in shoulders so hoping he will have some good advice/exercises.

First run after 5 weeks but not tried swimming or cycling yet.

I've done a lot of online reading and it seems most people grade 3 or less manage it conservatively and those grade 4 and up have surgery. With this in mind, I'm not sure why my consultant was hesitant to recommend any surgery, do you think it's because of the movement I've got back already or are they (NHS) just fobbing me off? She did say it would be possible for me to have surgery at a later date so perhaps the best thing to do is to work hard at the physio and hope I regain 99% of functionality for triathlons and just left which a lump.

Hey, I don't know why they didn't recommend surgery. I learned that this ac lux grades are not a continium. Because grade 4 is a ac lux that is moving posterior and grade 3-5 can look more the same. I got this old operation with a s-hook. I have all my movements back and swim even faster than before the accident. Got a lump and sometimes click in my shoulder, but this doesn't hurt. Are really sensitive in the injured area when my kids jump on me. Good luck with your shoulder I really belive in training.

I'm sorry for your (and everyone who posted on this thread) injury however I am really thankful y'all posted as I came here to type the same story/question. Crashed 2 weeks ago at 25mph. Went to ER w a Grade 2.5-3 AC Seperation. I've since been bounced between orthos who take my $$ but then tell me that my needs are not their speciality. I have a good friend who is an ER surgeon and he said looking at my x-rays that if it were him he wouldn't have surgery unless it was necessary for pain/ROM.
So far, 2 weeks out the pain is just a dull roar when I do try to do too much. I've started not wearing the sling at all times and the ROM is pretty decent- not 100% but better than it has been. The road rash on the ugly bump I have is healing and while the bump (reference to step earlier was an apt description) looks terrible, I think the road rash is making it look worse.

For all those that opted no surgery, given that this thread is 5 years old- how are you feeling to date? Did the bump/step reduce some in size? Any thoughts about your recovery adn what PT is most effective? As of now, all I have been doing is the pendulum swing adn I need more PT exercises. Thanks in advance to all my Separated AC Joint brothers and sisters!

i crashed on oct 5 2013. did research here and sent xrays to several doctor friends / acquaintances. same level AC3. went for no surgery after seeing some people with surgery had issues afterwards.

my decision framework was if it doesnt work i can always have surgery later even if the scarring would make the surgery worse.

went with a sling and little movement beyond mobility and soft tissue work ( the one that looks like steel spatulas tools ). i used a figure 8 elastic strap ( bought on amazon ) to hold it in place day to day on top of the sling. 4 weeks post crash went with mobility + strength therapy.

to this day no pain or issues with ROM. i even switched to breathe on my left side when swimming which means i pull with my from crash affected side while breathing. never had pain or issues even one year later when upping my weekly swim meters by 50% to 15k a week thanks to desert dude.

ymmv. i am happy i went this route. hope you find a solution that works for you.

r

Hey
I was injured the same in april 2017, didnt take a surgery. Used an elastic band (a very soft one) and a lot of ROM exercises starting 2 weeks post the injury. Today my ROM is bigger, the pain is long gone but the bimp stays..
The other funny thing is that my arms now are not the same length..
Returned to swim around 6 weeks post injury. I believe the most important thing is to keep moving and listen to your body

Thanks, this is comforting. I start PT on Wednesday which will 3.5 weeks frmo crash date. It's feeling better and I'm spending more time out of the sling. Even got back in to running- slowly and short distances, but moving feels good. The bump is something else, but I'm hoping when the road rash is gone it won't be as irritated and funky looking.

related but different question- did you start riding again and if so, when? Did you get back to the same level of confidence you had pre-crash? I'm having trouble envisioning doing the things I did pre-crash on a bike after going through this and knowing how much worse it could have been.

i fell in a race sim for my second IM. got up. dusted myself off. i knew something was off but only really felt pain when pushing in my bottle in the BTA cage. completed the ride and did a short brick so my mindset was more like if everything is ok then lets not waste this day.

i went to get xrays etc when we got back into the city and then outlook changed quite a bit.

all this is to say that since i got on the horse ( bike ? )immediately it has never been a concern. havent been the most daring descender or good handler but crashing i feel has not really affected me.

after i decided on not racing i went the conservative route or what that seemed to be for me: 4 weeks off only pt and mobility. got back to riding, running and strength one month out.

just checked tp for this and 1st swim back was 6 weeks out in sprint tri with a friend that was racing for first time, sea was rough for a first timer so went in to help out. no pain that dat or to this day.

hope everything turns out well for you!

r

Went over handlebars mountain biking in Jan 2019. Grade 2, right shoulder. After 4 weeks, was back in the pool and worked my way back to the A lanes (from C). Everything was fine, could do pullups, pushups, etc. Only issue was cosmetic. Just as COVID was kicking off, we purchased a Concept 2 and I took up rowing. I probably did too much too fast and irritated my shoulder. Pain so bad I thought I had ruined it for good. Took months off from any activity and now, 9 months later, back to lifting and biking with no issues. Originally I thought I should have the surgery but in all my reading I've convinced myself that I don't have it so bad. Right shoulder gets more tired faster than left shoulder, but all in all, I'm ok.

Just chiming in with a little experience re your second question / confidence with cycling. I had a Grade 3 AC separation a few years ago, no surgery. I stuck to the trainer for just under a month before heading outside. It took a little while to get confidence back -- looking back in Training Peaks I was a bit weary of wind, cars, descents, etc. for a couple weeks, but just kept getting out there. Eventually the confidence did return and it really didn't take long. I think descending took me the longest to get my nerve back; riding with a couple friends who were clued into to my hesitation helped. Once the shoulder was no longer something that I was noticing/ thinking about non-stop, the fear seemed to subside and I'd say I ride the same now as I did before the crash.

I did the first week or two on a gravel bike on non-technical, flattish dirt roads and that seemed to help.

i crashed in april 2019, grade 3, after 5 days on a sling, i started swiming one harm, biked and ran after 7 days. Raced on day 14 at my local sprint serie (one arm swim) and actually won my age group. The discomfort lasted 6 months, i remember doing push up stayed very unconfortable for more then a year. @ years latter, besides from an uggly bump, all is fine and i am really happy i did not stayed on a sling for too long

all really helpful to read, thanks! I did a short trainer session yesterday and despite going pretty easy, I did put some weight on the arms/bar and it felt ok. I'll prob increase a bit this week adn I start PT wednesday. Hopefully I'll follow y'all's example and be back out soon-ish.

Thanks again!

Found this thread very informative during my research process so wanted to share my story too.

On May 29, 22 - was mountain biking and had a nasty fall at a good speed. Went to the ER and was discharged with an AC separation. Mid week got in touch with two orthopedists both said it was a grade 3 and for my age (34) and goals recommended surgery (although methods were slightly different). My third opinion a week later measured the distance in the separation and deemed it as a bad 4 - this part was interesting because it was the only doctor who measured things to get to the type (which I recommend because a three is so widely diagnosed).

Fast forward I opted for surgery with a sports medicine orthopedist who specialized in shoulders and working with athletes. They utilized a method that wrapped the collar bone down with a pin - in theory hopefully no need to remove unless it creates a problem. Recovery time is 6 weeks in a sling and 4-6 months until back to normal.

I had my surgery on 6/16/22 and have been recovering in week one - comparable to week 1 after accident tbh in terms of pain and lack of mobility.

I’ll update on progress in several weeks and any questions please don’t hesitate and I can share my experiences - I’ve learned this type of injury is much more an art than I would like ☺️