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 ☺️