The grades are defined here:
http://en.wikipedia.org/...ulder#Classification


Again, it's interesting the different advice from different surgeons. The surgeon who went through the options with me described the hook plate within ~3 weeks as having an extremely high success rate, greater than 90%. Even waiting, then having a reconstruction with surgilig, he said had a 90% success rate, which appears to be supported by the study on pubmed:
http://www.ncbi.nlm.nih.gov/pubmed/20397357

You will find lots of conflicting stories and advice....among patients and among doctors.....as is clear in this thread.

There have been different classification systems and there will always be errors in grading AC sprains/seps.

Most people who do not have surgery are happy.
Most people who have surgery are happy.
Some people in both groups are unhappy.

Early repair/surgery sounds the most attractive to most active people and seems to be the current most recommended approach by shoulder specialists. Nobody wants to hear that their clavicle will float up and down forever....yet seems like most people tolerate it just fine....

Helpful - huh?

Find a good ortho that you like and see what they say....if in doubt get a second opinion. In the end, you will need to make a decision without perfect information.

Dave

When I want to freak my wife out I put her hand on top of the clavicle and push down.

good times

Whether surgical or conservative management is better for grade 3 also depends on age. Under 40? Full carpentry repair will postpone osteoarthritis disability.

Back in college separated shoulder playing third base. No idea what degree it was but was out for two weeks of complete rest and no issues since

Thanks Steve for that long explanation. It was helpful for me. I am in Peru and do not have very good medical help for my hook plate. I have a few questions if you could help.

When should PT begin after hook plate is put in?

How long should the sling be worn?

What is the earliest time I can have it removed and how do we know it is ready to come out.

I also live at very high elevation, over 11,000 feet which slows down healing. Will that matter for removal?
Thanks for your help!
Nicole

Here is my recent story, I am 50.
Fell from bike 5 weeks ago, ER diagnosed type 3 separation and saw my surgeon 2 days latter who confirmed.
day 4 I was swimming one arm in the pool
day 6 I was on my bike riding slow 21 mph
day 8 was riding at 24 mph for 90 mn
day 10 first slow jog
day 11 my surgeon advised on starting PT rehab
day 12 did a local sprint and won age group (first time I could fully extend my arm on the swim although very slow)
day 19 sprint triathlon and won age group
day 26 and 27 won 2 sprint triathlon over the week end in my AG
it is now 5 weeks, I have a huge bump on the shoulder, it fells a little tight and I can't do push ups or sleep on the shoulder side. I do fell that because I did not stay in the sling for more then 5 days I was able to recover fairly fast. I do hope I made the right choice and will not suffer in the long term.

Hi Nicole, I'm not a medical person, just someone who went through this and read a lot of scientific papers and other information around the subject at the time.

It was nearly 6 years ago now, so my memory of some timescales may not be perfect, so please just treat all this as approximate, and check out other sources of information.

From memory, I think I was in a sling for 2 weeks, and started PT after that, but I found it very difficult to do much while the plate was in. Apparently this varies hugely between people.

My plate was removed early due to an infection, it was removed around the 8-9 week mark, I think, and it wasn't really in for long enough, the bone moved out of place a bit over the years after the plate was removed. I believe one manufacturer of plates recommends the plate is removed after 3 months, and I read that the reason for this is primarily to keep the wear the plate causes to an acceptable level. I have seen some people talk about the plate being left in much longer than this, so ideas on the best time to remove it appear to vary a lot. In the reading I did at the time, I didn't encounter any discussion of techniques to look at the actual healing that has taken place to judge whether the plate can be removed or not, I think it is normal for the decision to just be based on past experience of other patients. I don't know anything about the impact of living at very high elevation.

I'm sorry I can't be more helpful, I hope you're able to get the help you need and it works out okay for you.