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Thread: AC Separation

  1. #1
    Senior Member Krispy's Avatar
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    AC Separation

    This weekend while riding at Palo Duro Canyon I was going way too fast and mis-judged a drop off. The end result is that I have between a grade 1 and grade 2 AC separation in my left shoulder. (separated shoulder)

    The ortho doc seems like he knows what he is talking about. Nearly all of the docs at the practice are cyclists or tri-athletes. He told me that he doesn't feel at this point that I will need surgery but not to try to get back on the bike for 6 to 8 weeks. He warned me that if I do and crash on my shoulder it will easily make it a grade 3 or worse which will then require surgery to put in screws. He told me that riding my bike on a trainer or riding a stationary bike would be good as long as I don't injure my shoulder. So far I have only found a few websites that discuss AC separations but they seem to back up what the doc told me.

    Has anybody here had the same or similar experience? How soon did you fully recover and how soon did you get back on your bike? Any suggestions for not going nuts while I can't ride? I had just bought a truing stand and books to learn to build my own wheels but since I don't have much use of my left arm I can't even do that right now.
    Ride anyway!

  2. #2
    bac
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    I separated my right shoulder (also a grade I/II) while skiing a few years back. Your doc has given you good information given my experience. Be careful over the next several weeks so that you don't injure your shoulder worse. When all is said and done, you'll have a a bit of a lump where your clavicle ends. My shoulder has recovered fully, but it has never felt quite the same as my left shoulder. It doesn't bother me; it's just a bit different now.

    Good luck with the downtime - it hurts the worst.

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    Same here - did it last year skiing. Have a permanent bump (mini-Quasimodo )

    I wasn't biking then, but I did ski again just 3+ weeks later - just made sure I didn't fall again. It took maybe 3-4 months before I had pretty much full strength back in the shoulder, and I couldn't throw a baseball or even serve in tennis for 2-3 months (overhead movements with force were the last to be tolerated without pain or weakness).

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    meh goodcatjack's Avatar
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    Had what my doc called a Type III (bordering on what would be IV) due to an idiot in an SUV who thought it would be a good idea to cross two lanes of traffic to stop for a 3pt turn directly in front of me.

    Even so, he gave me the option of letting it heal in place, but given my activity level and age (32), we decided to repair it. As far as screws, he said that he preferred not to use them as he'd seen too many cases where they tended to propogate cracks in the bone. So I had to deal with pins (kept 'em!) and having a bit of the end sawn off, as well as a fairly miserable recovery period.

    but! happily enough, I'm reasonably well recovered after five-ish months, I'm back on the road and trail, and it only hurts occasionally.

    good luck with yours! hope it's a totally routine and uneventful recovery! (that hospital food just sucks.)

    -alex.
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    "Some mornings, it's just not worth chewing through the leather straps."
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    "I guess you should never judge a club by its cover." Alison Berkley

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    Senior Member Krispy's Avatar
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    Quote Originally Posted by bac
    Good luck with the downtime - it hurts the worst.
    Thanks for the advice everybody. The downtime is what worries me.
    But at least it happened during winter.
    Ride anyway!

  6. #6
    Don't Believe the Hype RiPHRaPH's Avatar
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    mine was also a grade I/II separation. since i was 35 and was pretty muscular, my ligaments and tendons didn't move much because of the bulk in the shoulder. in the emergency room a little 90 lb chinese female doctor got up on a chair, took my arm and manipulated it back in its socket (i was on a mix of drugs that left me looking glassy and without memory)

    i have only one word of advice for you....
    ***do your exercises/rehab

    anti-inflammatory drugs don't work because it isn't inflammation you feel. And once the SCAR TISSUE grows in you will lose your range of motion if you don't follow up with the rehab (thank you athletico)

    do them do them do them.

    i was stupid however. it was middle june (softball...don't ask) and i continued to road ride (thank you smooth steel) although i couldn't raise my arm to brush my hair...
    I have enough words to get me into trouble, but not enough to get me out of trouble.

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    hehe...He said "member" ChipRGW's Avatar
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    I am currently in the same boat.
    I hit a road groove on our club century last month and went down hard on my left shoulder. I went to the ER where they told me it was probably a sprain, but to follow up with an Ortho. (fortunately I have one already)
    He advised that it looked like a gr 1/2 AC seperation. Keep it in a sling, limit use, stay off the bike, come back in 2 weeks for follow-up x-rays. Well, the follow-up shows a fracture on the Acromion process.
    Off the bike for 4 weeks already, probably gonna be a few more. He DID approve the trainer, so I won't lose ALL my recent gains.
    Sometimes you just let the rabbits run, but sometimes you gotta let the dogs run.

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    I too had an AC separation. Going on 2 years now (Jan 12). It was a 4 degree, my ortho didn't want to do surgery (not that I did either). I still can't handle pressure right on top of it (purse). About the hump, I had to go with tee back bras, just to stay up. (sorry too much info)

    Physical Therapy helped. What hurt the worse was the pulling of the muscles on the inside near the shoulder blade. I still get "Trigger Points" near the center of back after a long ride. Maybe a masseuse or chiropractor will be my try, before the cortisone shot the ortho wanted to give me.

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    Senior Member Krispy's Avatar
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    Quote Originally Posted by ChipRGW
    I am currently in the same boat.
    Bummer! Sorry to hear about your injury. Yours sounds like it might be in a little better shape than mine. I hope you recover quickly!

    I just went for my one week follow up visit and the doc upgraded me to a grade 2 AC Separation. Still no surgery, still same projected recovery time but it just made me feel a little more depressed about the whole thing. While I was talking to him he looked at me funny and said "I can see your collar bone moving around"! Oh, great!

    I went and bought a good trainer and set it up and started riding it. It will be better than sitting on my @ss eating donuts but it is going to be a real challenge to make myself get on it every day.

    My biggest challenge is going to be not letting myself get depressed over this. When I'm off the bike for more than a few days I really notice how it affects my temperament and overall attitude toward everything. My wife usually notices too! I ordered some bicycle related books to read hoping that it will help keep my spirits up.

    Keep us posted on your recovery and what you are doing to keep yourself from going nuts when you are off your bike. I'll try to do the same.
    Ride anyway!

  10. #10
    Senior Member Krispy's Avatar
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    [QUOTE=scubagirl]I too had an AC separation.[ QUOTE]

    Wow yours sounded pretty serious, especially if you are still having troubles 2 years after the injury. How long did you have to stay off the bike? How were you able to keep from going nuts while you were off? Being off my bike is getting me down already and I've only been off it a week. I'm trying to stay positive about it though.
    Ride anyway!

  11. #11
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    Krispy - I feel your pain! Literally! I hope you are well healed by now.

    Ten weeks ago I was going about 35 mph downhill on a gravel road when I spied a conveniently located pile of gravel on the side of the road. It was obviously there to spread over the road, and was my apparent good fortune to find such a terrific jump opportunity. Away I went, up and over... only to find a second pile on the other side of the first one. Needless to say, I went down... hard! Bike damage - bent handlebars, trashed grip, torn seat, bent rim, and broken derailleur break-away mount. My damage - broken right hand (you could actually see the break through the missing piece of flesh in my palm), broken left wrist, broken left forearm, cracked ball on the left humerous, dislocated left shoulder, grade III separation of the left AC joint, and about three square feet of road rash on my back and legs.

    Fortunately, most of the bone injuries were still aligned. I was able to get by with wearing splints and slings. It hurt a lot, but I started some easy road riding about 10 days later. I've been at it every day since. It helped keep my joints from scarring stiff or with too much movement limitation. My hands and left forearm hurt a little, but aside of very audible crepidus in the left elbow, I think they're pretty much healed.

    My AC separation was complete on the distal end, leaving only the attachment at the sternum. It "floats" about two inches in any direction, and has shown no sign of reconnection (as yet). I wouldn't call it painful (I've had worse!), but it's certainly uncomfortable. I've forced full range of motion exercises every day since "D+5", and can move the arm every direction the other one can do. What I don't have yet is stability. The shoulder starts to come out of joint at about 50 lbs of pressure. My doctor is all about conservative treatment, and wants to wait a year before deciding to do surgery. I'm less patient (pardon the pun!), and am researching the pros and cons of early surgical repair. Anyone with recommendations, feel free to chime in!

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    anyone out there with a recent AC separation? I have a 3/4 grade and am debating whether or not to go the surgical route. Aside from not wanting to have surgery, from what I've been reading, there seems to be not all that much difference in prospect of healing. I am only 2 weeks post-accident (a beamer vs. me on my bike) and already I have pretty full range of motion with only a little pain. Any suggestions?

    Many thanks!!!

  13. #13
    Out the door roadie gal's Avatar
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    2 thoughts:

    First, it used to be that none of these got fixed, even the grade IV tears. Now, the ortho docs, especially the ones into sports medicine, are fixing more of them. Unless they are so displaced that they are tenting the skin, they wait for a few weeks to see how the healing is going.

    Second, a personal story about how important it is to let things heal: A few years ago I went OTB on my mountain bike and gave myself a grade I-II ac sep. I was told to wait 6 weeks, but instead tried to do bench presses after 2 weeks. Well, I ended up injuring it more and got aseptic necrosis of the end of the clavicle. That's where you cut off the blood supply and the end of the clavicle dies. I converted a 6 week injury into a 1 year injury and almost needed surgery. Six weeks is a long time, but believe me, it's a LOT shorter than 1 year. Let it heal! Don't push it!

  14. #14
    Respect Your Hill spindog's Avatar
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    I too suffered an ac separation @ 7 years ago. I had to cut off my shirt because I could not lift my arm above my head, could not brush my hair or teeth, etc etc. I listened to my ortho (something that is very hard to do sometimes) and I used a sling and rested it for much longer than I thought I was capable of doing.

    I never needed surgery. Through consistent physical therapy, I ended up being as strong as ever. I do have a noticeable bump atop of that shoulder (or is that a chip on my shoulder?) and still experience pain time to time when lifting my arm over my head. But two out of three doctors told me surgery was necessary and I decided to go with the "conservative" approach and boy am I glad. Beware of all of those doctors who immediately want to cut you open. Make sure that they don't need the practice.

    Rest up and Good luck.

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    Around here mountain bikers refer to that as 'the bump' and it is almost a badge of honor, except for the fact it means you crashed. It is very common among crashees. When I did my right shoulder I was never told a grade but it was about 9 weeks before I did much riding at all and a year before I could sleep on that side. The doctors told me that surgery would be a waste of time and 'you will die with it, not from it'. Comforting statement, that one. A friend who is a doc explained that the ac joint is always trying to pull itself apart so when the muscles get ripped it is practically impossible to get the bone back down without extensive surgery that is going to cause as much harm as good by the time they get done with you. Something to think about.

    I'm okay now (that was over 2 years ago) but I don't do any more technical mountain biking, I just have fun doing less difficult trails.

    BTW, I really like the Quasimodo reference. Two clavicles way up!!!!
    He's not the messiah, he's a very naughty boy!

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