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Very separated shoulder: The aftermath

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Very separated shoulder: The aftermath

Old 05-12-16, 02:10 PM
  #1  
Snowden
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Very separated shoulder: The aftermath

Hey - if this is the wrong forum, feel free to move the post. I didn't see an injury specific one.

And a disclaimer: I realize this is a massively subjective subject, and completely different for each and every individual. I know there isn't a *right* answer, especially from (lovely) randos on the internet, I'm just looking to hear some stories and general reactions to help me with my decision making.

I was involved in a bad bike moment 3 weeks ago and received a level 5 AC separation to my left shoulder. No broken bones or dislocations. Although it looks like I have a tree branch growing out of my shoulder, it's been disabled while staying remarkably pain-lite. I'm currently right about to have reconstructive surgery (like, Monday), but here's the kicker: it's entirely elective. If I do it, the Dr says it'll probably be nearer to how it was, eventually. But it also might heal up exceedingly well without the procedure.Or I may lose a bunch of strength and endurance, and have a supremely janky shoulder for the rest of my life. Like I said, the injury was received 3 weeks ago, and at present the hurt arm is pretty functional, virtually pain free. I can tweak it if I get too wild, but it's okay. Not perfect range of motion, but not bad, and improving. Starting to ride again, gently, and lifting med. weight things over my head with not much trouble.
There's maybe a time factor involved. The surgeon told me that the procedure would be best performed within a month of the injury occurring, in order to take advantage of maximum healing energies etc etc, and that window is closing fast.
I really don't want to go through with it if I don't have to, 4-5 mo for full recovery (second consecutive missed cx season due to injury!), unnecessary trauma etc...
Some other personal facts. I'm 30. SUPER active person, physical work environment, semi serious racing and all the time funsies cyclist, mountaineer (activity, not club), rock climber etc. Getting rad outdoors is my life. So my questions are such:
Those that have had this injury - lvl 5 AC separation, what did you do? Reconstructive surgery or no? Why or why not? How long did you wait to have it done? Do you wish you had done something differently? Are you able to wear a backpacking pack now with no trouble (silly question, but actually a big issue)?
Please tell me you stories...

Thanks!
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Old 05-12-16, 02:39 PM
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Since at the point you say you are pretty much pain free and functional, I would never submit to an operation. Anyway the body pretty much does a great job of healing itself.

I say this because I had rotator cuff injuries to both of my shoulders. After a regimen of self proscribed exercises I have full use of both and no pain.

Last edited by rydabent; 05-12-16 at 02:42 PM.
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Old 05-12-16, 04:03 PM
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I am not exactly sure what’s up here.

As I understand an Acromio-Clavicular Separation is when the three ligaments holding your shoulder blade to your collarbone get shredded ... say, in a bad bike wreck (that’s my preferred method.)

Thing is, all a doctor can do is saw off the protruding clavicle end—it is purely cosmetic. There is no way (at least, there was no way back when I did mine) to Reattach or Replace those ligaments. All the docs can do is make your shoulder look more normal.

And frankly, to me that is elective cosmetic surgery and not worth the risk. One could easily wake up with no arms because a doctor in a hurry mixed up a couple patients. Or, the anesthesiologist could space out and you might never wake up. Your spouse could buy a nice bike with the settlement ... in about thirty years.

I was told that I had a better chance of developing arthritis, but I am not sure about that. Otherwise, there are a lot of people who have suffered the injury and are fine. A couple years after I did mine I met a rock climber who had blown out both of his, and he said that after rehab, he hadn’t lost a thing .... and this is a guy who might have to hang by one had hundreds of feet in the air.

One warning: I got back on the bike without enough retraining, and to this day I tend to put too much weight on my other arm, instead of dividing it up equally—which really sucks because I hurt my other shoulder weightlifting.

I’d say, work back up to normal by using very small weights, do a lot of shoulder-specific exercises very gently, and expect a 100 percent recovery, except for a slight lump on top of your shoulder.

Of course, I might be describing a completely different trauma, and all my advice might be worse than worthless.

Last edited by Maelochs; 05-12-16 at 05:38 PM.
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Old 05-12-16, 04:46 PM
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You may want to get another opinion. I'd also recommend getting an assessment from a physical therapist. Those are the folks that make the surgeons look good (and often make them irrelevant).
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Old 05-12-16, 05:40 PM
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I'm the master of putting off surgery until it's no longer necessary. So far I've been lucky and in very decent shape for someone my age, with no material pain or reduced motion.

Everyone is different, so you have to make your own decision. If you're like me you'll decide based on how it's trending. If it's continually improving, I'd wait and see where it's going. If it seems to have plateaued, I wouldn't expect some miraculous improvement later and decide based on whether the current status is acceptable or not. The key here is "will I be happy living with this for the next 40 years, or am I willing to give up 3-5 months now to be rid of the problem after.

The third possibility, little or no improvement, or even getting worse over time, is a no brainer. Have it fixed because it's not fixing itself.
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Old 05-12-16, 05:44 PM
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Get a second opinion from an M.D. who does not specialize in surgery. When a hammer is your primary tool, everything starts to look like a nail.
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Old 05-12-16, 05:58 PM
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I separated my shoulder in 2007, but "they" decided that it was borderline when it came to surgery or no surgery ... so I did not have the surgery.

What I should have done, however, is to keep up with the physio beyond about a month. I regret that I didn't.

Nearly 10 years later, and I still have problems with that shoulder.
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Old 05-12-16, 06:06 PM
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I had a pretty bad separation many years ago. I wan't even offered any surgery. I was in a sling for a 6-8 weeks, but it took a year to be heal and be fully pain free. Left arm still sags a bit. Get your tailor to put some extra padding in that side.
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Old 05-12-16, 07:31 PM
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DON'T DO IT BRO!!!

My opinion.
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Old 05-12-16, 07:42 PM
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I had a grade III acromio-clavicular separation several years ago. The orthopedic surgeon I saw said the outcomes would be pretty much the same with or without surgery, so I opted against surgery and got a couple months of physical therapy instead. Several years out, I can tell the affected shoulder is not the same as the other, but I have full function, range of motion, strength, etc. If I had the opportunity to do it over, I don't think I'd choose differently.
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Old 05-12-16, 07:58 PM
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Originally Posted by Snowden View Post
Like I said, the injury was received 3 weeks ago, and at present the hurt arm is pretty functional, virtually pain free. I can tweak it if I get too wild, but it's okay. Not perfect range of motion, but not bad, and improving...
I'd give it a little more time to heal before I made the decision if I needed to have surgery or not.
It sounds like it is mending, so far, to your expectations. Good to hear that the physical therapy is going well.
I've always considered surgery as one of the very last options when it comes to trying to rehab a buggered knee/elbow/shoulder.
The less surgery the better, I say!
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Old 05-17-16, 08:12 PM
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I had shoulder surgery and it is a hard recovery.
Unless your quality of life is bad, and it sounds like you're doing well, then go for PT and no surgery.
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Old 08-24-17, 09:24 PM
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I realize this is an old thread, but I was just diagnosed with a Grade 5 separation and everyone I speak to, in the medical community is telling I'll only be happy in the long term if I get it fixed, and sooner the better.

Any updated info from other posters?
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Old 08-24-17, 09:47 PM
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I had the exact same injury in 2010. Touched wheels and went down on the left shoulder. Was able to ride home, very little pain. Went to emergency, x-rays, sent home and told to see a orthopedist. Orthopedist said I can have surgery or not, either way, it'll be fine. Elected not to have surgery. Except for a bump from the end of the collarbone which surgery would have fixed, no problems at all in flexibility or lifting. It took a few weeks for full arm strength to return.
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Old 08-25-17, 08:46 AM
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Originally Posted by carl7 View Post
Orthopedist said I can have surgery or not, either way, it'll be fine. .... Except for a bump from the end of the collarbone which surgery would have fixed, no problems at all in flexibility or lifting. It took a few weeks for full arm strength to return.
This is what I have heard. Surgery is 100 percent cosmetic--there is no way to repair or replace the severed ligaments, that is permanent damage. "Surgery" is really just trimming to protruding top of the bone so it doesn't stick up.

I did mine back in the 1990s and have never regretted not getting it "operated on." if there had been an operation which would have repaired the damage, I would have gone for it no matter the cost. Bit cosmetic surgery is rolling the dice with your health and live with how much possible prize? Pretty much zero, in this case. Unless you are a swimsuit model or something ....

I think it was Machka who said she wished she had never stopped physical therapy ....I say the same. Once I healed I got right back on the high-activity lifestyle and I was fine ... until I stopped when everything went wrong. Separated shoulder or not ... my regret is that I stopped working out fro a few years, not that I didn't get some surgery which wouldn't have actually improved my health anyway.

Not surprising the medical community wants you to buy more of their products .... but also, I don't think i have ever heard of anyone with a full separation who didn't fully recover ... but then, almost everyone I have spoken to returned to an athletic lifestyle afterwards.
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Old 08-25-17, 09:18 AM
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The issue is that there are different degrees of severity with this injury. My collar bone and scapula have displaced >200% when compared to my non-injured side. The "bump" on my left shoulder is large, painful and not just cosmetic. My pain today at rest is zero, but with motion is significant.

I've read that with Grade 1 thru 3, surgery is optional, with similar outcomes achieved by surgical and non-surgical treatment. On the other hand, with Grades 4-6, surgical fixation delivers optimal results.

The surgery - in my case will restore the clavicle and scapula back closer to anatomically correct positions.
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Old 08-25-17, 11:06 AM
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I recommend amputation.
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Old 08-25-17, 11:27 AM
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Originally Posted by Maelochs View Post
I recommend amputation.
If he gets a mechanical arm is it considered "mechanical" doping?
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Old 08-25-17, 02:57 PM
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Obviously I cannot offer responsible advice, but I can offer my own experience ...

I went over my handlebars at approx. 30 mph, rolled when I hit the ground, and separated 6 tendons in my left shoulder in the proccess. This happened on a steep city street and I had to limp my broken self to emergency about a mile away. They told me at the time that surgery would not repair the injury and that I should let it heal naturally. It took a good 18 months before I was pain-free. At the time I could not lift my left arm above shoulder height.

It's now been approximately 20 years and the shoulder works well enough for the most part. I can no longer participate in archery or weight-lifting, but as long as I don't overdo it, I really don't notice it too much.

Just left with reduced motion, popping and clicking, and maybe 50% strength compared to what it was.

Life went on and I learned to work around my limitations. Good luck with your choice and recovery
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Old 08-25-17, 09:10 PM
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Originally Posted by tramptrade View Post
............ Good luck with your choice and recovery
Thanks.
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Old 08-25-17, 09:13 PM
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If it were me, I'd do PT before even considering the knife.
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Old 08-25-17, 09:25 PM
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Originally Posted by BlazingPedals View Post
If it were me, I'd do PT before even considering the knife.

That's a great suggestion and was my initial reaction.

But, I'm a retired US Army Occupational Therapist, and I've reviewed the rehab literature, and spoken to some PT friends of mine and they all say that rehab is useless on a separated shoulder as bad as mine.
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Old 08-25-17, 11:36 PM
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Not as a scolding reply, but I feel that with your background you should know to have a second opinion on something as serious as surgical repairs. Is there any change in the severity of your pain so far? It seems that the high degree of separation is not going to see as high a level of recovery without some very serious PT and/or surgery. Probably "and".

I have not had as severe a shoulder injury as yours, but the two I have been dealing with are painful after 2(left) and 3(right) years respectively. I am in the same school of thought as the long PT replies to the OP about his, after surgery I'm afraid. I'll hope for less pain, more recovery and some good thoughtful physicians. Oh, thanks for serving in a very necessary field and billet.

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Old 08-26-17, 09:27 AM
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Originally Posted by qcpmsame View Post
Not as a scolding reply, but I feel that with your background you should know to have a second opinion on something as serious as surgical repairs. Is there any change in the severity of your pain so far?

Bill
I've actually spoken via email to 2 military ortho surgeons and 1 additional civilian doc who all advise surgery. So I've had 3 "second opinions"' actually. Like you I figure the more eyes on and consensus I get, the better I'll feel with my choice for surgery.

My purpose with this thread was to actually get an idea how guys are doing post injury and surgery, long term.

I'd like to know what I can look forward to, in terms of functional use on - and off the bike, for the long haul.

My pain has remained constant, but I'm only 6 days post injury.
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Old 08-26-17, 10:45 AM
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I opted out of surgery. As it was explained to me, tendons and ligaments do not grow back once severed, so there really is no "repair" possible. I was told that arthritis was likely, and my shoulder does make some alarming noises ... and I have lost a little mobility.

All that means nothing. Unless my injury was identical to yours, I have no useful information.

One thing---unless the "second opinions" came from people who saw the x-rays ... surgeons tend to think surgery solves everything ... ("Well, it sure Looked like a nail.") They also assume that surgery will proceed according to the book. In real life, every time you go under there is a real though admittedly tiny chance you will not wake back up ... or might find that someone did indeed amputate your arm ... "Oops." it happens.

I would want to know Exactly how the surgery would "repair" the injury or improve the joint. According to what surgeons told me ... separations really cannot be repaired.
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