rseeker

Happy 2018 everyone. To celebrate the new year, I crashed on my first ride of the year and now I'm on the injured reserve list with a shoulder that doesn't work. I was at the doctor's within four hours of wrecking. It doesn't seem like a separation -- it could have been if I'd been going faster, but I was on an uphill when I lost it -- but the same tendons/ligaments/muscles are involved. The sternum side of the deltoid in front, in back from the shoulder blade to the base of the neck, and lower down, from the shoulder blade toward the spine. Very sore, obviously swollen, very painful, too painful to use. I landed on my right shoulder while still on the bike, hitting asphalt, and that shoulder took most of the energy, folding forward and under me as I somehow managed to be moving toward my rear as I came off.

So has anyone had a similar injury, and what treatment worked for you? I'll be following up with the doctor, but for therapy afterwards what worked? Especially what can I do myself, at home?

The doctor gave me a pain shot and a steroid shot for inflammation, and send me home with pain pills and a six-day steroid pack and told me to come back in a few days if it's not better for x-ray/MRI and more treatment. He didn't physically examine me (???) but I felt around behind my neck and along the top of the shoulder blade for any parted tendons sticking out and didn't feel anything like that.

And what happened: dark pre-dawn ride, 8F/-13C, fully lit and reflective bike, me with reflective clothing, working hard to climb a hard hill (they're all hard for me) on a curvy two-lane rural/suburban road. Not a lot of traffic, but some, a few early commuters were out. I got passed by a big pick-up in a double-yellow no-passing zone -- I was going pretty slow because of the climb -- and he was squeezing by me because of an on-coming car, and really he was going for it when he should have waited. This squeezed me over and that's why I got in trouble. It's a recently-repaved road and they haven't gotten around to putting white stripes along the edges. The edge of the road is a steep four-to-eight inch drop-off from asphalt to grass. And my helmet directional light is inadequate. (I'm giving myself a new helmet light for Christmas but I haven't picked it out yet, and .. yeah, that's what got me.) I couldn't see exactly where the edge was, went off while leaning toward the road, steered back toward the road because that was all I could do with that lean, which caught my wheel, stayed upright while continuing hard across the road in a sharp left then turned back to the right and went all the way over. I ended up facing downhill, in my lane, hurting. Picked up pieces of handlebar grip and rode home, hurting.

The other part is I was committed to finishing the hill -- hill-training, because after becoming a new-again rider in 2016 the hill-climbing strength and coordination is finally all there -- and forgot that on those tight roads I usually just pull off when cars are going to be a problem. I was so into finishing the hill -- over-committed, really -- that I just didn't think of that. Much better to have stopped, pulled off and walked the rest of the hill if I had to. Yeah, I know, take the lane, but I'm fine with yielding at night since the cars are rare.

I was in rehab for hip overuse last year -- spending fifteen years in an office chair working in front of a computer is no way to maintain flexibility -- and I have really great detailed rehab and stretching instructions from that, which I'd be happy to share if anyone wants.

Machka 

I had a Grade 2 Separation after a crash in 2007. Impressive flexibility! The most comfortable position was lying on my back with my arm flopped above my head like it was hardly attached to me. Apparently that's normal for that kind of separation.

Visit the Dr.
Go to physio.

My Dr and the subsequent MRI were what diagnosed me with a Grade 2 separation.

I only did about a month of physio before I moved and couldn't continue ... I regret that. I should have continued. 10 years later the shoulder still subluxates from time to time, and my chiro pops it back into place ... or sometimes it goes on its own.

That incredible flexibility tightened right up and now I no longer have full range of motion.

jpescatore

Well, maybe some good news for you: that does not sound like what I felt after I tore my rotator cuff in 2013 (nothing to do with a bike crash.)

My advice is don't wait on the MRI - work your insurance policy to get the MRI sooner not later. I wasted 3 weeks of physical therapy, and steroid injections, etc. before an MRI that showed a complete tear - that probably was not a complete tear before the PT... I understand the reasons they don't just send every sore shoulder to get expensive MRI exams, but if pain killers are involved, I'd push for the MRI sooner rather than later.

rseeker

What does Grade 2 mean?

Machka 

Google 'Shoulder Separation' that should fill you in.

Here are a couple:

https://www.thesteadmanclinic.com/pa.../ac-separation

AC joint sprain symptoms & diagnosis


BUT you do need to be diagnosed by a medical professional. The first one I went to kind of brushed me off and told me I'd be fine. The second one did more tests while I was in the office and determined that something wasn't right. He sent me for the MRI which confirmed the problem. They did debate brief whether or not surgery might help and decided physio was the way to go.

rseeker

Thanks for the context. I'll be taking your advice.

Right now that sounds like mine.

wschruba

Aye, do and continue the physical therapy--three years after a class 3 (worst case before mandatory surgery), I retain full range of motion, albeit with occasional pain/discomfort/occasional popping. Guided PT is helpful, and your insurance may even pay for some, but for me, doing exercises 2-3 times a week showed no loss of flexibility or motion.

On the plus side, it's almost impossible to be chicken-winged on that side, so you know, benefits.

fixedweasel

Unfortunate that he didn't examine you. Welcome to today's Health Care. Yay! But seriously, you yourself need to specifically find your range of motion and where it is limited either with movement or pain/weakness. All information that you have on return to this guy is actually important in helping to diagnose. If you do not have any issues with GI bleeding/Ulcers/Regurge/etc, and you are not allergic to it, you can take Naprosyn 2 tabs (220mg per tab) initially and follow up every 12 hours or so with one tablet. This is Aleve basically but save yourself some cash and buy the Generic. It's all the same thing.* Since the injury is older, heat will help unless it is terribly irritated, then go back to ice. BTW, you will never feel a tendon sticking out with your fingers on exam.
If it does not improve with PT, then you most definitely need an MRI. Without it everything from there on is almost useless and you really need a film.**** This will specifically show in great detail the soft tissue injury and the extent of it. It is invaluable.
If it shows a rotator cuff injury or tear, then depending on the location and extent, you may be able to get better with continued therapy or may need a repair.
In any event, talk to as many folks as possible about transferring to a good Ortho guy or gal. I have seen numerous shoulder surgeries/rotator cuff repairs go south because of a crap Surgeon. Use your PT as reference as well. Folks in the Medical Field know exactly who is good and who to steer away from and this also includes different Hospitals as far as specialties go.
I know money is tight but get the best you can as your quality of life is not a commodity.

To note: I have had rotator cuff repair in 2009 with brilliant results and I have been in the Medical Field for over 30 years as an ICU Nurse. I've seen my share I can tell you.





*as is with pretty much every medication**
**albeit i have had some patients that did better on the Name brand with BP meds***
***odd
****not an X-Ray (plain film).........not a CT..............you need an MRI

joelcool

Well I'm not a medical professional, but even for me a "shoulder that doesn't work" isn't a lot to go by.


I crashed on my MB a year or so ago at age 54. I went to the ER because I was feeling some crunching and feared that I had broken something, plus I had some pretty nasty road rash that needed some attention. The doc said there was really too much swelling that soon after the crash to do any nerve examination, told me it was rotator cuff damage. That's pretty broad... In the end, about 3 months I was fine.


A couple things I'll say that helped me heal was spending time in the gym working on upper body strength, balancing workouts equally from front to back, and stretching.


I think the older we get the longer it takes to heal.


Good luck, and get off the pain meds as soon as possible.

DannyL

x2 on the second opinion.

I have very bad shoulders from hockey and being an idiot in general so I'm in a constant state of shoulder rehab. For me personally I use/can't live without a compression band called "Voodoo Floss" by Rogue Fitness. There are a bunch of youtube videos on how it works but I'm not allowed to post links yet.

Good luck with the shoulder!

canklecat

Regarding the hill climb training, that was my goal beginning last June when I got my first road bike in 30+ years. I'd been riding hybrids for a couple of years but my conditioning had plateaued and I was still struggling with even moderate climbs.

At first I confined my climb training to low traffic areas, never near peak traffic hours. Between asthma, age and poor conditioning I knew I'd be wobbly so I avoided situations where a wobble might result in a crash.

When you're feeling well enough to resume training, find a segment with some reasonable climbs away from traffic and try intervals and repeats. It may be boring. Some of my training segments range from 5%-11% climbs that are as short as 25-100 yards long, because that's all we have here. Others are around 2% over a half mile. Most are either on little used access roads, quiet residential neighborhoods where folks don't drive like maniacs, and a new housing development that doesn't yet have much traffic (although it'll be crazy busy in a year or so).

After a few weeks of that I was more confident tackling climbs in traffic on segments that used to worry me a bit, or I'd avoid if I couldn't maintain at least 15 mph on a climb. Just my personal guesstimate, but 15 mph seems to be a reasonable speed for a solo cyclist on a fairly busy 30-35 mph urban or suburban street. Anything much slower seems to confuse drivers who aren't sure how to pass us. At around 15 mph we seem more confident and flow with traffic so drivers seem to flow around more smoothly with less drama.

Keep at it until you can handle climbs in traffic without huffing and puffing. You don't want to be exhausted close to losing control if some idiot driver commits a brush-by pass.

rachel120

The story of my shoulder is novel length. The quick and dirty summary is that other than bone the last 20 months have left me with very little left to screw up.

Big, big, big thing. See an orthopedic surgeon immediately. Don't wait, don't rely on your primary doctor, get to an orthopedic surgeon. You don't want your primary doctor diagnosing tendonitis and making you do home exercises when it's actually an AC separation that should have been put in a sling and not used until the ligament healed.

Second thing, do the home exercises the PT tells you to do. Good days, bad days, just get at least a little of everything in. It did nothing for my pain, but I managed to straighten my crooked shoulder, get full range of motion back and then a some (hyperextension) and regain full strength pretty quickly because I didn't stop doing the home stuff. There was one exercise very difficult for me to set up the equipment and I skipped that and in two weeks I really felt a big difference in difficulty between doing that exercise in therapy and doing the ones I always did at home. I found a way of getting the equipment set up.

Rest, rest, rest. Sometimes we just need to be lazy for the insides to heal right. Going on FMLA for something else combined with hitting a point where PT could do little and stopping that is what finally dramatically lowered the pain that PT couldn't get rid of.

Work restrictions. You can't get better if you are stressing it too much or re-injuring it every day. Talk to the orthopedic surgeon about all you do in your job so he or she can determine what is okay and what isn't.

Prepare yourself as best you can for a bad outcome. I mostly had good luck. I had some bad luck too, and I'm facing pain for life. Even if I finally get a couple of tendons that are probably at the point of being tendinosis to finally stop hurting, the AC separation damaged the cartilage pretty good and the resulting arthritis hurts every day. Sucks when I can't even take an aspirin for it.

PdalPowr

Yes but,how's the bike?

I am glad your shoulder is no worse than it is.
One day bicycle and human parts will be interchangeable.
Drugs meant for humans will repair bikes.
If you get a flat just give your bike a blue pill.

bobwysiwyg

My sentiments exactly. I tore my rotator several years ago, non bike related. I had no idea how severe until an MRI was done. As I recall, after surgery, 4-6 weeks in an awkward sling then rehab. I make every effort to include upper body strengthening in my workouts now. Don't bother with your PCP.

rseeker

@Machka, @jpescatore, @wschruba, @fixedweasel, @joelcool, @DannyL, @canklecat, @rachel120, @PdalPowr, thanks for sharing your stories and ideas, that's really valuable. It's great learning from people's first-hand experience (painful though it was for some of us).

rseeker

@fixedweasel, thanks for your real expertise.

Yeah, I was like, that's it? Anyway, going back in a couple days for more.

my doc put me on mobic (meloxicam), but very good to know about naprosyn.


That's great news.

rseeker

All good advice, thanks. I have a gym only a mile away from home and it taunts me every time I go by, this'll probably finally get me in the door. I really have no excuse not to.

I was 54 when I picked up riding again after 26 years away, 55 now, and while I feel pretty great (other than ..) I've learned to let my body tell me what it can do. I had knee problems my first summer, rested and recovered, then hip problems last summer, rested and PT and recovered, and now it feels like my body's ready for more. I do attribute that to learning to rest and stretch. While I'd like to be able to commute, I don't ride every day, I take one rest day after an easier ride and two rest days after a longer one, and that seems to be working. There was one ride a couple months ago, after resting most of the summer, when all the hills were suddenly shorter, and doable. Really amazing when it all came together.

Hiro11

I have a very similar injury right now due to being hit by a car. My orthopedist don't think I've injured the joint itself (woowho!) but I had a lot of tightness and mild pain with the muscles and ligaments around the shoulder. I never took any pain meds stronger than Tylenol and I only took that for a couple of weeks. The good news is that it feels A LOT better than it did right after the accident and that I can do most anything for the past month or so. The bad news is that it's now been 9 weeks since the accident and I'm still not 100%, more like 87%.

I've been rehabbing with bands and weights.

I'd go to an ortho, see what they say. Family practice doctors won't be of much use. I'd get an MRI if the doctor deems it necessary.

knitguy

I don't have experience with shoulder injuries but I do with knee injuries. I really wouldn't go to the gym to work on upper body strength before being properly diagnosed and going to a physical therapist. The risk of further injuring your shoulder is just too high. I third the suggestion of getting a second opinion from an ortho, perhaps one specializing in sports medicine.

rachel120

Do NOT go to the gym except under the supervision of an orthopedic surgeon or a physical therapist. I simply carried a 7 quart crock pot and that was enough to turn a minor AC separation that would have healed quickly into a nearly year long recovery and damaged the cartilage enough for arthritis to develop. I hurt every morning and will do so for the rest of my life.

rseeker

Yeah, thanks, that's what I meant. I'm just assuming that sometime in the future, as PT progresses, it'll involve resistance training, even if very light, with machines in a gym, and that's when I'll get my gym membership.

I had actually been thinking this would be the year to get back to strength training, but that's obviously on hold now.

I'll be a very good patient. That business with my hips last year had me in PT once a week for eight weeks with home exercises every day, and I did them all, and still do, between 20 minutes and an hour every day of stretching exercises.

Stupid crock pot. Thanks for warning me.

So at this point, follow-up with primary doctor tomorrow morning to get ortho referral because my insurance plan requires all that to happen through my primary, then on to ortho ASAP.

Charliekeet

Now you're on the right track.

I had a grade 3-4 (can't remember, but 100-200% dislocation of the AC joint). Again, for those who don't know (I sure didn't!) this is assuming what you injured is the acromioclavicular joint area: the ligaments etc between the collarbone (clavicle) and acromion (shoulder bone). The inner shoulder joint. I can't speak re: the also painful outer stuff.

When they get a good look inside, the ortho surgeon will prob say well, it's like super blown apart or just partial tear etc and you could rest it, do PT and stabilize surrounding muscles after it's healed some, work on strength and flexibility and go from there, or have surgery and then do all that anyway, but with the benefit of having ligaments reconstructed first. That's where I'm at.

Surgery for a separated shoulder like mine meant about 7 weeks of time in a sling, and the first half of that you'd also have icepacks on it on and off all day. During that recovery, don't lift anything heavier than a cup of coffee, and don't stretch or lift it. After that, you start PT and slowly build flexibility and then strength.

Either way, it's not fun, but hey, at least it's not your head!!

rseeker

Ouch ouch ouch ouch! How long ago was surgery, and how's it feeling now? Were you on your bike when you got hurt? (Errr, right before you got hurt?)

I hope it's going well for you.

I'm pretty sure mine is injury involving the AC joint. I'm no doctor, and I'd never heard of AC-anything before this, but I can read and watch videos and try simple tests, and all that seems to point to AC. I guess I'll find out when I go.

If you can believe this, I'm still waiting for a referral to ortho. Kinda steamed about that. I talked to my family doctor again today, at this point the request is in to the ortho, so maybe I'll get the callback about an appointment tomorrow.

Charliekeet

Nah, not riding. Just fell onto pavement off curb straight onto side of shoulder, so was pushed down + clavicle pushed up- lump in my shoulder was quite clear. So if you don’t have that, that’s a start!

But yeah you need expert ortho knowledge and exam. And I don’t know how it is where you are, but those folks are generally in demand. At big hospitals they tend to work with or advise pro athletes, right?
So it can take a while to get seen, but once you are I bet it will go great.

I injured it in June or July, had surgery end of August. Started PT I think end of November and feel much, much better since beginning PT.

PaddleFoot

Hello,

I had a broken shoulder and the PT for it can be a bit tough, but I found the most helpful thing for me to get it moving again was water therapy, so find a Physical Therapy place with one of those small exercise pools (when the Dr says so). Best of luck to you.