# AC joint separation grade three



## dbltap (May 29, 2012)

Hey all. Last week I went down and separated my left AC. Determined to be grade 3. It is a dispute between surgery and rehab. Either way my season is done. I have chosen surgery. He is affiliated with some local pro team ortho and going to us donor tissue. 

Anyone have experience in this? Outcome? Time frame? Etc. 


Thanks. 


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## zvonler (Jun 22, 2010)

Same injury from motocross in 2008. Also grade 3, surgery was optional and I declined. I think the procedures now are better so I might choose differently now. They were telling me 6+ months before I could lift any weight after the type of surgery they did back then. I have been able to keep mine mostly pain free as long as I keep up with PT-type exercises to strengthen it, and I still have full range of motion. When it's working well the worst thing is the cosmetic aspect - my clavicle is displaced around 1.5" which makes a very noticeable bump in my shoulder in some positions.


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## zvonler (Jun 22, 2010)

[double post]


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## henryspencer (Jul 29, 2020)

Sorry to hear about this. I did mine just about six months ago, also Grade 3, going over the bars on a new bike. I was not considered a surgical candidate. According to both my sports medicine doctor and my orthopedist, the 12-month recovery rate is the same for both surgery and PT. 

I have done intensive PT since about two weeks after the injury. It still hurts, but nothing like it did in the first two to three months. I'm able to sleep on that side, have a full range of motion, and have been back on the bike for about three months now. Bumpy descents are a bit painful, as are quick handlebar corrections and front wheel lifts, but I'm basically able to ride. On my road bike, I have no limitations from the injury.

Other effects are the cosmetic bump, and limits to strength and dexterity (it's my dominant arm, of course). The most painful thing remains reaching across my body--scrubbing my opposite armpit in the shower, putting on deodorant, and so forth, which basically feels like the day after the accident due to all the scar tissue. I can't imagine serving a tennis ball or throwing overhand any time soon, if ever. But it has definitely gotten better over time. 

Best of luck with the recovery. Sleeping in a reclining chair as opposed to a bed helps greatly for the first few weeks.


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## mudflap (Feb 23, 2004)

Bummer to hear of your accident. Crashing potential is just one of those things you have to live with if you ride a mountain bike.
Three months ago I went down hard and landed with all my weight on my elbow. The impact transferred up my arm to my shoulder and scapula and all the soft tissues associated with it. The result was a broken arm just below the shoulder, a low grade A/C separation, and lots of muscle/ligament trauma.
I've been seeing a PT for more than a month now and she thinks I may have Frozen Shoulder as I am still unable to use that hand anywhere across my body, like washing my opposite armpit.
My orthopedist gave me a couple options, and I opted for PT rather than surgery. She said either way, it would be at least a year before everything was back to normal, if at all. 
My experience has been lots of pain, sleepless nights, and stiffness that is slowly starting to loosen up with the physical therapist.
But on the up side, I've been back on my bike and out on the trails, although riding with a lot less confidence and a lot more caution. Going down is out of the question at this time even though the arm is healed, it's still pretty vulnerable.
Just lately I have resumed lifting light weights, and from the early results, I have to say the pain isn't as bad anymore as it seems to have tightened things up some. So if you're ready, you may try that. 
Also, for pain, I have been using CBD cream and Topricin ointment, both very effective for pain relief.
So good luck with your recovery. Down time ain't fun, but the way I look at it is I couldn't have picked a better time to mess up as I've been self quarantined for months now and recovery just fit right into the stay at home and chill routine I was already following.


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## dbltap (May 29, 2012)

Surgery completed this morning. Two button technique. Let the fun being. 

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## eaxford (Dec 20, 2019)

*2 button AC repair*



dbltap said:


> Surgery completed this morning. Two button technique. Let the fun being.
> 
> Sent from my iPhone using Tapatalk


How is your recovery coming along? My grade 3-4 is about a year old. No pain but very limited mobility also. Contemplating surgery.
Thanks


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## dbltap (May 29, 2012)

eaxford said:


> How is your recovery coming along? My grade 3-4 is about a year old. No pain but very limited mobility also. Contemplating surgery.
> Thanks


Just over two weeks post op. The surgeon wanted to let it be, but I wanted to have the best odds of recovery. But there is a 20 to 30% chance of slippage resulting in real elevation of the clavicle. At first I wanted the donor tissue for reconstruction. But he assured me that that was a much more invasive surgery and longer recovery. The good part is that if this fails he will be able to do the reconstruction as it's intended for athletes and chronic injury (like yours). The button technique is not.

Muscle vanishing, incisions healed, 4 weeks left in a high and tight sling, 4 weeks until rehab, can safely manipulate my arm at elbow, cannot/should not abduct it away from my torso, Can sleep on my good shoulder,

Not much discomfort unless I deviate from orders. Still a small bump. No idea of my range of motion though.

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## Bike man2234 (Feb 26, 2021)

I had a grade 3 separation last year thankfully I didn’t do the surgery pretty much painless ( FINALLY) and I can do everything I did before with full mobility zero aches


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## dbltap (May 29, 2012)

My Distal clavicle still sticks up a bit at times. The surgeon said it may happen. Gaining strength and mobility. Simple things like putting glasses away or raising arm for deodorant is noticeable. 


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## gilz (May 5, 2021)

Hey, sorry for the late response 

GRADE 3-4 ACJ SEPARATION :

Was in a car crash on my bike about 6 weeks ago, got picked up by ambulance went into ER etc.
Had an xray, they said they couldn't see anything. Said I probably hit a nerve thats why I had the insane pain after the crash... Put me home 1,5 weeks and said to go visit the ortho after that. I decided to go to the ortho 1 week later, ortho said from just looking at it it would most likely need surgery so he send me back to the hospital straight away to get another xray. I went to the hospital and got the xray, 1 hour later I get a call from my ortho telling me I need to get surgery asap. They scheduled it for some days later ( this would put the timeframe to 2 weeks post initial crash. ) On the 2nd xray they took it was VERY CLEAR that I had separated my ac joint and had fully torn my ac and cc ligaments. Clavicle was seriously displaced(nearly puncturing the skin).

Surgery took place using the dog bone technique aka tightrope. Was sent home same day with a few instructions on how to do excersises ( pendulum and shoulder abduction ). Had to wear a sling for 3 weeks.

1st week post op : I was in LOTS of pain, though taking opiod painkillers that I had been perscribed and smoking the occassional blunt the pain would go down ALOT.

2nd week post op : almost no pain (stopped taking painkillers at this point) still in a sling doing my daily excercises ( pendulum and shoulder abduction )

3rd week post op : pain is still very minimal but today I am going on my ortho visit for my first check up ( NOTE : I took my sling off at the 2 week and 5 days mark as I was just very tired of it and it annoyed me as I hadn't really slept well in what was almost 3 weeks.. ( im a belly sleeper and you're forced to sleep on your back/side because of the sling ). Visited the ortho, he moved me arm in certain positions, 90 degree angle etc etc.

The next day I am in SERIOUS pain again ( probably because of him moving my arm and the arm being very stiff from being immobilized for about 3 weeks ), even though I can take quite some pain the first day the ac joint hurt alot and had some kind of ''beating'' pain as if my heart was beating through my ac joint.

^ The pain on the ac joint lasted for 1 day but then I had arm/muscle/slight shoulder pain for about 5 more days. After those 5 days the pain completely disappeared. Arm still not being used except for my pendulum/shoulder abduction excercises.


4th week post op ( today ) : First physio visit! Yay! Very mixed feelings, haven't moved my arm that much myself because obviously I don't know how ''far'' I can push it thats why I waited for my physio visit.

Physio tells me to move my arm in certain positions, 90 degree angle stretched arm , touching other shoulder while trying to get to a 90 degree angle with injured arm etc. Everything seems to be alright, I'd say after my first visit to my physio I have about 50-60% range of motion. I am able to stretch my arm fully in a 90 degree angle. Still struggling touching my other shoulder and having my injured arm at a 90 degree angle at the same time but this will better in time. No pain at all during my entire physio visit, just lots of discomfort at first. Now home at physio about 2 and a half hours later and I can safely say I am NOT experiencing any pain. Scheduled to go to my physio again next week and getting emailed excercises later today so I can do them at home. Hope my recovery keeps going forward from this point on 


Just wanna add 1 more thing :

1 day before surgery ( 1week and 6 days post initial crash ) I did have about 90% range of motion and almost no pain. The clavicle would pop up and move around alot though, also had a massive bump on my shoulder.. Was also told by my ortho (who is also my surgeon) that having surgery would be better for me in the long run as all the ligaments are fully torn and the shoulder never gets back to the way it orginally was if u go for the conservative approach.. If you get surgery fast ( max 2-3 weeks after the initial crash ) they can basically put the clavicle back down on the acromion and your own (fully torn ligaments) will heal back together while the dog bone technique keeps the clavicle in place while the ligaments heal.

Hope this helps - gilz


EDIT : Just saw that you already had your surgery with the dog bone technique, I hope everything went well . How is the strength now etc? Would you say the shoulder is back to normal after all this time?


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## TylerVernon (Nov 10, 2019)

I had a Grade 2 a few years ago. Had it diagnosed and then just did my own immobilization for a few weeks, then pt until it got better. Can't even tell.


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## malebundle1 (5 mo ago)

Sorry to hear about this. I did mine just about 4 months ago,


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## dbltap (May 29, 2012)

Im going back in for a revision. this time with a surgeon who works on football and hockey players. the most recient imagages showed that it is worse than the inital injury. interestingly enough, there is no calcification 2 years post op. thats a good thing. strange, but good.


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## Huskyathon (3 mo ago)

dbltap said:


> Im going back in for a revision. this time with a surgeon who works on football and hockey players. the most recient imagages showed that it is worse than the inital injury. interestingly enough, there is no calcification 2 years post op. thats a good thing. strange, but good.


Did it fail over a period of time or was it a new trauma? What method are u co side ring the second time round?
I had a failed surgery 4 months post.. the system failed.. not sure what to do now.. whether to leave it and train hard.. or get revision.


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## dbltap (May 29, 2012)

Huskyathon said:


> Did it fail over a period of time or was it a new trauma? What method are u co side ring the second time round?
> I had a failed surgery 4 months post.. the system failed.. not sure what to do now.. whether to leave it and train hard.. or get revision.


It wasn’t a Re-injury. Unknown if it failed or was ever optimal. Being a Rad Tech with 22 years of experience, the one c-arm image post op was horrible and gave no insight into its articulation. I asked for a follow up xray at my post op visit. He didn’t see the need. That raised an eyebrow. 

About a week post op, I was leaning forward from a recliner and felt a (painless) vibration. Kind of like extending a bendy straw. I could be crazy, but…

The NEW surgeon is going open ,not laparoscopic, to add more reinforcement in two different areas. The catch is keeping it as far away from the original holes while still providing structure. The holes will fracture if too close together. 

To revise or not? my lateral clavicle has migrated more laterally. This is causing rubbing over the top of the coracoid process when I raise my arm. This friction will cause wearing. Leading to pain (arthritis) later in life. 

Bottom line: I cannot advise you because these injuries are difficult due to the joint dynamics. Not an easy decision. Weigh your options and go see a surgeon who deals with athletes if possible. 


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## Huskyathon (3 mo ago)

dbltap said:


> It wasn’t a Re-injury. Unknown if it failed or was ever optimal. Being a Rad Tech with 22 years of experience, the one c-arm image post op was horrible and gave no insight into its articulation. I asked for a follow up xray at my post op visit. He didn’t see the need. That raised an eyebrow.
> 
> About a week post op, I was leaning forward from a recliner and felt a (painless) vibration. Kind of like extending a bendy straw. I could be crazy, but…
> 
> ...


Yeh ok.. yeh I thought I had a decent surgeon.. Tuen sour not so good.. so yeh I am seeing a new guy. Don’t the holes close over? I assumed new bone would grow into those holes.
I had open surgery using Lars and two screws.. I would advice the type of procedure to anyone.. screws sit proud of collar bone and cause pain.. I wouldn’t consider using a back pack.. if I could go back, I’d prob op against the surgery.. so u k ow what your knew me tho is called?


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## dbltap (May 29, 2012)

Huskyathon said:


> Yeh ok.. yeh I thought I had a decent surgeon.. Tuen sour not so good.. so yeh I am seeing a new guy. Don’t the holes close over? I assumed new bone would grow into those holes.
> I had open surgery using Lars and two screws.. I would advice the type of procedure to anyone.. screws sit proud of collar bone and cause pain.. I wouldn’t consider using a back pack.. if I could go back, I’d prob op against the surgery.. so u k ow what your knew me tho is called?


They are human. Good days and bad. 

The holes don’t close per say. The bone grows as close to the screws as possible and fills the void this eliminates any gap. 

Think carpentry. Because that’s all this is. If you drill holes too close together, you risk fracture. The issue rests in the size of the bone and screws required. 

Grade 1-2 is an opt out and deal with it. Grade 4-5 is a fix-it situation. Grade 3 is the boarder line. Statically speaking. 

Backpacks and messenger bags do irritate the buttons/dog bone affixed to my clavicle. I’ve learned to pack lighter and switch shoulders for messenger bags. 


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## Huskyathon (3 mo ago)

dbltap said:


> They are human. Good days and bad.
> 
> The holes don’t close per say. The bone grows as close to the screws as possible and fills the void this eliminates any gap.
> 
> ...


Yeh I get it.. I’ve actually seperated both shoulder.. left shoulder 8 years ago.. right shoulder this time.. 
sorry to ask again.. when is your next surgery and what technique is he using? Where are u based.. different countries use different methods


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## dbltap (May 29, 2012)

Going to be before the end of this year. Probably in December

I think he going to shot for the “triple endobutton” technique. Not the true techniqu, but a modified version since there is existing hardware placement. 


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## Huskyathon (3 mo ago)

dbltap said:


> Going to be before the end of this year. Probably in December
> 
> I think he going to shot for the “triple endobutton” technique. Not the true techniqu, but a modified version since there is existing hardware placement.
> 
> ...


Best of luck with the operation.. I find it hard coping with metal on top of clavicle!! Hope it work for u and u get full strength and motion back!


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## dbltap (May 29, 2012)

Revision is complete. I went to a dedicated sports medicine orthopod this time. He ordered an MR and discovered a bunch of things. 

Procedure: Revised/removed some of the double button hardware, replaced with more reinforcement and a cadaver ligament, cleaned up the labrum, rotator cuff, and repaired the “shredded” biceps tendon. 

Note: if you have this injury, get an MRI. X ray will show position l, but not a he full extent of tissue damage. The AC joint helps to hold the shoulder up, not so much the clavicle down. My lack of due diligence resulted in all the extra damage. What was initially diagnosed as grade 3, ended up being a grade 5. 


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