# Shoulder injury - should I have someone look at it?



## bank5 (May 7, 2008)

I went to do a about a 3 1/2 foot drop today but was off balance and slammed the top of my shoulder into the ground. I was initially in a lot of pain and was on the ground for a bit but it started feeling much better about an hour after crash. 5 hours later, it feels about the same and I have sharp pains when I move my arm. I think I just bruised my shoulder but might get it checked out if the pain doesn't subside. Most of the pain is right on the top of my shoulder. Has anyone had a similar injury and what did you do?


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## flyag1 (Jun 9, 2007)

bank5 said:


> I went to do a about a 3 1/2 foot drop today but was off balance and slammed the top of my shoulder into the ground. I was initially in a lot of pain and was on the ground for a bit but it started feeling much better about an hour after crash. 5 hours later, it feels about the same and I have sharp pains when I move my arm. I think I just bruised my shoulder but might get it checked out if the pain doesn't subside. Most of the pain is right on the top of my shoulder. Has anyone had a similar injury and what did you do?


Go see the DR,I did almost the same thing in Whistler... flew home the next day and then went to DR.... lots of sharp pain anytime you move your arm or try to lift it. Also it's going to be a miserable night&#8230; once you lay down it's a real bi-atch to get back up:skep:

See my post:http://forums.mtbr.com/showthread.php?t=437514


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## bank5 (May 7, 2008)

Thanks for the reply. That's an amazing recovery!! If I have the same amount of pain tomorrow morning I'm going to go urgent care and get x-rays. It doesn't hurt if I don't move my arm, but moving it still causes the sharp pain. Hopefully if I keep in a sling and sleep on my back on the sofa I'll be able to get a decent nights sleep.


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## TrekChick (Mar 24, 2006)

bank5 said:


> It doesn't hurt if I don't move my arm, but moving it still causes the sharp pain.


Hey Bank, I said the same thing ~ mere moments after my crash ~ and have been saying it for the past 6 weeks! My shoulder is broken; here's my thread. I didn't land on top of my shoulder though; I landed on my left side with my arm outstretched above my head. IMO, you should definitely go to the doc, and get multiple-view x-rays. Best of luck to you!!


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## bank5 (May 7, 2008)

I had some x-rays taken today and my bones are ok, but the doctor said I tore my ac joint. I'm going to see an orthopedic and have some more xrays taken to see the extent of the tear and if I'll need surgery. Here's one of the xrays.


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## Bull_D (Apr 9, 2008)

yep, my guess would be separated shoulder (an AC joint injury, not shoulder dislocation as many people incorrectly use the term "separated shoulder" for) if the impact was kind of down onto the top of your shoulder, pretty good guess that is what it is. take your shirt off and look in the mirror......do you have more of a bump on top of that side than the other? grade 1 (even 2) might not show much of a bump, if you have a grade 3 or higher separation you will see a noticeable hump. see how the skin in the above xray has a bump above the separation? in most cases, they won't really do anything for you. after about 5 years, i had to have surgery to relieve some impingement i developed due to calcium growth after the injury. ice, ice baby......


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## Badmamajama (Mar 28, 2008)

Dont let them scope it. Your shoulder will never be the same again. Have an MRI done and seriously weigh your options. If they do want to do surgery, take some time off and jump into rehab for your shoulder. See if gettin the shoulder strong again will fix it at all. I royally jacked my knees up, and Ive been through the ortho process more than I want. 

The doc wanted to scope my shoulder after I hurt it playing football, I told them to go look some words up I went to rehab and im fine know, a little clicking every now and again (more often than not when Im on the bench press) but other then that its completely fine.

Just dont let them scope your shoulder before they do an MRI, ive seen it done before, it aint pretty.


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## bank5 (May 7, 2008)

Bull_D said:


> yep, my guess would be separated shoulder (an AC joint injury, not shoulder dislocation as many people incorrectly use the term "separated shoulder" for) if the impact was kind of down onto the top of your shoulder, pretty good guess that is what it is. take your shirt off and look in the mirror......do you have more of a bump on top of that side than the other? grade 1 (even 2) might not show much of a bump, if you have a grade 3 or higher separation you will see a noticeable hump. see how the skin in the above xray has a bump above the separation? in most cases, they won't really do anything for you. after about 5 years, i had to have surgery to relieve some impingement i developed due to calcium growth after the injury. ice, ice baby......


yeah, there is a noticable hump -- it's not huge though and I'm hoping some of it is due to the swelling. My clavicle feels solid so I'm guessing it's a grade 2 or 3. The sharp pains have pretty much gone away (just one day later) but it's still pretty sore and I have limited mobility. After I see the ortho I'll give the verdict.


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## bank5 (May 7, 2008)

Badmamajama said:


> Dont let them scope it. Your shoulder will never be the same again. Have an MRI done and seriously weigh your options. If they do want to do surgery, take some time off and jump into rehab for your shoulder. See if gettin the shoulder strong again will fix it at all. I royally jacked my knees up, and Ive been through the ortho process more than I want.
> 
> The doc wanted to scope my shoulder after I hurt it playing football, I told them to go look some words up I went to rehab and im fine know, a little clicking every now and again (more often than not when Im on the bench press) but other then that its completely fine.
> 
> Just dont let them scope your shoulder before they do an MRI, ive seen it done before, it aint pretty.


I got a recomendation of a great orthopedic surgeon who uses surgery as a last resort so I'm going to go to him. Based on what people have have written, I'm guessing it's a grade 2 or 3 and won't require surgery.

I agree about avoiding surgery at pretty much all costs. I completely tore my mcl playing football but didn't have surgery. Today the knee that I injured feels even stronger than my other one. I had another football injury (a boxer fracture and sprained ligaments) and after rehab wasn't 100% successful, the doctor wanted to try surgery. I said no thanks because I can live with a pinky that doesn't go completely straight.


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## Doggity (Mar 27, 2007)

Try PT first!! Can't emphasize this enough. I had a bad enough rotator cuff tear (supraspinatus and infraspinatus muscles) that they were talking about sending me to an orthopod. "Nothing doing!..." my body screamed. I found a therapist who worked outside the conventional paradigm. Whatever she did, it worked! (hurt like hell at 1st). I've got full R.O.M. again, only a little clicking with the bench press now, like BadMama. Couldn't even bench, for like 10 months, so this is majorly improved.


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## mlepito (May 1, 2007)

That's a grade 3 separation. The space is too big to be a 1 or 2. The AC joint should be 1-3mm. That's more like 10. I had a 15mm separation. They don't do surgery on these anymore. It will take about a year for your shoulder to feel decent again. But the sharp pain will subside over the next 4 weeks. PT can help with some RTC stuff and ultrasound to decrease the pain and speed up the healing.


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## bank5 (May 7, 2008)

*More bad news*

I went to the ortho today and the doctor confirmed that it was a complete tear. I said ok, when can I start PT, but he said I should have the sports medicine doctor to look at it and then decide the best option. My clavicle is sticking up quite a bit and I stay real active (lots of tennis, mountain biking, flag football) so we'll see what the next doctor says.


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## RideToLive (Mar 31, 2007)

bank5 said:


> I went to the ortho today and the doctor confirmed that it was a complete tear. I said ok, when can I start PT, but he said I should have the sports medicine doctor to look at it and then decide the best option. My clavicle is sticking up quite a bit and I stay real active (lots of tennis, mountain biking, flag football) so we'll see what the next doctor says.


I had Grade 4 last FEB'07. Mine was overlapped and locked into to acromion notch. Pretty ugly until it was reduced. I was offered Surgery, but elected for PT and lots of weight lifting. Today, I have a noticeable bump, but what I consider full 100% use. I can make the clavicle stick up a full bone width on command.

I can do Deadlifts and Squats with 75lb. dumbbells and ride hard XC. The surgery may make it look better, but my ortho buddies say early PT and joint strengthening is the safest way back.

I iced, compressed, slinged-it for 5-7 days, then hit the bands and weights slowly. In 12 weeks, I had full ROM and 95% strength. I chose rotator cuff exercises with rubber bands to begin with, and worked into weights (upright rows, shoulder presses, pullups, etc.) I'm sure a good PT will direct you to the proper exercises for you. Continue hot and cold during rehab.


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## bank5 (May 7, 2008)

RideToLive said:


> I had Grade 4 last FEB'07. Mine was overlapped and locked into to acromion notch. Pretty ugly until it was reduced. I was offered Surgery, but elected for PT and lots of weight lifting. Today, I have a noticeable bump, but what I consider full 100% use. I can make the clavicle stick up a full bone width on command.
> 
> I can do Deadlifts and Squats with 75lb. dumbbells and ride hard XC. The surgery may make it look better, but my ortho buddies say early PT and joint strengthening is the safest way back.
> 
> I iced, compressed, slinged-it for 5-7 days, then hit the bands and weights slowly. In 12 weeks, I had full ROM and 95% strength. I chose rotator cuff exercises with rubber bands to begin with, and worked into weights (upright rows, shoulder presses, pullups, etc.) I'm sure a good PT will direct you to the proper exercises for you. Continue hot and cold during rehab.


Thanks for the info. If the sports medicine doctor recommends surgery, I'll get a second opinion and maybe even a third. I can live with the bump there especially if my shoulder gets back to 100%. I think finding a good physical therapist will be key.


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## kmacon (Nov 15, 2006)

Might as well get started on PT. I didn't after my Grade III separation and after 6 months all of a sudden started having a lot of pain. Turned out that without the support of the AC joint there is a lot more stress that gets put on the surrounding shoulder muscles. The PT strengthens them so that they can handle the additional loads. I would have never thought it, but within 5 to 7 days of starting shoulder strengthening exercises my pain totally disappeared.


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## 187 (Oct 28, 2005)

I'm currently recovering from a Grade 3 AC Sep (and a broken radial head and broken wrist). 3.5 months out and my collar bone is still moving all around. Ortho says it will take 6 to 12 months to firm up. Not really painful it just feels really weird. I just leaned forward to grab a bagle and my collar bone jumped up. Nice.


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## bank5 (May 7, 2008)

*8 days later*

I took off the sling a few days ago but my mobility is still pretty bad. It's tough doing things like shaving, reaching across my body to put on deodorant and putting on t-shirts. It doesn't seem like it's improved much in the last couple of days but I'm going to start stretching it out to see if that helps. When you separated your shoulder did you have trouble doing the same stuff? Also, are there any stretches that you would recommend?


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## kmacon (Nov 15, 2006)

bank5 said:


> I took off the sling a few days ago but my mobility is still pretty bad. It's tough doing things like shaving, reaching across my body to put on deodorant and putting on t-shirts. It doesn't seem like it's improved much in the last couple of days but I'm going to start stretching it out to see if that helps. When you separated your shoulder did you have trouble doing the same stuff? Also, are there any stretches that you would recommend?


Boy does that all bring back memories! Believe me the sooner you get rid of the sling and start stretching and strengthening the muscles the better.

No way could I get my arm above my shoulder either. I started stretching by simply working my hand up a wall slooowwwly (shower stall wall is a good place to start). At first I had to help out by using my other hand to lift. Repeat this often until you can start directly stretching your arm up over your head without additional support. As soon as the muscles rebuild a little you will start to get your range of motion back.

Next, what worked well for me was to get some of those stretchy latex exercise bands (they come in several strength levels, start out light) and use them to work your shoulders. You can come up with exercises on the internet at orthopedic rehab sites pretty easily. Use the ones designated for shoulder strengthening. From there you can then move into using dumb bells etc. Of course it would be best to get your doc to send you to a physical therapist for help and guidance. That way you are on a schedule and you have someone to crack the whip over you. 

Remember that the support ligaments of the AC joint are gone and not coming back and the only support your shoulder has is by muscle. This is OK as long as you get the muscles good and strong and keep them that way.


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## bank5 (May 7, 2008)

kmacon said:


> Boy does that all bring back memories! Believe me the sooner you get rid of the sling and start stretching and strengthening the muscles the better.
> 
> No way could I get my arm above my shoulder either. I started stretching by simply working my hand up a wall slooowwwly (shower stall wall is a good place to start). At first I had to help out by using my other hand to lift. Repeat this often until you can start directly stretching your arm up over your head without additional support. As soon as the muscles rebuild a little you will start to get your range of motion back.
> 
> ...


Thanks for the advice. Did you have trouble reaching across your body too (like simply touching your opposite shoulder)? I'm hoping I didn't do any other damage and it's just my AC joint.

I definitely think the pro-active PT is the way to go. Right now the doc said just to do light stretches, but I'm hoping I get more of a green light after my next appointment on Friday.


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## kmacon (Nov 15, 2006)

bank5 said:


> Thanks for the advice. Did you have trouble reaching across your body too (like simply touching your opposite shoulder)? I'm hoping I didn't do any other damage and it's just my AC joint.
> 
> I definitely think the pro-active PT is the way to go. Right now the doc said just to do light stretches, but I'm hoping I get more of a green light after my next appointment on Friday.


Yes, originally I could could not reach across either. According to my physical therapist, after the AC ligaments tore the muscles that stabilize and strengthen the shoulder were riped apart also. I was told that the torn and damaged muscles are partly (mostly?) responsible for the limited range of motion and as they heal and strengthen the range will return.

I am a year out and my collar bone still moves around more than I would like. But hey, you just learn to deal with it. I do have full use and the strength feels about equal to what would be normal for me.


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## 187 (Oct 28, 2005)

It's going to take a while.

Given that I broke my elbow and separated my shoulder on the same side, it was about 3 to 4 weeks before I could touch my head/face with my left hand. I'm just starting to really focus on rehabbing my shoulder now that the elbow surgeries are out of the way. i'm doing the stretchy bands and other core exercises to streghten the rotator cuff. I'm using several resources to get ideas on strengthening exercieses to include my physical threapist, the book "Core Performace" by Mark Verstegen, the "Book of Muscle" by Ian King and the "Ultimate MTB Workout Program" by james Wilson available at www.leelikesbikes.com.


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## cocavaak (Apr 24, 2006)

Wow my x-ray looks just like yours! Mine happened in a crash last Saturday - I think I landed like you - on top of the shoulder. It's a grade 3 AC tear. I had one visit to an orthopedist and he said half the docs out there will recommend surgery, the other half won't. He leans towards surgery - arthroscopic and maybe using cadaver ligaments to re-attach it. If people do a lot of overhead lifting or pitch a baseball, the case is stronger for surgery.
After reading comments in here, I'm leaning more towards PT. I'm using my left hand for more things now! I just want to know that with just PT I will still be able to reach up to put my bike on my car rack, play volleyball (overhead spiking), etc. 
Let us know what the second doc says.
And to others who have been through it - how soon did you start therapy? A week or two?
thanks.


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## bank5 (May 7, 2008)

cocavaak said:


> Wow my x-ray looks just like yours! Mine happened in a crash last Saturday - I think I landed like you - on top of the shoulder. It's a grade 3 AC tear. I had one visit to an orthopedist and he said half the docs out there will recommend surgery, the other half won't. He leans towards surgery - arthroscopic and maybe using cadaver ligaments to re-attach it. If people do a lot of overhead lifting or pitch a baseball, the case is stronger for surgery.
> After reading comments in here, I'm leaning more towards PT. I'm using my left hand for more things now! I just want to know that with just PT I will still be able to reach up to put my bike on my car rack, play volleyball (overhead spiking), etc.
> Let us know what the second doc says.
> And to others who have been through it - how soon did you start therapy? A week or two?
> thanks.


I'd ask your doctor why he leans towards surgery and probably get a 2nd opinion. My shoulder is feeling a lot better (2 weeks later) probably because I've been working on stretching it more and more the last couple of days. I went swimming today (could only do the side stroke) but I think stretching in the pool helped. Also went for a jog and the shoulder got a little sore, but nothing bad.

The sports medicine doctor that I met with yesterday didn't even consider surgery. He just said start stretching it out and once I get full range of motion, start doing some light shoulder lifts to regain strength. Down the road, I'll probably work on my shoulders more when I go to the gym - I used to slack a bit on the shoulder lifts.

I wore a sling for the first 6 days, used my right hand for very basic tasks for a couple days after I took off the sling and have been working on stretching it out more and more the last couple of days. After reading some posts I was concerned about long term effects (I'm an avid tennis player) but two weeks later, I'm more optimistic.

Good luck! It'll probably start feeling better and better each day.


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## Jennifer_06 (Jun 16, 2008)

*2nd degree separation this morning*

i love mtbr. i think i say that every time i post. i rode an endo for what seemed like an eternity this morning and wound up ramming my head and shoulder into the ground. luckily, the PA at the ER said it's just a 2nd degree separation. i of course ran home and started google searching what to do now and when i can expect to be riding again... and mtbr never fails to help! my mom works for ortho. docs so i'm going to get the x-rays to give to them on tues just to see what they say about the degree. i'm using the sling and icing and popping advil and (hopefully this isn't a bad thing) i'm already doing super gentle motions to keep it as loose as i can. i've read some posts on here where people had 3rd deg. seps and they were road riding a week or two later. sweet!! if i feel up for that i will go for it, but just hope it doesn't do any more damage???

thanks to all of you for making this site the best resource ever.

 jen


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## cocavaak (Apr 24, 2006)

Jennifer_06 said:


> i'm using the sling and icing and popping advil and (hopefully this isn't a bad thing) i'm already doing super gentle motions to keep it as loose as i can. i've read some posts on here where people had 3rd deg. seps and they were road riding a week or two later.
> jen


If you do have a second degree the docs will probably say to do physical therapy. I have a 3rd degree and my second opinion doc said to just to PT for now, he didn't recommend surgery. With a second degree, the collar bone and your shoulder are still close enough together that it should heal naturally. With a third degree, there is enough separation that the collar bone won't rejoin the shoulder unless you have surgery. I figure I can live with a bump on my shoulder. 
My PT recommended taking Ibuprofen for 3 to 5 days to get the inflammation down. And even a week or two later doing a couple of heat and ice treatments - I've been a little lax at doing that.
After my crash, I was riding my road bike to work the next week - actually resting my hands on the bar gave me some support. It really hurt jarring over railroad tracks though. Now three weeks later I laugh at railroad tracks.


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