# Grade 5 Shoulder Separation



## tassels (Nov 22, 2009)

I am (was  ) a female expert mountain bike racer. On 8/28 I crashed and seperated my shoulder. I saw two differents ortho docs, was diagnosed with a 5th degree separation and recommended for surgery. I opted for the younger doc who did a modified Weaver Dunn through a scope.

4 weeks post op, I was doing great, very little pain, range of motion weeks ahead of schedule, awesome. Then a few days later, somehow the stitches on the internal device broke and my bone popped back up.

Now I have a 3rd degree separation...great! Doc says leave it and let's see how it heals. I'm okay with that (small bump, not a super model), but am now feeling like I'm running out of time to make the decision to operate again or not.

With this $32k surgery, I've met my out of pocket max for the year. So if he needs to operate again, it has to be before Dec 31rst.

Please help. Has anyone else ever had this surgery and then screwed it up. I just don't know what to do.

Thanks!!!

If you want more detials or pics you, check out my silly blog:

http://hammerandpsychle.blogspot.com/2010/09/shoulder.html


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## xcguy (Apr 18, 2004)

Hey, Tassels, we're all pulling for you. Myself, I never needed surgery as my bones never separated but what you're going through is a tough one. Don't rely on us to steer you to the "right" decision, consult other docs for multiple opinions and make a decision. The time to git 'er done is NOW so you can start the recovery process properly. Good luck. :thumbsup:


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## bbense (May 5, 2010)

You aren't the only person this has happened to. One of the docs I saw before my own operation said he had one patient that had to have the operation 3 times before it finally worked. It's the most serious risk of the surgery. 

You'll get lot's of different opinions on the web about what to do and what not to do. I would suggest asking around locally for a "good" ortho surgeon and getting second opinions. Even if you have to pay out of your own pocket it's worth it.

- Booker C. Bense


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## steadite (Jan 13, 2007)

I got a 3rd degree separation about 6 weeks ago going over the bars on a jump. Still have a big bump on my right shoulder, but I've been back on the bike for 3 weeks now...I'm still limited when I try to lift the front end of the bike (like for log crossings), but in general, I'm feeling better every day. I'm doing lots of shoulder exercises at the gym and I think it helps (light load-high reps).

I can't advise you whether or not to redo the surgery, but I would say that if you have to live with it "as it heals", it's not the end of the world. Soon enough you'll be feeling stronger again. Maybe for females the aesthetic part of the bump is a bigger issue...for me I just think of it like a fight scar!


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## tassels (Nov 22, 2009)

Thanks guys. I feel okay physically and have almost all my ROM back. I can lift my 32 pounds 2 y/o son without a problem (although that may be what broke my stitches). I have no pain. The bump is pretty minor. And although I love my bikinis, I think people will see the scars before the little bump. Plus doc advices against another surgery if it were him. And he is a mountain biker. So I think I'll wait it out till 12-14 weeks post op, get back on the bike and see how it feels. That will be early Dec which will still give me a week or so to decide if I really need to have surgery again and start over.

Bbense: I wish a doc had warned me about being more careful. They said the pain woudl guide me, but I had no pain, so obviously did too much.


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## Iridethedirt (Jan 20, 2008)

Hello, I am about a month into my grade 3 separation. I went OTB, landed directly on the tip of my shoulder. My doctor explained that most grade 3 separations are left to heal on their own. the reason is that while some folks opt for surgery, if does not decrease your recovery time, does not nessicarily make for a more stable shoulder. he said there are a variety of procedures to choose from, and that normally when there are so many choices, its is because none of them are nessicarily a great solution. At this point i am going to begin PT asap (ive put it off for a number of reasons) and just see how it goes per my doctors reccomendations. it still hurts, but has become more stable. i am going to talk to my doctor about potentially having the end of my collar bone trimmmed down to reduce the rubbing/grinding, but we'll see what comes of that. i guess my point is, if its a grade 3 now, letting it heal might not be a bad option. what does your doctor reccomend, or is he just telling you its your choice?


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## Roaming Oregon (Feb 24, 2004)

did the grade five separation about a year ago. Had the surgery, then got on the bike after 5 weeks (I know I shouldn't have but that's another story.) 

Shoulder has huge bump, and still have numbness. Best thing for it has been just to start riding and exercising again.


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## tassels (Nov 22, 2009)

Iridethedirt, thanks. I think everything you wrote is very accurate. At this point my doc (whom I still trust and believe in) says to let it heal and see how it works. He thinks my chances for a good result are very high. My PT girl says the same thing.

I know there are a lot of riders who had a grade 3 and let it heal naturally. I was hoping to find someone as stupid as me who had the surgery and them screwed it up. I'd love to know what they did and how they recovered/rode.

At 4 weeks post op, I was doing great. No pain, incredible ROM, great strength. I was feeling too good, and I'm sure that's how I broke the stitches on my device that allowed my bone to pop back up and my shoulder to drop again. 

It's not as bad as before the surgery. I had a 2+ inch drop and a huge bump. Now the bump is small and the drop is less than 1/2 an inch. 

I think my plan is to finish therpay at the end of November at which time I will be 12 weeks post op, and then try to ride carefully and conservatively. That will give me a few weeks to decide if I need surgery again before the end of the year.


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## tassels (Nov 22, 2009)

Roaming Oregon, when did the numbness start and where is it? Does it feel odd to ride with one arm longer than the other? Any issues with long rides, 6 plus hours? I am/was an endurance racer. Thanks!


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## bbense (May 5, 2010)

tassels said:


> Bbense: I wish a doc had warned me about being more careful. They said the pain woudl guide me, but I had no pain, so obviously did too much.


My doc pounded the "no movement of arms above the waist for X weeks" message pretty hard. Then the message was "work through the pain". There's a fine balancing line, there's a serious risk of complications ( elbow, shoulder joint freezing ) if you do no movement at all, and too much will damage the surgery.

The surgery pain wasn't that bad after the first couple days, but the PT pain was fairly intense and went on for about 8 weeks. My guess is your doctor is probably "right", but I would for sure see somebody else, just for the peace of mind.

The doctor will move on regardless, you've got to live the shoulder and the results. You don't want to be second guessing your decisions a year from now.

- Booker C. Bense


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## Iridethedirt (Jan 20, 2008)

tassels said:


> Iridethedirt, thanks. I think everything you wrote is very accurate. At this point my doc (whom I still trust and believe in) says to let it heal and see how it works. He thinks my chances for a good result are very high. My PT girl says the same thing.
> 
> I know there are a lot of riders who had a grade 3 and let it heal naturally. I was hoping to find someone as stupid as me who had the surgery and them screwed it up. I'd love to know what they did and how they recovered/rode.
> 
> ...


You're welcome tassles. 
I think you're on the right track! I wish you a speedy recovery! would you mind sharing the story of how it happened??

I went for my first ride yesterday, just a short 4 mile round trip to grab lunch with some riding buddies after they finished their weekend ride. My doctor wrote me a prescription for a brace which i filled through the office he reccomended, who specializes in braces, and prosthetics. this is what i ended up with. 
http://braceamerica.com/armadillo-shoulder-stabilizer-p-132.html 
I have worn this while doing anything exceptionally active, hiking mainly. it worked really well on the bike. i was surprised at how good i felt, and was perhaps a bit stupid myself, testing out how it felt now to bunny hop up curbs, off them, etc... it felt ok, i was shocked! I obviously was over-doing it and could feel the instability, but the brace helps immensely. 
so here's my story:
I have been a casual racer for a few seasons as an adult now, and raced a decent bit as a teenager as well. i mainly raced the beginner and sport level XC races and really enjoyed the Super D event at massanutten. i had planned on racing the blue mtn biker cross this winter, on the eve of my 30th birthday, but then the shoulder thing happened.

Here is a video of my stupid wreck from my helmet cam. 



 It is NOT spectacular. it is a fluke. it is a trail section locals call the "G-out" its nearly a halfpipe, probably 8-10 feet deep, maybe 15 feet across.... the exit is nearly verticle, and rolls out back to level slowly over the next 30 feet or so. in the video you see me get kicked forward, endo up the wall of the exit and fly over the bars. i plant my hands on the logs i was headed for to protect myself from landing on them, and result in plowing shoulder first into the uphill ground.... Im not a light man, i weigh in at about 200 lbs, 5'11. I am not 100% on what happened other than that i tried to ride it super casually, just rolling through it. In the past i have launched out of the G-out by a couple feet at a pretty good speed, i swear its when we let our gaurd down, and arent "going for it" that we really get hurt...


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## sic_nick (Oct 18, 2005)

Tassels that is unfortunate news, there are a couple more threads about recovering from AC injuries:-

Ac Separation (shoulder Separation)

and

AC Separation Grade III Recovery 

I know the feeling of having the surgery done, I'm 5 years on now and everything's pretty good although I've always had a lump even with successful surgery. I even had the same surgeon who operated on DH world champ Steve Peat using a new kind of technique. Like This;-

Simplified Acute AC joint Reconstruction Using the TightRope

Good luck with your recovery.


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## bbense (May 5, 2010)

sic_nick said:


> I even had the same surgeon who operated on DH world champ Steve Peat using a new kind of technique. Like This;-
> 
> Simplified Acute AC joint Reconstruction Using the TightRope
> 
> Good luck with your recovery.


That is the same operation I had.

- Booker C. Bense


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## tassels (Nov 22, 2009)

That's the same procedure I had. But I was lucky to have no pain, and therefore unlucky to do too much and tear the stitched before the ligaments had time to do their thing. I think having a 32 pound 2 y/o didn't help.

How it happened...really dumb! I was about 1.5 miles into a 50 mile bike race that I was going to win. There was a rocky climb that some guys in front of me didn't make, so I had to weave around them and slow down. At the top, there was a large drop that had a smooth roll to the left side. When I got to the top, before the drop, there was a guy stopped on that left side. I hesitated because I always go left. I didn't know what to do, ask him to move, get off my bike. I felt silly, this is a race, go for it. I didn't have much speed and took the drop badly and some how landed on my shoulder.

It's still pretty fuzzy. I tried to get back on my bike and race, but after a few seconds, the pain hit and I screamed and got off the bike. Then a medic pulled on my arm for almost two hours trying to pop the shoulder back in place...nice! That helped.

Anyway, I am now 8 weeks post op and have begun weight training. The shoulder feel funny. I could live with the bump but am not happy with how it's acting. I'm calling the doc tomorrow to tell him I'm going to start mountain biking to really test it.

A new doc I saw last week said go out and push it this month since I need to decide whether or not to have surgery again in December since it would be free.

So that's the plan. I am leaning on having surgery again in December. But my original doc said he can't do the same procedure again. So if you guys could send me your doc's contact info, I would love to call them and see if they've ever done that one twice on one patient.

Thanks again,
Layla

You can follow my progress on my blog... http://hammerandpsychle.blogspot.com/


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