# Ac Separation (shoulder Separation)



## JB800 (May 20, 2007)

I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The Doctors Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!


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## rugger (Jul 26, 2006)

Had the same grade shoulder seperation as a result of getting slammed to the ground in a rugby match. I went to a sports ortho who said they don't do surgery on that type of injury any more. Studies showed that 5 years down the road there was a higher onset of arthritis. 
I bypassed rehab as the doc said all the injury really need was time for the ligaments to heal. At about the 3 week mark I started light weights and I couldn't even bench press the bar. At about 8 weeks I went from 35 lbs to 135 to 150 over the course of 2 weeks. 12 week mark I was back to about normal. You'll know when it is healed. You can feel it. Don't rush it as you don't want to tear the ligaments and start over again. When it was all said and done - w/out surgey my shoulder is as strong as ever and I've got an enourmous lump on shoulder as a keep sake - which is actually the collar bone sticking up. But every other person I ride with has one of those.


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## JB800 (May 20, 2007)

Rugger, Thanks For The Reply. You Put My Mind At Ease. Just Don't Understand One Thing. You Said You Don't Want To Tear The Ligaments Again. I Thought With A Grade The 3 That The Ligaments Are Completely Torn And They Don't Repair. Your Body Just Adapts To It.


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## rugger (Jul 26, 2006)

You are right. I should have used the word "healed". I am still not sure what that means but the doc said I would be healed in 12 weeks. I guess I never asked him what he meant by that.
I do know that at 6 weeks I couldn't do anything and at 8 I could do the bar and at 12 I was feeling fine. I am 7 years out now and the only thing that still bothers me is the clicking of the tendons when I do shoulder presses. Otherwise there is no residual pain or weakness. 
On the other hand my wife thinks I look like a freak because my collar bone sticks up a good inch. And it is good for scaring the kids at the pool.


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## K4LK (Feb 2, 2007)

JB800 said:


> Rugger, Thanks For The Reply. You Put My Mind At Ease. Just Don't Understand One Thing. You Said You Don't Want To Tear The Ligaments Again. I Thought With A Grade The 3 That The Ligaments Are Completely Torn And They Don't Repair. Your Body Just Adapts To It.


JB800. Hope you heal fast. :thumbsup: Just a suggestion ... don't capitalize each word in your posts. It's a little hard to read. Welcome to the forum.


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## JB800 (May 20, 2007)

Thanks! I greatly appreciate the info. This injury has been very frustrating to me but I am now much at eased hearing the outcome of someone else. Thanks again!!!


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## Nostromo (Sep 22, 2005)

I believe the AC joint is a pretty 'average' design left over from when we ran around on fours, hence why when the ligiments tear they don't stress too much about surgical fixes. Its a joint with a really really small range of motion but the whole shooting match of joint bits ie. cartilege and ligiments. If it realy packs it in later they just remove the whole joint and the end of the clavicle (saw a piece of the the bone off) and let it fill with scar tissue which makes a flexible connection, and apparently that works good.
My shoulder sticks up on one side for the same reason, seems real common.


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## ncjumper (May 15, 2007)

Hey JB, another AC joint cripple here. 

Both of them actually. My right shoulder was a very serious grade 3 and my left shoulder a mild tear/strain. My Ortho Doc told me he would not recommend surgery unless I wanted it badly due to constant pain and also aesthetic reasons, mainly that the shoulder now hangs down and there is a significant bump on my shoulder. Also, when I have my arms hanging down one arm is slightly longer than the other.

If you can deal with the slight hunchback look and aren't in significant pain or have arthritis in 12 weeks or so, just let it be. If your young and take your shirt off at the beach and flex for the ladies...its your call. You will have that bump forever. If you get the surgery you will have a scar across the front of your shoulder. Take your pick.

BTW, my ortho Dr. is a pretty good doc. He fixes some major figures from pro sports. ACL and shoulder surgery are his big things that he does. I saw a WNBA player in the office when I was there so he knows his stuff. If he says skip the surgery, I listen. Peace.


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## Rower_CPU (May 7, 2004)

*grade 2 separation here*

I'm about 4 weeks since the injury and not doing much except resting (partly due to the bilateral radial head fractures I got with it ). I got the same story - rest for a few weeks, less pain after 6-8 weeks with return to activity. I seem to have lucked out in the arm length/shoulder bump area because I'm not really seeing either one.

I'd be careful with the bench (or overhead) presses because it can put a fair amount of load on the shoulder, depending on your form. I'm focusing on regaining range of motion and flexibility before worrying about strength, otherwise you risk letting too much scar tissue build up and not returning to full use of the joint (important for my throwing arm).

Good luck!


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## Nostromo (Sep 22, 2005)

Rower_CPU said:


> I'm about 4 weeks since the injury and not doing much except resting (partly due to the bilateral radial head fractures I got with it ). I got the same story - rest for a few weeks, less pain after 6-8 weeks with return to activity. I seem to have lucked out in the arm length/shoulder bump area because I'm not really seeing either one.
> 
> I'd be careful with the bench (or overhead) presses because it can put a fair amount of load on the shoulder, depending on your form. I'm focusing on regaining range of motion and flexibility before worrying about strength, otherwise you risk letting too much scar tissue build up and not returning to full use of the joint (important for my throwing arm).
> Good luck!


Good point about the presses, overhead stuff BB is not at all good for my AC joint, bench is OK, but dumbell presses put a lot less strain on that joint so I mainly do those myself.


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## StumpjumperUK (Dec 6, 2004)

Sufferred the same injury about a year ago but I don't remember what grade it was. Anyway, just wanted to say that some months later, and a bit of physio and excercises, it is like I never had it. I couldn't even tell you now which shoulder it was. Time is a great healer, so have patience. 

All the best!


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## JB800 (May 20, 2007)

Thanks for all the feedback! greatly appreciate it!!!


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## bikingbob (Jan 11, 2007)

Listen to your Dr. and do the PT as they suggest. I didn't really do any PT and it took a very long time to get the shoulder back to feeling normal. I never really fully regained the strength, but eventually got to a point where I could crash on the shoulder without it feeling any different than crashing on the other one. That is until I broke the collar bone a month ago. Now I get to go thorough the whole ordeal again. This time I will spend the time and PT.


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## sic_nick (Oct 18, 2005)

Had a type 3 AC separation two years ago and had surgery to fix. The very same operation and also the same surgeon as Steve Peat earlier that year.In simple terms they put a piece of tape around the collar bone and bone spur on the shoulder blade and in the doctor's own words "pull on both ends as you would fastening shoe laces" although this is meant to be the cutting edge method of fixing this injury. Convalescence was awful, two weeks with the shoulder completely immobile and no physio for 2 months. It took me 4 or 5 months to get back to riding to work and 6 or 7 months before I got back to using my shoulder as I used to.










Shoulder only hurts now as I got knocked off my bike by a bus the day before Xmas and landed on the same shoulder although this is being dealt with by my solicitor not my surgeon!!!!!


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## SkiBikeMan (Jun 22, 2007)

I suffered a third degree shoulder separation last November after crashing into a tree after a great ride and clearing some crazy ****. 

I opted for the surgery, modified weaver dunn, had it done December 28 2006. Today I was just released from Physical Therapy. Yes I have a scar on my shoulder, but very little lump and shoulder is almost as high up as before. 

Progressing well, mostly core and bodyweight exercises. Was in a sling for the first four weeks (sucked) then out of it. Initially PT was a *****, very painful. Right now I have almost all my range of motion back and some of my strength. Doc says 9 months (will be september for me) until it fully heals and a full year or more before it feels mostly normal. Cleared for biking this September.

I know it sounds like a lot but I am glad I did it. Google Weaver Dunn Procedure. I would go for it!


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## fosbibr (Apr 10, 2006)

oh wow.... i myself experienced a type II tear DHing this week. was told it would be a 4-6 week recovery. from what imreading here, i may be too optimistic


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## Rower_CPU (May 7, 2004)

I'm 10 weeks out from my 2nd degree separation and here's a basic timeline of my healing:

2 weeks - out of sling, range of motion (ROM) OK but still some pain/weakness with lifting
4 weeks - almost full ROM, little pain with light lifting/reaching across body
4-8 weeks - slowly regaining strength/mobility

I considered myself "healed" by 8 weeks, but I still have a little ways to go to get back to full strength and flexibility in my shoulder. I still can't lie on my injured side without experiencing a dull ache.


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## patch-rik (Aug 28, 2006)

I seem to be in somewhat of a dilemma. Apparently I damaged my scapula and a nerve that covers it when my 2nd degree seperation occured. My doctor says that I cannot do any PT because I risk damaging things worse witht the nerve and shoulder situation. So apparently I just have to let it heal with time. I'm at 4 weeks and I have full ROM but it still hurts to reach across to the other shoulder and if I push against something with my right arm my shoulder blade pops out of my back a bit. I'm concerned that not doing any PT at all is really going to make healing a ***** and take forever. Anyone else in the same boat? Should I get a second oppinion?


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## cazloco (Apr 6, 2005)

*Grade 2 seperation here.*

I'm thinking once we all heal, we should start the "Team Pointy Shoulder" and we'll get custom fit jerseys.

I seperated mine last week on a night ride. (I'm gonna get that punk that put the stick in the trail) When I woke up the next morning and I noticed the high collar bone and droopy arm; I went to the urgent care. Doc diagnosed it at first sight but couldn't understand how I could have full range of motion with very little pain. I think he was just looking for an excuse to take more xrays. He explained what it was and said no surgery and that it will heal itself and I'll always have the bump. He didn't say anything about a timeline.

I can go all day with no pain but sleeping hurts (still hurts to wipe my arse). Rolling out of bed is quite difficult.

We'll live.

Caz


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## Rower_CPU (May 7, 2004)

I was amazed at how long it took to be able to sleep on my shoulder after my grade 2 separation. I'm a little past 3 months now and it's only in the last couple of weeks that I can lie on that side without any issues - I had full range of motion in the joint and was able to start lifting weights again after 2 months, but there was still some deep tightness/soreness that reared its head when I tried lying down on it.


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## POG (May 20, 2004)

I've separated both of mine and I also had the problem of having pain when trying to sleep - took about two months before I could sleep through the night without waking myself up by rolling over on it.

My right shoulder is the grade III and I did it about 12 years ago in a road biking accident. Anyway, I had a really bad wreck last weekend and fell on - you guessed it- my right shoulder. I felt my shoulder giving way as I slammed into the ground and I was having flashbacks about pain. Funny thing was it didn't hurt as bad to slam my already separated shoulder into the ground. I know it moved enough that it would have separated had it still been attached. I've definitely had some pain but nothing like before. I guess the point is once the bone is ripped free you don't have to worry about the pain of having it ripped free anymore!


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## carl1266 (May 17, 2004)

I had a type 3 seperation in spring last year. My doc told as long as I don't experience any pain I can do whatever I wanted. After 10 days I was back on the road bike and after 6 weeks I did some easy trails. About 3 more weeks and I could ride everything I did before. Today I have no pain or any issues, just a lovely cycling lump.


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## racerXX (Mar 22, 2004)

I also separated my AC joint. I am not sure what grade, but not bad enough to warrant a sling. I never had an xray. A guy on his motorcycle was riding illegally on the trails. I came around a bend and we were face-to-face. I slammed on my brakes to avoid hitting him and flew over the bars. It hurt terribly. My arm/shoulder were weak for weeks. I rehabbed myself...started lifting light weights. To this day, the shoulder hangs different than the uninvolved shoulder.
I dont think surgery is recommended unless the injury remains painful.


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## grawbass (Aug 23, 2004)

Over ten years ago, I separated my shoulder pretty badly in a hockey injury. It took over a year to fully heal, but now its 100% and has been for years, never gives me any problems whatsoever.


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## stys (Aug 28, 2007)

*broken....but healing*

I've read the reviews on this thread. Lots of good advise, just Bcareful w/2nd hand doctoral advise. all injuries are person specific.

I hopped on looking for time lines for shoulder separation. I've got 4 collar bone, 1 shoulder blade, 1 broken hand and several ribs injuries for experience but the separation is a 1st. I likely have to multiply the time by 1.5 since i' i'm old.as in 41. Class ll is going to keep me from grp ride @ Gooseberry in Utah on 10/ 7.

Anyway....My additional advise for those early in the healing stage and esp for the guy
having trouble sleeping. I hate to say it as much as I hate to do it, but TAKE THE MEDS.
You are likely too active in the day like me..so bedtime can be good healing time....but
not if you keep re-injuring yourself.

The true muscle relaxers (in addtion to the anti-inflamitories, not to be confused with) help immobilize your injury for a good 6-8hrs. So get in a good "resting your injury position" before you nod off. When out of codine type drugs...I use 2 glasses of wine....almost as good. Obviously not good advise if you have addictive personality! (disclaimer)


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## daryl.king (Aug 27, 2007)

*I have grade I AC Separation maybe more*

Happened last Sat 9-1, haven't been to the doc yet but it really hurts to move my arm across my chest and rest my palm on the opposite shoulder. 
Also had some pulling/tightness in the muscle on the side of my neck and in my back and lats, but that's subsided quite a bit after a week; however the shoulder tighntess,pain is not.

I think I got REALLY lucky, actually, since riding group videod this particular descent and crash on DH section and it was pretty violent. My buddy rode the whole section and made a mistake at the end (a drop into a berm) and broke his collarbone. Buds said my crash looked way more violent than his, yet I get away with AC separation and he breaks a bone!

My advise for those who still want a cardio workout but can't get on the bike yet, if you can, ride road or use the recumbant bike in the gym - I've gotten 3 pretty good cardio workouts this week on it and it puts minimal load on the shoulder- up right bike might be better. Not sure about the road bike but going to try that tomorrow.

There sure are a lot of shoulder injuries on here and I didn't think about googling "AC Separation" or "Shoulder Injury" until tonight, when a friend mentioned it.

FAst healing everyone, and try to as active as you can (if you can at all) in the meantime.


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## nexus (Apr 5, 2007)

Had a type 3 seperation a few years back. Opted for the surgery route for several reasons. Def. slows the recovery process, but I'm glad I did. (2 times under the knife actually, had to go back to get a pin removed.) Have a nice huge battle scar to show for it now too. :thumbsup: Now I'm laid up again with some huge gashes on my arm from a slide down some rocks today.  

Def stick with the PT and training though, but don't over do it. It's easy to set yourself back when you start getting overzealous.


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## chas_martel (May 14, 2006)

Oh wow. I am 4 weeks into a AC separation. Doc told me same story about
the wait and let it heal strategy taken these days. 

Sleeping has been a real pain, as has removing shirts.

He told me to give it a solid 8 weeks before I worry about the pain aspect.

He did say to try riding on flatter ground. The visit before when I saw him
was for a broken thumb, messed up wrist ligament and messed up nerve in my elbow.


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## Oldnslow (Jun 21, 2005)

*I too, am a member of the "lumpy shoulder club"*

Did my right one 13 years ago playing judo....took a long time to get right, but anymore the only reminder is the lump on my shoulder and an occasional twinge when I overdo the push ups, or if I lay off the PT for a while and pick it up again. No surgery and no arthritis so far, still follow up with my ortho doc and he says not doing the surgery probably saved me a lot of pain in the long run. On the other hand the knees have been in the body and fender shop a couple times and the initial injury to my shoulder was far and away more painful than they were.


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## murphyd (May 14, 2007)

Four weeks out on a 3rd degree separation. Classic over the bars fall. God bless my brand new Bell Sweep that saved my melon. I second the pain being terrible, I'm not the toughest guy, but ouch. 
How soon did some of you with 3rd degree injuries get back on your bike? I rode some slow single track yesturday, with no pain. Really scanned the trail like never before, and the trees seemed VERY close to my shoulder. I probably shouldn't be riding, but couldn't resist.


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## outdoornut (Aug 13, 2005)

I'm glad I saw this post. I feel a bunch better after just receiving a grade 3
separation a week and 1/2 ago. I blasted down a 4 foot drop and the front 
wheel hit something in the leaves and just stopped. I did a bad body slam
causing the separation. I've been a bit worried about it, as many of you, the
doctors, even a 2nd opinion opted no surgery. 

Thanks for all your input. I feel a lot better knowing it will come around. The
doctor said to take it out of the sling as soon as I could do so without much
pain. I took if off this past Thursday and seem to be getting some use out of
it now. It will be two weeks into it the day after tomorrow so I guess I'll just
keep counting. 

Thanks again, everyone.

ODN


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## kmacon (Nov 15, 2006)

I am 5 months out on a AC 3 separation (no treatment) and have been riding since the third week. Funny thing is that the position while riding since the separation has always seemed stable and not induced any pain. My problems have been laying on my side to sleep and also pushing straight up with the affected shoulder from a laying/sitting position on the floor.

Went OTB again 2 weeks ago and landed on the same shoulder. Heard all the same crunching and scratched my arm and leg up pretty badly and had some deep bruising on my leg. With the exception of my bump sticking up a little more for a few days the shoulder though was OK. I am glad that I did not do the surgery. Would have probably messed it up real bad.


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## yoshua (Mar 29, 2006)

*Grade 4 separation*

Its been about four years ago now, did mine snowboarding. I opted for the non surgical route, no PT and no drugs. I still cant lift as much as before and rock climbing is a lot less stable but I dont notice it in daily life other than the big lump. I would recommend letting the injury heal on its own unless the bone is sticking out of your skin, but thats just me. Be patient with your bodies healing process and seek out some myofascial bodywork to keep the shoulder girdle opened up things stop working.


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## romar (Sep 16, 2006)

*My AC seperation has a little twist*

About 3 years or so ago I was working out on a shoulder press machine at the local Y. Pressing the weight back up I felt a pop by my right shoulder blade and dropped the plates. I was in a lot of pain and went to my Doc. I obviously strained myself and "rest and never lift that much weight again" was my doctors response. For the longest time I had a tough time with my right shoulder and my range of motion was quite limited. I could not for the life of me grab the back of the collar of my shirt to pull it over my head with my right hand. Due to my limited strength and flexibility working out became quite annoying and I stopped.

As a result of a trip OTB last year I received a class 2 separation on that shoulder. Within 4 months I could not believe how much better my shoulder was feeling. I regained much of my range of motion and was able to exercise that shoulder without pain. It's been a little over a year now since the separation and I've been back in the gym for about 3 months. I'm taking it slow but all of my strength is finally starting to come back.


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## SkiBikeMan (Jun 22, 2007)

Update: 
I am now 11 months out, coming up soon on the anniversary of my crash and my surgery (modified weaver dunn, read my previous post). Crash was on 12/26/06 and surgery on 12/28/06.

I have been religious about working out, mostly core exercises and power cal's (pushups of all kinds, pullups, etc. I can recommend books) and I am feeling strong and so is the shoulder. Occasionally it might feel a little sore if I push hard, but this is progressively reducing in what it takes to make it sore. I feel I am better off with the surgery, and it looks almost as before.

I have lifted weights heavy for 25 years. After the accident I had to learn new workout techniques and also learned how bad the bench press is for you (google bench press and paul chek), I would recommend you guys who are obsessing over the bench press (how much ya bench) to stop doing it and change your focus. My workouts leave me much more wiped out and I feel stronger, more of the entire body is worked out at once, has more real world applications for skiiing, biking, etc than isolated weight lifting, and this is coming from a former hard core weightlifter!

If you can find a good surgeon I would recommend it. Arthritis isn't an issue since they trim off a bit of the clavicle in the modified weaver dunn procedure. I would also recommend you thoroughly research that procedure first so you understand what they will be doing. Plenty of info on the net. I have heard guys have gone back to playing rugby after the surgery. 

I went biking two weeks ago, played it real cautiously as I wanted the shoulder to be close to 100%. I think its about 98% right now. 

Anyhow, thought I owed it to those who are looking for feedback. I know I was when I was contemplating surgery. I scoured the net and read everything I could.


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## Surfinguru (Feb 6, 2004)

Wow, good thread. I'm about 4 months out from a level 2 separation on my left shoulder. I too have the big bump now. My sports specialist said surgery was really for cosmetics and that in the long run, I'd heal up just fine, albeit with the "lump." If I chose surgery, the recovery time would be *significantly *longer.

I've also got a really bum rotator cuff that I'm going in for surgery on in January. My ortho said the same thing about the A/C separation - surgery would be more for cosmetics and would really increase recovery time. Although when I saw him last week, he said that he could shave off a little of the end of the clavical (about a 1/2") to reduce the bump and allow for better rotational movement.​
Race season starts in April, so I think I'll just stick to the arthroscopic surgery for the rotator cuff and be back in shape for Sea Otter.

In the meantime, I think I'll do some more research on the Weaver Dunn procedure.


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## Surfinguru (Feb 6, 2004)

Quick info update for those interested. Here's a really good overview of the modified Weaver-Dunn procedure.

http://www.shoulderdoc.co.uk/education/article.asp?article=525


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## SkiBikeMan (Jun 22, 2007)

Surfinguru, 

You are correct you will incur a much longer recovery, however, my ortho said I would achieve more strength then without the surgery and from everything I have experienced myself and read; replies, studies, etc I think he is right. Look at some of the people who have replied on this thread. I don't experience the same issues as they do after the surgery. Not trying to push this on anyone just trying to provide a response by someone who has had the surgery as it seems I am in the minority on this thread.

Your link was a good one also, I read that one when I was researching my procedure. The only difference was that they used a fastener rather than a piece of string or twine of some sort to anchor the clavicle down. I have after pics but unfortunately no before pics.


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## Surfinguru (Feb 6, 2004)

SkiBikeMan, sent you a PM, but I want to ask if anyone else here knows a surgeon in the California Bay Area that does the arthroscopic modified Weaver Dunn procedure?


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## Little Miss Sunshine (Nov 19, 2007)

This thread has been a great resource. I dislocated and fractured my shoulder just over 3 weeks ago and had no idea what to expect as far as recovery besides the standard stuff from the doc. Thanks everyone for sharing your experiences. Looking forward to getting back on my bike ASAP!


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## Surfinguru (Feb 6, 2004)

Hey nice x-ray. So what procedure did they do there for your *clavical*? Looks like they've done a Weaver-Dunn?

edit: Oh yeah, meant to ask if any of that stuff will be coming out?


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## dwnhlldav (Feb 2, 2006)

I crashed in September went to the ER and the doc said I had a bad bruise. When I asked about the huge lump on my shoulder she said it was tight muscles if I was still in pain I should go see an Ortho doc. Because we were in the middle of moving I didn't get into see the Orthopod untill late Novemeber. Did a grade 3 of my left shoulder. I also did a grade 1 to my right last february.

I'm kind of glad I didn't know about the second one. I was riding 6 days later. Crashed on the 7th day. And kept riding. Riding really didn't aggrevate the injury. Bunny hopping/pulling up on the bars did.

As far as the healing thing goes. I asked the Ortho Doc because of this thread. He said that what they find if they go in for surgery a couple years down the line is that the scar tissue develops into a cartilage type substance that helps to stabilize the join. That is what they mean by healing.

No surgery here as I was basically back to normal in 6 weeks. Just some pain if I lift things over 30 pounds, or hold lighter items for extended periods (think squirming 1 year old) but it's getting better.


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## Surfinguru (Feb 6, 2004)

Just a quick update for those interested, I went to get a second opinion from a guy named Tim McAdams yesterday since I was starting to get that "no so good" feeling from my other ortho. Dr. McAdams is the current team physician for the San Francisco 49ers and used to be the team physician for the Stanford basketball team. 

They took a fresh x-ray and he prescribed a new MRI which I'm getting done tonight. I asked him about the arthroscopic Weaver-Dunn and he point blank said it's still VERY experimental and that he wouldn't do it. (Case studies have revealed alot of complications.) He said he can do the AC reconstruction with at the most a two inch incision to implant a cadiver hamstring tendon, so that's not very invasive at all. He'll also do the arthroscopy proceedure for the labral, supraspinata tear etc. when he's in there and feels confidant I'll be back and ready for race season in three months.

I'll continue to post follow up on events as they occur since it sounds like it could be useful for others on the board.


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## JAK (Jan 6, 2004)

*I have a twist too*

I have an AC grade 3. Big bump. I can actually grabg the end of the clavicle and move it around. It happened in 1990. FWIW, I was in pretty good upper body shape when it occurred. I was recommended at the time against surgery and for PT, unless I wanted it ground down for cosmetic purposes...I went to the Jobe Clinic...Lakers docs. I did PT and still do...in the gym, I do some minor/fun exercises now and it is all it takes. Riding my bike seems to make it feel better. I ride regular one gear type of bikes and I think b/c I mix up my technique so much that it has had a positive effect on my shoulder...standing and reefing up and out vs. seated spinning pulling back, etc. etc. I climbed through it and I think that was some great PT as well. I was in the Valley for a couple years and I gotta say I think I had this minor advantage in offwidths and squeeze chimneys&#8230;the Steck-Salathe comes to mind, but anyway&#8230;.

No under the knife for me...not when just a minor change in lifestyle would do it...you know like going to the gym, stretching and whatnot. this little change has benefited me in many other ways as well....think of the whole.
The AC separation is a weird thing&#8230;I have spoken with folks who have had exactly the opposite experience of me&#8230;I forget I have one most of the time. After a couple years I could sleep on that shoulder again. I have been MTBing since '84. I have full range of motion.


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## Mojo Man (Sep 1, 2007)

*Body Armor*

About 10 years back I had my AC joint removed due to a bad skiing fall. Haven't been able to body build since because of the pain afterwords. Started MTB over the summer and it does'nt bother it.

Can someone recommend some type of shoulder protection for aggresive trial riding, something you can move and feel somewhat lively in? I don't want to break or separate another shoulder.

David


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## dwnhlldav (Feb 2, 2006)

Another update. I started swimming laps 10 weeks after the grade 3. I had some pain at first but on the whole my shoulders feel better then before my first separation. I can sleep on it no problem. Basically the only time I remember it is when I move my shoulder in such away that the bone sticks out to it's farthest. It just feels weird.


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## Surfinguru (Feb 6, 2004)

MTB'n Louie said:


> About 10 years back I had my AC joint removed due to a bad skiing fall. Haven't been able to body build since because of the pain afterwords. Started MTB over the summer and it does'nt bother it.
> 
> Can someone recommend some type of shoulder protection for aggresive trial riding, something you can move and feel somewhat lively in? I don't want to break or separate another shoulder.
> 
> David


Hey David, I separated mine while wearing a 661 Pro Pressure suit. I don't think there is anything one can do to completely eliminate the possibility of injury. There are only degrees of mitigation.


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## Surfinguru (Feb 6, 2004)

Well for anybody that might still be following this thread and my situation in particular, I had surgery on Friday the 11th. Doc said they did ALOT of work, but said it went exceptionally well. He took care of the bone spur, fixed the rotator cuff, bursa sack tear and the supraspinata tear. Then he went on to do the distal a/c reconstruction. (cadiver tendon graft slight clipping the last 1/8" of the bone to get the clavical back in place.)

I woke up from anesthesia with the worst pain I've ever experienced. As a result, they decided to keep me overnight and hooked me up with the PCA machine (morphine drip) and a bunch of vicodin. About 6hrs later came one of the worst sicknesses I've had. (I'll never take that again - I'll sack up and writhe in pain before going through that nightmare.) Got discharged about 3pm the next day. Staying overnight in the hospital is one of worst experiences to be sure.

I'm home now with strict orders to ice and not do anything with the arm for two weeks to ensure the tendon graft doesn't get screwed up. (Basically immobilization and lot's of percocet and darvocet - yeah!) Sleeping is a bit tough as I have to sit upright and sleep in the bolster/sling.

I've got a follow up appointment next thursday to have the stitches removed and then it's physical therapy. I'm really stoked so far despite the pain. Only got one stitch for each of the three arthroscopy entry points and the incision for the tendon graft was only like 1-1/2" long. 

The goal is to be back in the saddle for Sea Otter. Keep you posted!


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## G-reg (Jan 12, 2004)

*Me Too!*

Long story short&#8230;I'm in the club. 
The Details: I crashed out at mi 25 or so of the Chequamegon40. Spent some time in the Hayward ER, got some X-rays. And then was told that I probably dislocated something but it popped back into place and I will be sore for a while. Here is you sling and ice pack, have a nice day. I then pointed out the giant bump on my shoulder that the old ass Dr missed while yanking my arm around in his earlier inspection. He replies, "Oh, I missed that&#8230;.that's an AC separation, here's a prescription." Really? Ya didn't see that? Any ways I've got an appointment with a Ortho later today to get a good check out.


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## G-reg (Jan 12, 2004)

Well the verdict was level 3-4, with the dead guy ligament surgery as the recommendation. He only thought it would add a few weeks to recovery compared to leaving it alone. Being an active person was a big part of them suggesting surgery, and this was from a respected Ortho from a sports medicine clinic. He implied that doing nothing and just leaving it there, especially with grade 3, was more for folks who don't plan on hitting the gym after re-hab. The dead guy ligament is to reconstruct the inner ligaments and then they can repair the outer one, eventually giving a 100 percent joint without the crazy bump and equal length arms.


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## kmacon (Nov 15, 2006)

G-reg said:


> Well the verdict was level 3-4, with the dead guy ligament surgery as the recommendation. He only thought it would add a few weeks to recovery compared to leaving it alone. Being an active person was a big part of them suggesting surgery, and this was from a respected Ortho from a sports medicine clinic. He implied that doing nothing and just leaving it there, especially with grade 3, was more for folks who don't plan on hitting the gym after re-hab. The dead guy ligament is to reconstruct the inner ligaments and then they can repair the outer one, eventually giving a 100 percent joint without the crazy bump and equal length arms.


Hey G-reg I am 1.5 years out on a grade 3 and at this point I think I would concur with your ortho guy. While I have no pain and do absolutely anything I want to do there are still times when the shoulder is annoying. For example water skiing and wakeboarding with the torque that they place on your shoulder still takes a toll on the separated shoulder. Pushing up with that arm from a sitting or laying position is still bothersome too to a certain extent and yes people still sometimes ask what is wrong with my shoulder due to the bump. Thank god though, riding my bike has not been any problem at all. Also, and this is something to consider, I went OTB again 6 months ago and landed on that shoulder again and guess what, my separated shoulder probably helped absorb the impact and was non the worse for the wear.

Can't speak for those who have had the surgery since I have not had it, but if I had it to do over again, and surgery was an option, I think I would choose to get it done and be done with it.


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## G-reg (Jan 12, 2004)

I talked to another Ortho today, and he said that absolutely under no circumstances should I go with the cadaver tendon type surgery. 

It will come down to what the Flight Surgeon thinks(I'm an Air Force Pilot) of the three opinions I've got...More to follow.


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## lemmiwinks (Jun 17, 2005)

just did mine 5 days ago am waiting to see the specialist in 6 days but already its noticably better first ride today since and not too much pain so im thinking it might be grade .5 not very serious at all.


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## yomattyo (Dec 20, 2007)

I had a level 3 separation my freshman year in highschool from snowboarding. Totally blew it apart, after 1 trip to the PT, he recomended the surgery (granted, this was about 9 years ago). was a long recovery, can't remember the timeline, but i still have a big bump on the shoulder and about a 7 inch scar across the top. I think the overall strength is better having it fixed, but its hard to say. i've seperated the other shoulder to a level two and it feels fine now. I still have some pain when i put pressure on it in odd angles, but it doesn't slow me down at all, no problem at all for biking, but i get some pain when i do judo...Good luck to everyone and they're healing! 

i'm just coming off a bad bone bruise in my heel, but nursing it for a few months now, been on and off crutchs, in a walking cast, and now i'm doing a series of cortisone injections, seems to be the first thing to help...


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## petercarm (Nov 5, 2007)

Did mine today. my pic looks like your pic, G-reg. I've been injury free for a few years now. Only took one pedal strike to fix that.


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## G-reg (Jan 12, 2004)

I gathered another opinion, from another guy in a Sports Medicine facility. He was adamant about not doing the surgery. When he looked at the X-rays and did the physical inspection he gave me a cat 2, which was about 1.5 weeks after the injury. At the rate I was healing and the X-rays he was pretty sure the other Dr jumped the gun. He also mentioned that they can really repair things if it's within 24 hrs. After that time having the surgery done today or in 6mo is no different. So the extended down time is the only crappy part about trying to let it heal before trying surgery. Especially as the surgery's are less than proven. My Flight Surgeon thought the same thing, but the USAF's regulations don't really care how I heal, just as long as the end results are acceptable. So for now I'm going with the advice of, "ditch the sling when you are able, don't pick up anything heavy, and come back in 4weeks." At the moment I'm pretty much pain free, poppin Alive for swelling but no "happy pills." I get a reminder things are not right when picking up or placing torque on the shoulder with my arm out in front of me. I'll update as everything comes along.


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## Dominator13 (Aug 31, 2006)

I gained one of those on my 1st run down Livewire @ Northstar this year, left shoulder. My doc said it was a class 2 seperation and that it would just be up to me as to how much pain I could handle. Not worth the surgery. The same doc that reapired my torn rotator cuff last year. Ny wife says I need a new sport.


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## petercarm (Nov 5, 2007)

> So for now I'm going with the advice of, "ditch the sling when you are able, don't pick up anything heavy, and come back in 4weeks." At the moment I'm pretty much pain free, poppin Alive for swelling but no "happy pills." I get a reminder things are not right when picking up or placing torque on the shoulder with my arm out in front of me. I'll update as everything comes along.


That sounds a lot like mine. I'm doing well with a bit of supportive taping that seems to keep everything together even when I'm not wearing a sling. I'm pretty sure mine is a grade 2. The AC joint itself is completely nuked but I know from having done ligament damage previously to my other shoulder (skiing accident) that I've not ruptured anything other than the AC.

I'm really surprised by the absence of pain... except when I forget and flip my collarbone out of position. Then it hurts.

I still guess it is a long road to recovery. I'm 39 years old and have been riding with much younger, strong riders and holding my own. I'm not looking forward to losing that hard won fitness, but I've figured I just need to get this over with and not try to do anything too fast, too soon.


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## G-reg (Jan 12, 2004)

How are you taping things, I'm used to ankles and knees...but this is my first blown up shoulder.


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## petercarm (Nov 5, 2007)

I've basically got what's shown on pages84-85: http://books.google.co.uk/books?id=4gonj-IR2vIC&pg=PA84&lpg=PA84&dq=mcconnell+tape+ac+joint&source=web&ots=cOpMKYZAo1&sig=Trud31BvecvTu9cqdaOPkDY8zkE&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA84,M1


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## Shepherd Wong (Apr 24, 2005)

Did mine 3 years ago, completely blown and had a Weaver Dunn procedure with an allograft. The rehab wasn't easy, but returned to normal activity after 5 months. Now 3 years out it feels great, if anything stronger than the other one.


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## yoohoo (Jul 23, 2008)

I did mine 2 1/2 weeks ago. I went to the ortho yesterday and he told me that I had a mild grade 1 seperation on the ac. I was feeling really good until I went to the Chiropractor. The ER doc said that I had only inflamed the tendon so I figured a good adjustment would get me back on track faster. I have had really bad pain since the chiro. I told her to stay away from my shoulder but I guess she new more about my body and what pain level I had then I did. Thanks to her she upgraded my inflamed tendon to a grade 1 seperation thus sayeth the doctor. Oh well. I am starting all over with the healing process....:madman:


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## G-reg (Jan 12, 2004)

Hey folks,
Just got back from my Ortho follow up. He was impressed with how much I've healed in 4 weeks. At the moment I've got full range of motion, and 70% strength. And I wasn't exactly a powerlifter prior to the injury. The Doc said I'll continue getting better for 6 weeks or so. I already forget about it. It will never be 100%, but I'll probably only notice the injury when I look in the mirror. The best part is I'm cleared to ride and work out, and get back to flying!


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## hydrogeek (Feb 20, 2006)

*Me too*

About 4 1/2 weeks ago i did a nasty endo on my head. The Doc in Urgent car said I had just pulled the ligaments in my back. Sent me home with muscle relaxants and a pat on the head.

I started PT about 2 weeks later. The PT said, your left shoulder is higher than you right. He said must be muscle spasm. I went along with that diagnoses until this week when i said BS. I want another opinion. The pain was too great after 4 weeks just to be a muscle spasm. :nono:

Sure enough, I see a new Doc today and he says it's an obvious AC separation. Now I get to start over with a sling and more PT in two weeks. :thumbsup:


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## petercarm (Nov 5, 2007)

I'm one month on from my Grade 2. Everything is feeling quite good in terms of healing and day to day activity. Riding off-road is still a long way off. I tried yesterday and it was hopeless. The first gentle dip tugged at the shoulder - nothing to undo any of the healing but the promise that one false move could set me back weeks.

It seems mountain biking needs shoulders to be at pretty close to full strength. I pretty much figured this was going to be ~3 months before I'm going to be back in action properly.

More information from GPS logs on the accident itself shows that it all happened at 40kmh (25mph). After the pedal strike I was airborne to the point of impact. The more I think of it the more I realise I was lucky to get away with just an AC injury. It is going to take a while for my confidence to come back.


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## yoohoo (Jul 23, 2008)

I am about 6-7 weeks into mine. I have very little pain but my range of motion sucks. I cannot raise my left shoulder high enough to get stuff out of my jersey pockets. I have the strength back I just cant move very well. I have been riding but I have been taking it really easy. I hope I dont fall on my shoulder again. Does anyone where any sort of shoulder protection? I wear a chest protector when I ride my dirtbikes but there doesnt seem to be anything out there for the bicycle crowd.


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## petercarm (Nov 5, 2007)

I've had a couple more goes and I'm now able to ride gently. I'm using a SixSixOne neoprene shoulder support and a small amount of physio taping.


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## MikeBredley (Nov 15, 2008)

G-reg said:


> Well the verdict was level 3-4, with the dead guy ligament surgery as the recommendation. He only thought it would add a few weeks to recovery compared to leaving it alone. Being an active person was a big part of them suggesting surgery, and this was from a respected Ortho from a sports medicine clinic. He implied that doing nothing and just leaving it there, especially with grade 3, was more for folks who don't plan on hitting the gym after re-hab. The dead guy ligament is to reconstruct the inner ligaments and then they can repair the outer one, eventually giving a 100 percent joint without the crazy bump and equal length arms.


Thanks for posting on this AC joint problem. I have one from a single track fall and it really prevents some activities. I've been looking at various options. My concern has been that some of the stuff I read on the surgery is that there can be problems down the road from making the joint too stiff. Has anyone heard of this new Regenexx procedure? Sounds interesting as they place your own stem cells into the shoulder to heal the ligament tear (see www.regenexx.com). I'm also considering prolotherapy, but have seen pros and cons on the web. Have any of you had either of these?


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## cjcc55 (May 3, 2008)

tomorrow I will be 2 weeks into mine. The doc said I tore one of the three ligaments so I'm not sure if its a stage 2 or 3? I'm glad I found this thread, a lot more helpful then my doctor. Hopefully I'm getting out of the sling and starting pt next week.


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## jesse.futrell (Oct 9, 2005)

I endo'd on my bike a week ago and suffered a Type III AC Separation. The acromioclavicular and coraclavicular ligaments are completely torn from the collarbone. I went to the ortho and he recommended that I don't initially receive the surgery. He said considering that it was my left arm (my non-dominant arm), the fact that surgery has the potential to cause arthritis problems down the road, and that recovery can be 6-8 months it would be best to see what happens without surgery. The first week sucked. I couldn't do anything with my arm and it felt like it was hanging differently (because it was). The pain has subsided but I can still feel the collarbone loose in my shoulder (feels pretty weird). I bought a shoulder brace and wore it through the weekend. I can't do much with the arm (it is stiff to move and hurts as I raise my arm above shoulder level from the joint rubbing) but the brace supports it. I can put a little weight on it now, but not much. I hope to be able to ride at least a bit by next weekend. We'll see...


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## cjcc55 (May 3, 2008)

Hang in there it will get better, just this last week I have improved a tun, its now been about 6 weeks and I have full range of motion back w/ a little pain at the very top. I hoping to start riding trails and park by summer


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## kmacon (Nov 15, 2006)

jesse.futrell said:


> I endo'd on my bike a week ago and suffered a Type III AC Separation. The acromioclavicular and coraclavicular ligaments are completely torn from the collarbone. I went to the ortho and he recommended that I don't initially receive the surgery. He said considering that it was my left arm (my non-dominant arm), the fact that surgery has the potential to cause arthritis problems down the road, and that recovery can be 6-8 months it would be best to see what happens without surgery. The first week sucked. I couldn't do anything with my arm and it felt like it was hanging differently (because it was). The pain has subsided but I can still feel the collarbone loose in my shoulder (feels pretty weird). I bought a shoulder brace and wore it through the weekend. I can't do much with the arm (it is stiff to move and hurts as I raise my arm above shoulder level from the joint rubbing) but the brace supports it. I can put a little weight on it now, but not much. I hope to be able to ride at least a bit by next weekend. We'll see...


I feel for you, sounds like my situation a couple of years ago at this same time of year. Non-dominant arm and doc said about the same thing. I was riding again in about two to three weeks. Didn't really bother the injury to ride for some reason. There were a lot of other things that I could not do though if they involved weight bearing or lifting. Lots of those things just take time.

Try stretching/lifting the arm upward by using a wall to walk your hand up and back down. I found this really helped to get the range of motion back. Best thing is to start physical therapy ASAP if you possibly can. If not available then at least start using rubber resistance bands to start building strength back. Search the net for physical therapy for the shoulder and you will find a lot.

Yes it will feel weird probably from here on out. Mine still pops and moves around strangely even after two years. The bump is still there and it does still feel like my arm hangs lower than it should unless I concentrate on holding it up in position. Strengthening exercises do help though. Your shoulder position will now depend 100% on muscle strength and tone since you no longer have the joint to bear the load.

Also see my post #32 above if you are concerned about crashing again.
Good luck :thumbsup: .


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## G-reg (Jan 12, 2004)

Just to check in again, 8 months later. Cliffs notes: Class 2, 3 or 4 depending on who I asked. Ended up not getting surgery. Strength is nearly 100%, the strange situations where it's less than 100%, my uninjured shoulder is pissed too. Looking back, I'm REALLY happy I didn't have surgery. My understanding was that unless the injury was operated on within 24hrs, the main joint will never be repaired. Very few of the surgery options did anything more than trade the goofy bump for a scar. The ones that repaired the joint didn't give me a warm fuzzy about the actual usefulness of the joint after all is said and done. Looking toward drinking less and training more for next season, I'm not scared about re-injuring that joint......it doesn't exist anymore.


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## jesse.futrell (Oct 9, 2005)

kmacon said:


> I feel for you, sounds like my situation a couple of years ago at this same time of year. Non-dominant arm and doc said about the same thing. I was riding again in about two to three weeks. Didn't really bother the injury to ride for some reason. There were a lot of other things that I could not do though if they involved weight bearing or lifting. Lots of those things just take time.
> 
> Try stretching/lifting the arm upward by using a wall to walk your hand up and back down. I found this really helped to get the range of motion back. Best thing is to start physical therapy ASAP if you possibly can. If not available then at least start using rubber resistance bands to start building strength back. Search the net for physical therapy for the shoulder and you will find a lot.
> 
> ...


Thanks bro, the shoulder is already feeling better. I'll post back after my first ride. For now it's work on the stationary bike


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## cjcc55 (May 3, 2008)

ok guys its been 10 weeks, It was doing good and pain free untill a day ago. I tried to do a push up and it hurt a little so I didn't to any more, then today it's been hurting just about all day. Did I really re hurt it by doing a push up? How long did it take you guys before you could do push ups pain free?


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## racerx58 (Jun 2, 2009)

Dude,

If you are still suffering from pain after 10 weeks, you need to see a good shoulder ortho today. You may have some other issues other than a separated AC joint. You should be able to return to activities after 6 - 8 weeks with little or no pain if the separation was a mild one. Good luck!


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## LaXCarp (Jul 19, 2008)

Here is my shoulder story. Last August (08) I dislocated my shoulder, it was out of the socket for a couple minutes and slid back in on its own. Being the stubborn (stupid) man that I am I chose not to go to the doctor. Basically just rested and worked on range of motion for a couple months. I tried lifting weights again this winter only to reaggrevate something in there, laid up for another few weeks. 

A couple days ago I took a pretty mild spill, arms outstretched to brace for impact. I felt the shoulder pop out a couple inches (out the front side) and as I was getting back up it it slid back into place. Not really much pain, I contemplated to keep riding. Now the rear of my shoulder is sore, and am kinda back to square 1.

Does anyone have a link of exercises I can do to strengthen the entire shoulder. I travel a lot for work (months at a time) so its not the easist to get into a doctor or a regular PT program. Thanks for any insight given!


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## lytleric (May 4, 2006)

BTDT... Type 3 separation after flying over the handlebars going downhill in a race.

I researched the hell out of this injury and read every article I could on it. Visited three orthopedic docs, all told me to let it heal on its own and see how I do. Six weeks of PT, and about 6 months later it was 90% of the way back to normal (normal being full range of motion and strength), a year later I was probably 98%.

Will always have that hideous bump though. There goes my modeling career.


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## racerx58 (Jun 2, 2009)

*Shoulder Separation is different from Dislocations*

LAXCARP,

You seem to be suffering from shoulder dislocations and this is a much different problem than a separated shoulder. There is a real limit to how much you can strengthen the shoulder to keep the shoulder socket from popping out, there are ligaments and other structures in the shoulder joint that hold the shoulder in place and these can get stretched and damaged when you pop the shoulder out. The bad news is that while proper PT will make your shoulder feel better it may not make that much of a difference in your shoulder stability. The good news is that there is alot that a good shoulder ortho can do to tighten things up - but it may involve a surgical procedure to do so. Best of Luck!


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## zoro (Mar 14, 2007)

Just did myself a grade 2-3 AC separation yesterday while practicing 4x at the BMX track. You know, dumb crash because of a big round rock that rolled on the track accidently. Doctor said, after the X rays confirmed no fractures, to wear the sling for about 2 weeks and go to PT. Right now, the pain is not to bad, and I have a pretty good range of motion even if I feel limited in a couple of position. 

Any tips on what to do for sleeping, as it seems to be the worst part for me yet. Do you keep the brace on for sleeping?

Thanks guys and fast healing to everybody.


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## kmacon (Nov 15, 2006)

zoro said:


> Just did myself a grade 2-3 AC separation yesterday while practicing 4x at the BMX track. You know, dumb crash because of a big round rock that rolled on the track accidently. Doctor said, after the X rays confirmed no fractures, to wear the sling for about 2 weeks and go to PT. Right now, the pain is not to bad, and I have a pretty good range of motion even if I feel limited in a couple of position.
> 
> Any tips on what to do for sleeping, as it seems to be the worst part for me yet. Do you keep the brace on for sleeping?
> 
> Thanks guys and fast healing to everybody.


By the sound of it you have a fairly low grade separation for 2-3 since you can lift your arm at all at this stage. It took me at least a week to get my arm to shoulder level then I really had to work to lift to the sky. Do the physical therapy. After ripping your tendons/ligaments apart, the only thing that holds your shoulder in position is the strength of the muscles. Strength training for the shoulder became much more important to me after the separation.

Sleeping was definitely the worst (with the exception of getting up off the floor from a lying position). The first few nights I tried sleeping on my back on some inclined pillows and could at least lean toward the side. After a while I got a really thick (firm) pillow that holds your head and neck up high off the bed. This takes a lot of the pressure off of your shoulder wanting to fold over.

Two years out and still sometimes I get up and feel that I put too much stress on the shoulder while sleeping.

Good luck, maybe you will heal fast.


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## racerx58 (Jun 2, 2009)

Zoro,

kmacon already gave you some great advice. Some stuff I would add to the mix is this:

1. Try to get yourself off the sling as soon as you can. Only wear it if you feel discomfort.
2. Start slow but try to recover your range of motion sooner rather than later.
3. Be diligent about PT.

Monitor the progress of your recovery. You should not be in pain after 4 - 8 weeks, you may still have some strength deflicit in the injured shoulder, but you will eventually work this out. If you are experiencing significant discomfort or have not regained your range of motion, you should consult with your doctor again. Also before you start doing strength training, you should get cleared by the PT or Doctor.

While the shoulder will heal over time, you may have lost some (Grade 2) or all (Grade 3) of the ligaments that hold your shoulder together. Strength training will be key to you being able to return to your sport. You may also need to alter some of the things you do for strength training, i.e. NOT doing the bench press or at least modifying it since this excersize places such stain on the AC joint. Consult with a good sports trainer about how to proceed.

Good luck.


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## zoro (Mar 14, 2007)

Thanks for the support and tips guys! 

As for the sling, RacerX58, I thought having it stabilize your shoulder was supposed to be an important part of the healing process, as it helps to put everything 'in place' together again. I would feel comfortable to go on with my day without it, but I don't know if it's a good idea yet.

Right now, (2 full days after the crash), I can move arm shoulder high without pain in most positions, except when moving it backwards. Pain mostly comes when I do a sudden move or try to lift something.

Last question: when should one start the PT treatment? I know it varies from individual to individual, but what would be a rough guideline??

Thanks again!


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## racerx58 (Jun 2, 2009)

Zoro, it is important to use the sling - but if you use it too long - you may get some painful adhesions when you start using your shoulder again. So try to reduce your use of it, key here is that you do not feel discomfort. Another thing to consider is the position of your shoulder, chances are your shoulder is pulling a bit forward because your muscles are trying to support it. You might experience some tightness because of this. A person familiar with muscle release therapy can help you with this and it will really make you feel more comfortable. Just make sure that the person knows how to treat arm and shoulder injuries.

As for PT, it varies quite a bit and you seem to have medium grade shoulder separation of either a type 2 or 3. If it is a type 2, you could return to activities and begin more active PT at 2-4 weeks, if you really have a type 3 - then it can take 6 - 12 weeks. It really has to do with your level of discomfort and the types of excersizes you can do. Range of motion stuff you can do as soon as you can tolerate it. But in general don't hurry and don't push yourself to get your strength back. The first 6-8 weeks of recovery from an injury is very important, so let your body heal. Here are a couple of links you might find useful:

This is an excellent source of information about AC separations.
http://www.uptodate.com/patients/content/topic.do?topicKey=~8Xm8h.pwl70pNy

This is a link with rehab excersizes that you may find beneficial
http://www.med.umich.edu/1libr/sma/sma_shldsep_rex.htm

This is a recent article about Grade/Type III AC separations and treatment
http://www6.aaos.org/news/pemr/releases/release.cfm?releasenum=788

Take care,


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## zoro (Mar 14, 2007)

Thank you very much for the links and the tips (especially the one with the exercices). As for the position of the shoulder, you might have touched a point there. I just don't know if the position I have it in in my sling is the proper position to adopt. Seems to induce more pain when I am in the sling than when I have it loose.

Will try to consult for that, or call PT maybe to schedule an early appointment in order to have tips for the use of the sling etc...

Happpy healing to everybody (if there is such a thing...)!


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## dysfunction (Aug 15, 2009)

racerx58 said:


> Zoro, it is important to use the sling - but if you use it too long - you may get some painful adhesions when you start using your shoulder again. So try to reduce your use of it, key here is that you do not feel discomfort. Another thing to consider is the position of your shoulder, chances are your shoulder is pulling a bit forward because your muscles are trying to support it. You might experience some tightness because of this. A person familiar with muscle release therapy can help you with this and it will really make you feel more comfortable. Just make sure that the person knows how to treat arm and shoulder injuries.
> 
> As for PT, it varies quite a bit and you seem to have medium grade shoulder separation of either a type 2 or 3. If it is a type 2, you could return to activities and begin more active PT at 2-4 weeks, if you really have a type 3 - then it can take 6 - 12 weeks. It really has to do with your level of discomfort and the types of excersizes you can do. Range of motion stuff you can do as soon as you can tolerate it. But in general don't hurry and don't push yourself to get your strength back. The first 6-8 weeks of recovery from an injury is very important, so let your body heal. Here are a couple of links you might find useful:
> 
> ...


thanks for this list. very useful after today:thumbsup:


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## G-reg (Jan 12, 2004)

Here's one more update at 1 year. I had a Cat 3, did no surgery. About the only type of movement I can't really do is wide grip pull ups. That kind of movement makes the end of my collar bone hit the little process that it used to be attached to on my scapula. Otherwise, full recovery. And I don't have to worry about injuring the joint again...as it does not exist. If you are thinking of surgery, that was the big reason my Ortho recommended against it. If you are likely to injure the shoulder again and it is surgically fixed, you run the risk of blowing up that surgery.


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## Frosti (Jun 15, 2009)

I did my shoulder in 3 months ago now, and the worst part it was because I was going too slow while exploring new routes to take some friends on. I hit that root so bad off of that little hop that I even bent my front forks. Sling was on for 5 weeks ( at which point only 60% healed according to the doc)

Sleeping is still the rough point for me after 3 months. I find that some nights I must be tossing too much and when I wake it feels like my shoulder has shifted a bit out of place. Gonna ask the doc today about it as those days I feel I need to pull on the shoulder to get it to sit right and then I can get full motion. Still could be the healing process as the doc say it was a grade 3 and the only true way to fix it is to put a pin in but like the others above stated he doesn't recomend it.

At the 3 month mark I am riding (pavement only) again and playing ball ( just can't cannon the ball anymore ). Still have yet to get up the nerve to hit the trails though as I don't want to do my shoulder in worse, as I am not a spring chicken anymore.

The only good thing was the 5 weeks in a sling was that my wife was actually nice ( as nice as a sarcastic wife can be anyways) and even opened my beer and brought it to me.

Glad I found this thread though.


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## kmacon (Nov 15, 2006)

Frosti said:


> I did my shoulder in 3 months ago now, and the worst part it was because I was going too slow while exploring new routes to take some friends on. I hit that root so bad off of that little hop that I even bent my front forks. Sling was on for 5 weeks ( at which point only 60% healed according to the doc)
> 
> Sleeping is still the rough point for me after 3 months. I find that some nights I must be tossing too much and when I wake it feels like my shoulder has shifted a bit out of place. Gonna ask the doc today about it as those days I feel I need to pull on the shoulder to get it to sit right and then I can get full motion. Still could be the healing process as the doc say it was a grade 3 and the only true way to fix it is to put a pin in but like the others above stated he doesn't recomend it.
> 
> ...


Hey Frosti, I'll give you my opinion, but you know what they say about opinions...

First, three months in a sling? Ouch, that would really suck. That's a lot to go through to get your wife to open your beers for you.

With Grade 3 separation what is done is done and its not going back together no matter how long you baby it. All you are waiting for is for torn and bruised muscles to heal after a Grade 3. No ligaments/tendons etc. are going to magically reconnect. The only thing you can do now is to strengthen the shoulder muscles so that they can do the work that the blown joint used to do (ie holding your shoulder in place). If you have not done any physical therapy and been shown what exercises to do then you need to get to it pronto.

At this point you should be OK to hit the trails again. If not then it is more than likely because you have lost muscle and strength due to using the sling too long.

Grade 3 management = Exercise, Exercise, and more Exercise

Good luck and happy trails.


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## ZoeBike (Aug 26, 2009)

I had a completely separated shoulder (not sure the grade; heard from one doc it was a grade 3, from another a grade 6), all to say, it was completely messed up. My neighbor is a Orthopaedic surgical assistant and she took a look at it and sent me to the ER immediately. She got me in a 8 a.m. on Monday morning to see her Ortho. His suggestion was the same; that they just let scar tissue form and surgery is only done if you are a high level athlete. My biggest suggestion is to be patient and let it heal. However, start PT as soon as possible with a certified PT tech. It helped me tremendously and I have all my flexibility and strength back and only have a big lump on my shoulder to show for the injury. Occassionaly I get a little slight pain if the weather is bad. Must be arthritis setting in. Best of luck to you for a speedy recovery.


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## shrubeck (May 11, 2006)

Man I'm glad I found this thread. I just found out yesterday that I have a minor AC separation. The doctor didn't tell me the grade, but it's probably only 1 or maybe 2. I don't have a noticable lump, and I've got pretty good range of motion. We figure it happend about a year ago on a pretty good crash, but it just flared up real good 5 days ago bouldering. Same consensus on no surgery unless it gets much worse. Man I hate taking time off the rocks and even worse is time off the bike, but it sounds like that's what I have to do at this point to keep it from getting worse.


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## feelmjawlk (Aug 11, 2009)

Hello everybody, my first post at the MTBR forums although I've been reading around for quite a while.

Had a grade 3 separation one and a half week ago, I went over the bars from taking an unintended 1 meter drop onto a sidewalk. I have opted for the surgery after having read up alot before my decision and although I'm pretty much trading a lump for a scar (and a couple of additional months of rehabilitation) I still feel it's what I want. I'm 23 years old and having the surgery done on Tuesday. I'm not sure what procedure it will be but I will report back here later since not many of the riders here seem to have chosen the surgical route.


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## d-mass (Oct 24, 2008)

Hi all, suffered a grade III AC seperation five days ago.Doctor advises against surgery at this point.I did enjoy doing recreational powerlifting in my spare time and I'm concerned I will have to give this up now. Has anyone been able to resume heavy lifting after this type of injury even after a year or two? Thanks.


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## guero grande (Jul 10, 2008)

Separated mine yesterday (grade III), coming up short on a double and goin otb. Glad i found this thread. Thanks for all your stories.

I gotta say it was one of the most painful injuries i've had. The ortho doc shot me up with some cortozone with novacain today... it's helped the pain a ton. I can actually lift my arm now. The hard part is... i also fractured my wrist :eekster:. Should be a challenging recovery.


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## AntiNSA (Oct 29, 2009)

urt Collar bone bad in China today. Doctors no help. Need MTBRs advice. Hurts so Bad
I have been riding my new cobia for 2 weeks now. Like 80 km a day weekdays after not riding for 8 years andbeing out of shape. Someone burglularised my home and stole 8 years of my life work 3 weeks ago I decided I was going to bury ky self in my mountainbiking, get my healthback and now today the worst thing happened.

First woke up and am scared my youngest child might have the pigflu as he is showing flu symptoms...

Then I left and rode 35 kilometers on one of my fastest commutes and had an accident. I was in a small back alley street and I saw this guy on the side of the road trying to walk out in front of me it looked like on the shoulder of the road..

Then blam I hit a speed bump the same color as the street.. totally missed it and indo'd over my front handle pars feet locked in place and slammed head and shoulder into the pavement.

The Chinese walked around me as if nothing happened. I walked for about a kilometer then felt the most horrific pain I have ever felt.

Went to the hospital.. and then the doctors tok an exray and said somethinglike two tendons n my collar bone were ripped and I would need a surgery. First they said 10-15000 rmb, then their boss came in and saw I was a foriegner and was like "oh no... thats like 25000 rmb"

This is some serious cash. I can tell you that this hurts soo bad. They gave me morphine and some other pills Celecoxib. 

That didnt really do anthing that I can tell. I cant stand up and have to hold my arm up and out words of my body in order to not feel any pain... I mean not bad pain. Even when I walk. MY woman has to hel me piss as I cant doi it myself. They put some kind of harness on me and a free hanging splint. I am under the impression they dont know how to make splints because I cant do anything unless Ihold my arm up with my other arm.

I need You help. 

Can you help me with the following questions?

1)I can attach a picture of the x-ray and can someone tell me the name of what I have in English?

2) Whats a good a good painkiller, 

3) how to make the proper splint?

4)and is an operation necessary?


And what is it that I have in English? 

The google translation says:

"The right shoulder is sorrowful place right shoulder lock joint space widened, distal clavicle upward shift"

I hurt so bad. i need to take care of my two children and 25000 is so much/

5) Will I ever be able to ride again?

6) It hurts so bad.. when will it stop hurting?

Thanks for your help

Robert ...

Dead sad. Hurting.
Attached Images


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## Dominator13 (Aug 31, 2006)

*Wow!*

Robert,
You've had a bad spell.
First, don't panic about your son. I believe that China has the vaccination for H1N1, as well.? I have known a lot of people that have contracted it and they are all fine now. :thumbsup:

1. Broken Clavicle (collarbone)
2. Vicodin - Pain Reliever/Anti Inflamitant
Motrin
3. How old are you? If you are concerned about the physical appearance you can get surgery and or use a brace. I did this exact break this summer and it just takes time. Put your arm in a sling and leave it there for 2 weeks. Find a good physical therapist.
4. So, NO! It is not necessary to have an operation.
5. Absolutley, you'll be riding after 6 weeks. Be careful! IT doesn't completely heal till about 4-6 months.
6. Yes, it will stop and might be as you are reading this. Get/make a sling, soon!

The healing that has to occur is the gap you see in your x-ray has to fill with bone. If youu were to go back in 6 weeks you'd see a cloudiness developing between the two bones that used to be one.

I hope this helps? P.M. me if you have any further questions.

Things should be brighter for you soon...good healing!


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## cg61doc (Sep 11, 2006)

Robert,

Looks like a grade 3 separation. I don't see a fracture. Typically there will be some soft tissue trauma with these and and that is where the pain comes from. There are three ligiments that hold the clavicle down. From the look of the x-ray, you may have ruptured all three. Surgical options for this type of injury for for looks only. Very little gain in function (if any). It will take several weeks (6-8) to be pain free. Start taking Ibuprofen right now. Take 800mg every 8 hours for at least 10 days straight. A little tough on the stomach, but it will control the inflammation and help the rehab. Start doing active range of motion 5-7 days post injury. Sling your arm while sleeping so you don't reinjure in your sleep. Your pain will be your limiting factor while your awake so don't worry about the sling then. I don't reccomend surgical options as there are very little gains for your troubles and you also risk surgical site infection and post surgical arthritis. Many hockey players have this same injury to both shoulders and still keep playing. I had a similar accident about five years ago and was back on the bike in about three months riding hard. I had several broken ribs also and that was what took the time. Hang in there. Tincture of Time will heal this. Do your physical therapy. Good luck.


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## guero grande (Jul 10, 2008)

Any of you all with type 3 Separations, feel the need to wear any kind of shoulder brace device, now that your back on the trails riding? My doctor said it was a personal preference thing, and didn't think it was needed, unless I felt more comfortable with one on. I'd like to hear other riders opinions/experiences, though.


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## AntiNSA (Oct 29, 2009)

Dominator13 said:


> Robert,
> You've had a bad spell.
> First, don't panic about your son. I believe that China has the vaccination for H1N1, as well.? I have known a lot of people that have contracted it and they are all fine now. :thumbsup:
> 
> ...


Thanks for your advice...!

I am happy to say that I dotn think anything is broken... Im not going with the operation for a lot of different reasons.. but most have said it is not necessary. Its not so disfigured... after 2.5 weeks It is still pretty week but I am gettign the feeling Id like to ride a little...

Took bufferin, and ice... and wrapped it with a horse collar like brace...

Have to say the brace helped the most.


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## AntiNSA (Oct 29, 2009)

guero grande said:


> Any of you all with type 3 Separations, feel the need to wear any kind of shoulder brace device, now that your back on the trails riding? My doctor said it was a personal preference thing, and didn't think it was needed, unless I felt more comfortable with one on. I'd like to hear other riders opinions/experiences, though.


 I feel much better wearing a brace... I am on 2.5 weeks and have not ridden yet.. I have this brace that wraps around both shoulders and velcros in the back. First I have my woman wrap the shoulder and diagonal across my chest. I take off the brace at night after work and put it on in the morning. Seems to have helped... I feel much mroe invincible with it on.l I can see the strength slowly returning. I ahve rasied my hand up twice since the accident.. once yesterday and once 5 minutes ago.. Couldnt even think about doing that last week. Id say wear the brace to you have full strength.. I definately dont at 2.5 weeks but am feeling like I would like to try riding the bike for 10 miles or so.... but at the same time in the middle of the day' when it aches I can easily realise its too soon to try to ride. I would hate to ride ten miles and be stranded in pain or roll back the clock on the healing process..


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## xcguy (Apr 18, 2004)

AntiNSA said:


> I feel much better wearing a brace... I am on 2.5 weeks and have not ridden yet.. I have this brace that wraps around both shoulders and velcros in the back. First I have my woman wrap the shoulder and diagonal across my chest. I take off the brace at night after work and put it on in the morning. Seems to have helped... I feel much mroe invincible with it on.l I can see the strength slowly returning. I ahve rasied my hand up twice since the accident.. once yesterday and once 5 minutes ago.. Couldnt even think about doing that last week. Id say wear the brace to you have full strength.. I definately dont at 2.5 weeks but am feeling like I would like to try riding the bike for 10 miles or so.... but at the same time in the middle of the day' when it aches I can easily realise its too soon to try to ride. I would hate to ride ten miles and be stranded in pain or roll back the clock on the healing process..


Wearing your brace is good for awhile (I was in what I'd call a sling) but PT, range of motion is your friend. At some point real soon you need to start working your arm through its normal range of motion so your shoulder doesn't freeze up. Use it or lose it, they say.

Your injury is much worse than my shoulder was/is so others can give you hints about how soon and what kinds of ROM movements you should be doing. Just don't immobilize your shoulder for too long a period. Forget about riding for now.


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## AntiNSA (Oct 29, 2009)

Like your wells quote btw... I use that in my class whe teaching debate basics....

I can raise my hand over my head real slowly... I know this is stupid but.. I am thinking Idont ride my bike with my arms raised  

I am feeling almost confident enough that I am internally debating to ride or not..
I ride about 80-90 km a day going to classes..
I knoe I cant do that now... but was thinking 26 km in 13 km splits...

The thing is half of my route is through peasant villages in China.... I am clearly aware that even in my safety zone I can srew up my body for the rest of my life as what got me hear was going over the bars completely unexpected from an unseen speedbumpp... I mean who the hell would have thought.

The biggest issue to me riding right now is I am thinking I should buy medical insurence as I have two children and one on the way. I naever thought I would get hurt on a bicycle... but all y iuds depend on me and yeah the streets i china are dangerous but I got taken out by a spedbump on a street with no traffic... Freak accidents I guess can happen. I mean going down ski slopes in Germany or coming down out of the mountains in colorado 50 mph on a bike thats too small doesnt kill me... it is the speed bump going 14 kph...

SO I guess I am going to have to get insurance.. But my bike is chained to my office desk and it is soooooooooo tempting... I seem to get fatter each day and cant stop drinking beer... I want to ride so bad.


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## twistedlizard720 (Apr 3, 2006)

*Grade 3 separation*

I suffered a grade 3 (left side) in a snowboarding accident in early Dec. 2009. Now Feb. 2010, I have regained motion, and strength seems to be returning. I have returned to the slopes. I still do favor it a little. My biggest concern is my arm gets achy when I'm on my feet for a period of time. Example: if I'm at the mall or shopping for an hour, my arm starts to ache. My arm also gets achy when I wear my brace skiing and snowboarding, but it won't ache if I leave the brace at home (always have a backpack on). Sleep is still uncomfortable on the left side.

My question is, will the the aching go away with time, or is it here to stay? I also have the "bump" and its hideous. Does the self-consciousness go away with time too?

Thanks, and sorry for thread jacking.


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## jesse.futrell (Oct 9, 2005)

*Aches and Pains*

I suffered a 4th degree (the AC and CC were completely torn) back in Spring of 09 and I still have the aches and pains. I am now at a point where I can do just about everything I could do before. The only holdups I have is doing heavy resistance stuff like pullups or pushing heavy weights in the gym. When things get heavy I can feel the ligaments pulling and don't wanna risk hurting it. But I still encounter soreness on a regular basis but never any real pain.

I do remember how wearing a backpack caused minor aches and soreness early on. This went away a few months ago. I would get tightness in my shoulder on the side of the injury. I would guess that will go away for you. Just stretch it out (I twist my back opposite of the injury and it helps).

I don't wear my brace often but i did just last month when I went snowboarding and while I never felt pain (I fell a lot  I did experience soreness. Currently I mountain bike (absolutely 0 issues and I ride pretty hard), do triathlon (sometimes swimming will cause soreness) and run (13+ miles I feel that side fatigue quicker than the other but just soreness). I don't wear my brace through any of this.

The last two weeks I've started playing basketball which I was really worried about. I play pretty hard and I wasn't sure how my shoulder would hold up because the shoulder moves alot and has some sudden jolts quite often. There are times when a quick jolt will be uncomfortable (not painful) but no lingering pain, just moderate soreness.

So to answer your question (simply from my experience), the soreness hasn't gone away yet (I'm seeing it subside through time) but the functionality is all there and there is no pain. I just stretch it out and it feels much better. I did get a massage in summer and it was AWESOME! Just play it safe and don't push it too hard, let it heal.:thumbsup:


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## AntiNSA (Oct 29, 2009)

Damn... here I am .... 4 months nealry later and I can say it is sore everyday still... not as bad... I got range of motion .. but if I raise my hand straight up... I can do it.. but it hurts. I dont know if I should do it a lot and hopefully the pain will go away? I am sick of the sore ness.. cant wait...
I can mountain bike.. mainly road bike.... its sore but works


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## c_dinsmore (Feb 22, 2010)

i got hit by a car one week ago today and landed directly on the shoulder. i didn't see a doctor because i hate going, it's bad for our companies worker's comp rates, and i knew they would try to make me stay off of it. and i'd rather work if i can. just in the last day or two the swelling in my shoulder went down enough that i could really clearly follow the clavicle and make sure it wasn't broken, but i figured it wasn't because i've had very little pain the whole way through. but i finally with internet research was able to self-diagnose as a level 2 or 3, probably 3 AC separation. i wish i'd known earlier, so i could have taped it for support during that vital first week of healing. i'll still tape it from now on. here are some pictures of the injury, one week after occurence.

https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00198.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00197.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00196.jpg
https://i153.photobucket.com/albums/s230/djustins/Colin%20and%20his%20injury/DSC00199.jpg

but the truth is... the shoulder locked up after about 20 minutes to where i couldn't lift the arm near shoulder length. by one or two days after, i could lift the arm above shoulder height again. of course with pain, but i could do it. the most painful things i've done is pulled up on the handlebars (no curb hops for me this week) and lifted something kind of heavy into the bed of a tall pickup (lifting up was fine, setting it back down in the truck a foot away from the body was what hurt). the second most painful thing i do is to swing my bike chain lock around behind me to catch it with the other hand. it's hard to switch hands with this habit, but switching helps enough to make it worth it. other than those things, i've used it pretty regularly already. so, i don't think i would consider surgery or even consultation because i've worked 9 hour days as a messenger, sometimes with up to 40lbs in the bag weighing on the shoulder, beginning about 30 minutes after the accident and through this whole week.

SO. with that long bit out, here is my final question though - after the injury does heal, what will a trauma incident to the same area do later? is there increased risk, or is there maybe decreased risk because significant scar tissue has formed and the joint isn't even there to break anymore?

p.s. the last picture is to show where my bag rests for work.


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## AntiNSA (Oct 29, 2009)

Im not a doctor.. your bone sticks up more than mine. In fact I cand figure out why my bone doesnt stick up as much as others... but I have a little bigger neck muscle so mabe I cant see it sticking up so much because its hidden? I wrapped mine up for like 5 days really hard and kept it immobile.. I couldnt even hardly walk for 4 days the pain was so intents. i kept my forarm bent parralel to my body .. I needed help just goin to the bathroom for 3 days + and taking a shower by myself was almost impossible for a week. I try not to think of myself as a *****, but all I had was some mild muscle relaxers and liike ibubufferin . I sear I thought It would never heal... but 5 months later I am 90-95% back to normal. Some advised the operation, some advised it would be cool to heal normally. Id say go natural. But I had this butterflycolarbone brace thing I wore and wrapped my body up forcing teh bone down for a week-2 weeks. Maybe thats why it is not proturudign now? I wouldnt **** with anything or try to be macho about it it will only keep it from healing and stuff. But I am serious to say I had no ****ing choice.. it was very painful.

Good luck,


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## c_dinsmore (Feb 22, 2010)

that's what is so wierd to me... the bone protrudes up as far as the model/textbook cases i find on medical sites... enough to definitely hint at a level3 separation. but the pain just hasn't been there for me. certain motions cause me to say "ooo" and retract from the movement quick, but nothing constant and nothing unbearable. so i do believe in trusting your body and its signals, and if it really really needed me to lay off it'd tell me so. but my mind simply thinks that i need to let it rest. so i might trade with a coworker biking for driving (he drives usually but would like to get a little time in the sun on the bike), maybe a week or so.


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## d-mass (Oct 24, 2008)

Dinsmore, congratulations, your the new owner of a AC seperation. Even though you are starting to regain strength and mobility, you should still get an x-ray to see if it's a grade 2 or 3 seperation.If it's a 3 then all ligaments are torn and you can't really do any more damage, but if it's a grade 2, then another hit to that shoulder could result in an increase in severity which might require surgery.I'm not a doctor, but to me your seperation looks like a grade 2.I injured mine about six months ago (grade 3)and it looks like a golf ball growing out the top of my shoulder and I have alot of upper body mass.You look pretty thin and with the injury being pretty new doesn't look to severe. Good luck brother.


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## c_dinsmore (Feb 22, 2010)

thank you for the warning about protecting if it's level 2. for as much info on the injury as there is on the internet, i found nothing at all about the risks of repeat incidents.

and, yeah, based on the low pain level, only a half day or so of limited range of motion, and the not so bad bump, it's probably level 2 as you say.

do you think med students do free x-ray clinics like they do for some other procedures? ha.


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## AntiNSA (Oct 29, 2009)

Yeah I dont know how its not painful for you. The **** really really hurt for me. Ratherit hurts or not, be easy on it for the long run. SStrange it doesnt hurt.


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## d-mass (Oct 24, 2008)

dinsmore, the real danger to a repeat incident is that you don't know for certain what grade seperation you have. A grade 3, is that all ligaments are torn, a grade 2, to my understanding is not all ligaments are torn.There are 2 group of ligaments that stabilize the AC joint.


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## tracerprix (Dec 26, 2009)

Well I went OTB yesterday when I hit a root sticking up. I went to Not So Urgent Care last night. After 4 hours they said AC seperation. Now I need to go to an orthopedic Dr. tomorrow. I'll let you know what they say!


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## LuckySomer (May 1, 2008)

The AC joint seems a little over rated. I had a grade 3 sep 8 years ago. I ended up having the bone cut and AC repinned that year, so I wouldn't have the bone looking like it would burst through the skin at any moment. I never had any pain. I had some clicking and mashing of the bone through the muscle when doing shoulder presses or rows. I no longer do chin ups. 

I'm happy I had the bone cut and the AC repaired. I brought my shoulder almost all the way back up to normal position. It was limited some my range of movement a little. My shoulder would get pretty sore if I was doing rowing and press type motions. It looked pretty funky to have my shoulder an inch lower on my left side with a protrusion popping up through my shirts. I have paid for a lot of insurance over the years. I'm glad I used it. 

Be glad it was not a rotator cuff injury. Those don't have happy endings near as often.


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## tracerprix (Dec 26, 2009)

To respond to my last post, I went to the Dr. yesterday. He said it is a minor AC separation. That's good!

Honestly from me not being able to move it Saturday evening, Sunday all day, it felt like 75% better on monday. Today is feels a little worse than yesterday, but still much better than sat/sunday. I plan on going back to work on monday. 

Mike


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## logman64 (Apr 26, 2010)

LuckySomer - how soon after the injury did you have the Weaver-Dunn?

I did my AC 11 years ago. Level 4, pretty nasty, snowboarding. Hit a quarter wrong, came down on the shoulder. I popped all the ligaments. Had surgery 3 days after the accident but not really sure what was done. I live in Japan and back then my Japanese wasn't good. I know I had a large pin in my shoulder that was removed a month after surgery.

Anyhow, the surgery did nothing apart from taking me out for 3-4 months. As soon as the pinned was removed I felt the clavicle ping like it was on a spring. I can put a finger between the clavicle and shoulder blade. I can't do heavy weight training as the shoulder gets too sore. I'd love to put some muscle on the shoulder so the clavicle is not so pronounced but it just doesn't seem possible.

I'm now thinking about corrective surgery as I'm just sick of being deformed. The Weaver-Dunn procedure looks promising but I think finding a willing ortho doc here will be hard plus it is going to be pricey

I also do a lot of Aikido (I train every day) and some of the throws and locks twist up the shoulder. Sometimes I am simply incapacitated with pain. I'm 37 now and have a lot of active life ahead of and i really feel like the shoulder is holding me back. So I have the jutting out collar bone and nice scar plus vary degrees of pain, soreness and aching. I'd rather do what I do and take the pain though than not do it. But if I could get it fixed by corrective surgery that would be awesome.

Anyone heard of having this procedure done years after the event? I can also feel the onset of arthritis and heard this procedure can also help with that.

Oh, also, that "bump" you all got....well, be prepared for it to get BIGGER. Especially if you're active. Weight training definitely widened the gap by a good few millimetres and I'm sure Aikido has added more. Basically after 11 years and surgery the clavicle is 50% higher off the shoulder than it was after that fateful quarter pipe jump.


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## SkiBikeMan (Jun 22, 2007)

Update:
I am now 3 years and a few months out from my crash and my surgery using modified weaver dunn, (read my previous post and follow up post). Crash was on 12/26/06 and surgery on 12/28/06 for third degree separation.

My shoulder feels strong and my range of motion is nearly 100%. I can do most all the things I could do before, I choose not to do bench presses as I just don't think they are as functional as push ups. I am happy with the surgery and would not do anything different. My pin is still in, never had it removed. 

Hope this helps any of you who are wondering what to do and good luck to you! If you have any questions feel free to PM me.


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## twistedlizard720 (Apr 3, 2006)

*update on mine*

Snowboard crash causing separation: 12-5-2009
Today 5-5-2010

The last month my shoulder has been getting worse in terms of pain.

Activity is pretty normal with the effected shoulder. Good range of motion. bump is bouncy and moves around when arm is moved. I am able to work out, but for every hour of working out, there is 3+ days of pain afterwards. Can't be out for multiple hours at a time, Example: denver auto show, after 2 hours of walking around pain was unbearable and had to go home. Normally starts out as a dull ache and escalates the longer I'm on my feet.

I am actually needing some input of those who have had surgery. I am planning on seeing an orthopedic. I hear surgery puts you out for 6 months. Is there supposed to be pain with conservative healing? will there be this pain after surgery?

Thanks for any input


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## logman64 (Apr 26, 2010)

Post-op surgery was the most paid I've ever felt in my entire life. Way much more pain than the actual separation and more painful than being run over by a car and fracturing my skull as a child. I was shaking with pain for about 12 hours. Excrutiating.


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## bgfthntr (May 18, 2009)

I had a 3D+ separation (R) in 1998 and had it repaired. It took about 6 months to heal and get back on the bike. It was a drag but well worth it. My surgeon was able to get to 99% rotation and now I can throw a fastball better with my kids. Go figure. My left shoulder has been bruised a few times (just recently) but seemed to escape any serious injury. The right side has a little bump to match my normaly bumpy shoulders.


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## Sonoran_Flyer (Sep 22, 2008)

Ask for a nerve blocker and you will feel no pain until it wears off (12 hours). I am 3 months out from surgery. Still sore but have 90+% range of motion. Really glad I choose surgury, had a grade 4 separation. Clavical was just under the skin.


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## pacing08 (Jan 15, 2008)

Just separated my shoulder last Wed. going down a chute on mt bike (done it before). Messed up on line and and next thing you know.... Have no insurance cus just got new job so 2 more months to go and hope they keep me. Should have rode conservatively cus could have been worse and no insurance.

From reading forums and researching web, I have a type 2 separation. Can't lay down on left side. Bump on shoulder is not too noticable. ROM improved from last week. The thing that bothers me is how my injured shoulder is not as wide as the normal one anymore. Looks like it dipped down at the edge so to speak. When I wear T-shirt the sleeve on the injured shoulder appears longer than the sleeve on the normal shoulder. 

I know the bump will stay forever but mine is not that noticable, but will the shoulder ever look broad again or will it always be a 1/2 to an inch lower than normal?

Also, Do ligaments ever replace themself or once damaged its gone forever? Do the ligaments get replaced by new bone if ligament cant heal itself? What is the disadvantge if support is with other bone vs ligaments.


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## Sonoran_Flyer (Sep 22, 2008)

Grade 1, 2, and 3 separation are generally treated without surgery. Once the ligament is torn it stays that way unless surgically repaired. What ever your posture is now will stay that way. A separated shoulder can lead to other problems in the future. Just depends on how severe it is.

http://www.aafp.org/afp/980215ap/980215a.html

These are the types of exercises you need to strengthen your Rotator Cuff.


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## pacing08 (Jan 15, 2008)

Sonoran_Flyer said:


> Grade 1, 2, and 3 separation are generally treated without surgery. Once the ligament is torn it stays that way unless surgically repaired. What ever your posture is now will stay that way. A separated shoulder can lead to other problems in the future. Just depends on how severe it is.
> 
> http://www.aafp.org/afp/980215ap/980215a.html
> 
> These are the types of exercises you need to strengthen your Rotator Cuff.


Thanks. I'll probably wait one more week before I do that. Right now I'm just focusing on shoulder shrugs, raising arm up and down with the natural wait of my arm.

Just curious when you say problems in the future, do you mean things like arthritis? Can I choose to do surgery later so that ligaments are fixed. I read somewhere that surgery would have to be done with 3 days for ligaments to be fixed.

When I become permanent at my job and get insurance I will see an ortho just so I can get a better understanding of long term effects.


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## Sonoran_Flyer (Sep 22, 2008)

If its grade 1 or 2 probably no or minimal complications. Grade 3 or higher would be of concern. It is just the shoulder is out of its natural position and is using different muscles to support it. This can lead to Rotator Cuff issues 10 to 15 years later. In my case the clavical was just under the skin(punched thru muscle), which can lead to Necrosis (death of skin or infection).


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## jathanas (Dec 9, 2009)

I'm 2 weeks into a grade 2 separation that I suffered in the most ridiculous OTB scenario ever. 

Usually I bounce back very quickly but this is different. The recovery process is much slower and I now believe my physio when he says "6 weeks" at least.

Trying my best not to lose fitness.

To all the other AC joint injury sufferers out there:

"GET WELL SOON & CHIN UP"


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## pacing08 (Jan 15, 2008)

jathanas said:


> Trying my best not to lose fitness.


Thats for sure. I'll continue running treadmill and stationary cycling for the mean time once I feel my arm is a tad better. Right now I'm still too paranoid to be swaying my arm that much from jogging/running or putting wait down on the handle bars of the stationary cycle.

I'll begin the third week after injury. For now I will continue working my ROM at home with the natural wait of my arm.

Also hope I can eventually lay down on my left side.Some people say that they still can't lay down on their injured side after months after injury. :madmax: :madman:  :cryin: :sad: :incazzato: :nonod:


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## xcguy (Apr 18, 2004)

pacing08 said:


> Thats for sure. I'll continue running treadmill and stationary cycling for the mean time once I feel my arm is a tad better. Right now I'm still too paranoid to be swaying my arm that much from jogging/running or putting wait down on the handle bars of the stationary cycle.
> 
> I'll begin the third week after injury. For now I will continue working my ROM at home with the natural wait of my arm.
> 
> Also hope I can eventually lay down on my left side.Some people say that they still can't lay down on their injured side after months after injury. :madmax: :madman:  :cryin: :sad: :incazzato: :nonod:


Been 9 months for me, still can't sleep on my left side. But I can pull a tee shirt over my head using my left arm!


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## jathanas (Dec 9, 2009)

The recovery was going great. 5 weeks from my grade 2 separation I was on the roadie without discomfort...

On my third ride back I got collected by a car. Diagnosis: Grade 2 AC Separation - Same shoulder. Back to step 1.

Son of a b#(ch.


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## cannonman (Jul 11, 2010)

Glad I found this thread. I am amazed at how many people there are with this type of injury. I suffered a Grade 4 separation a few weeks ago. The first ortho I went to said to just leave it alone and deal with it until scar tissue helped to stabilize the joint. A few days later, I got a second opinion from an ortho who specializes in shoulders and it seems there is a newer procedure out there that must be done within 2 weeks of the injury. It's similar to Weaver-Dunn, but they use metal buttons on top and bottom and very strong sutures to pull the bones back ino place. The ligaments are butted together and reattach and heal, which takes a long time because ligaments are nonvascular. You can be in a sling up to three months and then 9 months of PT. It was put to me that since I was very active to do the surgery, otherwise, just let it scar up. It's been two weeks since the surgery and the joint seems to be quieting down. Coughing and sneezing does not cause much movement anymore and I have confidence that it will heal up completely in time.

Just wanted to let everyone know that there is another option out there for higher grade separations.


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## jathanas (Dec 9, 2009)

cannonman said:


> Glad I found this thread. I am amazed at how many people there are with this type of injury. I suffered a Grade 4 separation a few weeks ago. The first ortho I went to said to just leave it alone and deal with it until scar tissue helped to stabilize the joint. A few days later, I got a second opinion from an ortho who specializes in shoulders and it seems there is a newer procedure out there that must be done within 2 weeks of the injury. It's similar to Weaver-Dunn, but they use metal buttons on top and bottom and very strong sutures to pull the bones back ino place. The ligaments are butted together and reattach and heal, which takes a long time because ligaments are nonvascular. You can be in a sling up to three months and then 9 months of PT. It was put to me that since I was very active to do the surgery, otherwise, just let it scar up. It's been two weeks since the surgery and the joint seems to be quieting down. Coughing and sneezing does not cause much movement anymore and I have confidence that it will heal up completely in time.
> 
> Just wanted to let everyone know that there is another option out there for higher grade separations.


Get well soon mate.

I'd also have considered surgery if I had suffered a grade 4 AC separation. Luckily, mine wasn't so bad, even the second time around.

All the literature I've read states that for grade 3 and above you'd be looking at a 12 week recovery period. Chin up!


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## kmacon (Nov 15, 2006)

twistedlizard720 said:


> Snowboard crash causing separation: 12-5-2009
> Today 5-5-2010
> 
> The last month my shoulder has been getting worse in terms of pain.
> ...


Hey, I was in the same boat as you with the throbbing pain that comes up the longer you are up so I thought I would respond. I dealt with healing a Grade III AC Sep for about 3 months without any intervention and then between 3 and 6 months my pain started getting worse and worse to the point of being unbearable just as yours has. I was sure that I was in need of surgery. Finally went back to the Ortho doc and he suggested first to try some physical therapy before moving to surgery. Within one week of starting PT with an actual Physical Therapist the unbearable pain like you are having went totally away and has not been a problem since. Thank god for physical therapy!


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## canonshooter (May 10, 2009)

well I had a grade 3/4 about 10 years ago now. The bump is still there. I have a muscular/lean frame and I still cant get the shoulder built up 100% around it. I have full mobility and maybe a little less strength in left shoulder vs. right. It will always be noticable. I have just learned to love it! It makes for a great story!! You will get past it!


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## tracerprix (Dec 26, 2009)

Update after 3.5 months:

The pain never really when away. Dr. worried about rotator cuff tear. He called for a MRI, but for some reason I could not handle it so they did an arthrogram this morning. Rotator cuff is good! He said the scans showed an ac separation. But knew that from the beginning. The weird thing is that the separation is bigger now than it was before. My sister works in the imaging office and said it is 1.5cm apart, which is more than last time.

I have to go back to my Dr. on Friday. I will ask him if it is a level 2 or 3 and why it got bigger. I think it is only a level 2 because I can't really move it around. 

It's been over 12 weeks. I wonder why I still have pain raising my arm or doing some over head work. Painting and sweeping with a push broom forget about it!

Biking doesn't bother it, which is great.


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## toytech (Jul 14, 2009)

I guess I get to be a member of team pointy shoulder too. IO went OTB yesterday and sustained a pretty obvious left shoulder separation as verified later on my xrays. Sucks with arm in sling everything is awkward, and as an auto mechanic I am off work for a good while.
Worst part? I only got to ride on my new Magura Thor fork once, and it was working sooo good! Now I have to stare forlornly at it for awhile....


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## jathanas (Dec 9, 2009)

Update 5 weeks after my 2nd degree AC separation. I can crank out 25 push-ups and 7 chin-ups (close grip). The shoulder does not feel normal yet, the physio suggests that's still months away.

Riding again which is good. Enjoying it too, more importantly.


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## xcguy (Apr 18, 2004)

jathanas said:


> Update 5 weeks after my 2nd degree AC separation. I can crank out 25 push-ups and 7 chin-ups (close grip). The shoulder does not feel normal yet, the physio suggests that's still months away.
> 
> Riding again which is good. Enjoying it too, more importantly.


Can you use the affected arm to help put on a tee shirt? How about using that arm to shampoo your head in the shower? These were benchmarks I used. Ten months after my crash I can finally sleep for awhile on my affected shoulder. Woo hoo!


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## jathanas (Dec 9, 2009)

xcguy said:


> Can you use the affected arm to help put on a tee shirt? How about using that arm to shampoo your head in the shower? These were benchmarks I used. Ten months after my crash I can finally sleep for awhile on my affected shoulder. Woo hoo!


As of last week, I can answer YES to both your questions :thumbsup:

You don't know how valuable your right arm is in all hygiene & grooming activity until you must do without... Shave, toilet, shower, dressing up etc

Still can't sleep on that side though, it still doesn't feel 100%


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## marko1480 (Apr 10, 2008)

Hi guys - joined the club last monday in an OTB incident I can't remember most of!, saw consultant last night who confirmed grade 3 separation.

Recommended waiting 2 weeks to see if it was recovering before deciding on surgical route or not, but said that it was too early to start physio in the meantime which didn't sound right to me.

When did you start physio in your recovery phases?

Mark


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## Sonoran_Flyer (Sep 22, 2008)

I would get a second opinion. Find a doctor would specializes in Sport Medicine and shoulders. From what I know surgery is most successful when done within a couple of weeks of injury.


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## jathanas (Dec 9, 2009)

marko1480 said:


> Hi guys - joined the club last monday in an OTB incident I can't remember most of!, saw consultant last night who confirmed grade 3 separation.
> 
> Recommended waiting 2 weeks to see if it was recovering before deciding on surgical route or not, but said that it was too early to start physio in the meantime which didn't sound right to me.
> 
> ...


Your physio is right. The first 2 weeks of the injury are the inflammation & repair phase. It is important to rest your shoulder, and reduce inflammation during this time (ibuprofen during the first week).

Usually a physio will recommend a sling or shoulder brace to keep the shoulder still during this period.

The ultrasound, TENS, and exercises can start later.


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## BOAB (Sep 11, 2008)

Well I'm 8 weeks in to healing a type 2 AC seperation in my left shoulder, but the ortho wouldn't address it until the right arm radial head compression fracture healed. So I start PT today for 4-6 weeks 2 time a week. What I want to know is how has the after healing riding been? I currently ride full rigid.


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## Old Head (Sep 6, 2010)

I'm 2 months out from a grade 3 AC separation. The doc (his specialty is shoulders) said he normally wouldn't operate but since I do sports 6-7 days per week, he wants to use a cadaver tendon to tie the clavicle and scapula together. I'll get a 2nd opinion in 9 days. 

On the weight machines my pulling (back) strength is about 70%, my pressing strength is only 15%-25% of my uninjured side. The wild card is that I'm 60 which means I should heal more slowly than a young person. 

Most of the posters above seem to recommend against surgery but without shoulder stability, I can't see my strength increasing much at all, especially since I've been lifting weights for 46 years and could do 1 arm chin ups until the injury.

For the benefit of those injured in the future, I'll update my story when changes occurr..


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## tracerprix (Dec 26, 2009)

Here is the xray from the day I went OTB on 4-3-10









Here is it 3 months later. See how much further the separation is. I wonder why?


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## Old Head (Sep 6, 2010)

I'm seeing 2 different orthopedic surgeons next week about my grade 3 AC tear. Feel free to send me questions that you have about grade 3 AC tears. I'll add your questions to my list of questions and then report back on the forum with the doctors answers. My appts are Sept 15 and Sept 17.

The first doc wants to use a cadaver tendon. I'm going to ask if there isn't a stronger synthetic material available. It will be my first appointment with the 2nd doc.


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## G-reg (Jan 12, 2004)

Since this keeps getting bumped up.....I'm a week or so away from two years out on my cat 3/4.

I did not have surgery, partially because my job frowns on retained hardware/spare parts. But also because after 3-4 second opinions it felt like the Ortho Doc's really just wanted to do an uncommon surgery. Thing is that *none of the surgeries actually repairs the ligaments*. All going under the knife was trade the odd bump for a scar, and bring the two parts close together so you can have an operation later in life when the joint is terribly arthritic.

I'm not a Doc, and far be it from me to imply they would rather do 20K worth of surgery rather than just send you home with a sling and a scrip for some narcotics...................

That said my shoulder is stronger than it was prior. I only notice the separation when I sleep too long on that side or when doing things like wide grip pull ups.


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## Old Head (Sep 6, 2010)

G-reg

You are correct about the ligaments. On a grade 3 the ligaments are completely torn and are useless. The surgical procedure my doc suggests uses a cadaver tendon to tie the clavicle and scapula together. Prior to the grade 3 AC tear, 2 ligaments secured the clavicle to the scapula.

My doc was opposed to surgery the day after the injury. I was the one who wanted the surgery, not him. Because of the number of sports I do (wakeboard, kiteboard, jui jitsu, surf) he said I was not the usual case and that the surgery would help me.

My injured side lifts approx. 20% as much as the uninjured side on pressing motions and lifts 70% on pulling motions. The injured area muscles haven't gotten weaker. The muscles are still strong but are not able to exhibit strength now that the bones are no longer tied together to stabilize the shoulder. Any pressing movement, even 10lbs is very herky jerky. 

I haven't made my final decision but surgery seems like the best choice for me.


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## G-reg (Jan 12, 2004)

Old Head said:


> G-reg
> 
> ..... cadaver tendon to tie the clavicle and scapula together........


Note that there is a big difference between tie and repair. The surgery won't really gain you the stability back. Surgery or not it is muscles compensating and the scar tissue that encapsulates the blown up ligaments that eventually brings back stability.

Also think about the forces that popped those ligaments in the first place. Would the surgically repaired shoulder take that hit?

The one ortho I saw described it like this: "I don't know how religious a man you are so I don't want to offend you.....But the AC joint is more from the swinging from trees section of evolution."

Just make sure you are getting something beneficial from going under the knife.:thumbsup:


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## Old Head (Sep 6, 2010)

G-reg thanks for the reply. 
I am 64 days out with no shoulder stability. If I forego surgery, what type of time range do you think before I notice some shoulder stability? 

Does the scar tissue form on each torn ligament to reattach them together and reestablish the connection of scapula to clavicle? I'm lifting every day and I haven't noticed any muscle compensation yet as movements are herky jerky. I'm seeing a 2nd doctor next week. Hopefully I'll be armed with intelligent questions from what I've learned from you and others on the forum. My first doc didn't say much. Thanks again.


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## G-reg (Jan 12, 2004)

At two months I was still pretty unstable, no pain anymore but I had to be careful. If I recall correctly one of the surgeries can actually kinda repair one of the ligaments IF done within 24hrs of the injury. Otherwise those three ligaments are toast. The scarring encapsulates the ends of the clavicle and scapula-nubbin, the ligaments doing nothing anymore. Muscles will eventually compensate, as if the clavicle was never there. 

At two months if you are able to work out enough to determine that you are still herky-jerky....you're probably doing pretty well. Give it some more time, maybe get on a dedicated PT program. 

Good luck with the second opinion, make sure to say "this guy on the internet said" as much as possible.


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## flogger13 (Oct 5, 2010)

I separated mine (Grade 3) 6 weeks ago, after 12 days of that pain we all know!! It was feeling better. After a few visits to the hospital. I was offered the Opp by the surgeon and advised of the complications. After much research, and if I'm honest the thought of that lump on my shoulder forever. I decided to go for the operation (Weaver Dunn), Was done 4 weeks ago today. Recovery was going fine until this week at PT, I informed them that i was getting pins and needles in my little finger and my ring finger and that I had shooting pains at my shoulder and neck. I was given some tests and some new exercises to do. I was told I have some sort of nerve damage/ trapped nerve. and that I need to go to the doctors and get some Amitriptyline. I don't like taking painkillers and have taken the minimum (When waking at night) amount throughout the recovery. I checked them out and don't really want to go down this road.

http://emedicine.medscape.com/article/1244885-overview

http://www.google.co.uk/search?clie...oe=UTF-8&redir_esc=&ei=SCirTN38Apm8jAeVz_zJBw

On returning home I researched and found that the nerve in question is the Ulnar Nerve, (from your shoulder around your elbow to your wrist then fingers) And that I may have ulnar nerve entrapment. I was sure this was a consequence of the Opp. (Bugger) After some more digging I found that this could have happened

Because the elbow was immobilised for a length of time.

I was not told this by the surgeon or the PT that visited me after the Opp?? 
Can't seem to find any similar experiences, Yet I feel this information should be out there. I am hoping to get an appointment the next few days or next week to discus the matter with the surgeon..

I would say "be careful of the amount of time you immobilise your elbow wouldn't want this to happen to anybody else.....Ask your doc about it".

Hopefully if its not degenerative, I can sort this with good PT..... Really Not looking forward to another Opp

Les T Morris Age 43


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## MindTrik (Nov 10, 2008)

Got my separation a week ago Saturday....OH WHAT FUN...Pain is a LOT better now and I am 10 days in and not wearing the sling all of the time...doctors said use it as needed...sling was driving me nutz! Feels like a migraine in my shoulder now instead of an elephant sitting on it. The first day it happened...I couldn't even get out of a chair without agonizing pain..getting out of the bed was an adventure as it was on an air mattress in a tent...Grade 3...the bone opposite the collar bone isn't totally under the collar bone...so it isn't a full Grade 3...but I do have the bump and it...HURTS


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## twistedlizard720 (Apr 3, 2006)

flogger13 said:


> Recovery was going fine until this week at PT, I informed them that i was getting pins and needles in my little finger and my ring finger and that I had shooting pains at my shoulder and neck.


That's a bummer. Don't feel completely left out though. It seems that my arm falls asleep much fast on the effected arm. I sometimes worry about nerve damage and blood flow. At this point I am 10 months post of the separation, 2 months post PT which made a great difference. At this time I am not getting surgery, but it may be an option in the future if things continue to degrade.


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## Colcal77 (Oct 7, 2010)

*lev 4*










just happen, lev 4...doc said no surg and just to tack it ez....really. had mri and e-xray.


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## Colcal77 (Oct 7, 2010)




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## Colcal77 (Oct 7, 2010)




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## Old Head (Sep 6, 2010)

2 orthopedic surgeons told me that I had a grade 3 AC tear. I got an MRI. 
Since I had no strength in my arm and couldn't play any sports, I opted for Weaver-Dunn surgery 10 weeks after sustaining the injury. I requested a copy of the surgery report which said that I had a grade 5, not a grade 3. Apparently that wasn't evident to the surgeons by looking at the x-rays and MRI. 

When I see the doctor again (5 weeks after surgery), hopefully he'll tell me to discard the sling and start rehab. The surgery took a lot of energy out of me. I went to the gym 11 days after surgery to lift with my good arm. I wasn't very strong. When I went home I collapsed and slept for 2.5 hours and woke up feeling exhausted. I guess my body has marshalled its resources to heal my shoulder and doesn't have the energy for other physical demands.


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## jathanas (Dec 9, 2009)

Did my grade 2 separation in June. Within 6 weeks I was back on the bike. The shoulder was nowhere near 100% but I kept at it, finding satisfaction in the small progress I was making.

4 months out and I'm much better. I can sleep on it! Pushups and chin-ups are still a little weird. MTBing is fun again and I've nearly regained full confidence on the descents 

Helpful tip: I'm doing kettlebell workouts and they've done wonders for shoulder stabilisation.


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## Old Head (Sep 6, 2010)

Type 4

This is a type III injury with avulsion of the coracoclavicular ligament from the clavicle, with the distal clavicle displaced posteriorly into or through the trapezius. This injury is generally acknowledged to require surgery.


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## manosteel00 (Aug 31, 2009)

lol....I came across this thread while researching if my collar bone is going to permanently stick up. Guess I found out the answer is yes!

My story: August 2010. Won a work trip to Lake Tahoe, took a close friend of mine. We are staying at the Ritz Carlton in Truckee (North Tahoe) and are looking for something to do. We look up the mountain and see a bunch of dudes going up the lift with bikes.

We talk to the biking guy and he suggests if we want to take it up a notch, we do downhill. This is after a several red bull and vodkas, so it sounds like a good call. Mind you I've never mountain biked before and had limited BMX experience up until I was 16 (10 years ago). 

I figured things were going to turn out bad since I kept on landing on my front wheel and couldn't fix it. I made it down about halfway before I flipped over my handlebars, not sure what happened since I blacked out.

I somehow made it down the hill and thought I dislocated my shoulder. Had some really nasty road rash all down my back too. Since it was the first day of the vacation, I chose not to go to the hospital and just party it off. It really sucked. 

Finally got back home, went to the doc. Grade 3 separation, borderline grade 4. I still feel it and need to get back into lifting after a few months off. Oh, and I'm never touching a freaking mountain bike again...lol.


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## AntiNSA (Oct 29, 2009)

I never had any physical therapy, and no fancy doctors or doctors I couild understand in China. Thank god, no bump... but even more so seems pretty useable a year later... believe in your body. Hope you guys are ok too,


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## Old Head (Sep 6, 2010)

I was in a sling for 5 weeks after surgery for my grade 5. The doc said to throw away the sling and to rehab. He said I could lift light weights like 5lbs. I used to curl 30lbs dumbbells but now 5lbs is too heavy! I'm using 3lbs until I get stronger. A 1st grader could handle more.

Normally one has about 30% more strength in the eccentric part of the lift vs the concentric part of the lift. That is, if one could curl 100lbs, one should be able to resist while lowering 130lbs. Oddly, I have noticeably more strength in the concentric part of the lift vs. the eccentric. I can curl 3lbs ok but lowering the dumbbell is very shaky.


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## cannonman (Jul 11, 2010)

Everyone is giving updates, so I'll give mine.

Grade 4 - Opted for the surgery. If done within 2 weeks, the surgeon said that there is a good chance that the ligaments will reattach and heal, just like when you get stitches to push the sides of a laceration together. Mine was done 1 week out from the accident. The procedure was the AC Tightrope. You can see the procedure at http://actightrope.orthoillustrated.com.

Was in a sling for 3 months to allow the ligaments enough time to heal. I'm two months into therapy, this week being my last. Most of my range of motion has returned. The shoulder feels normal now, just that the muscles are still sore as they are rebuilding strength. As for the bump, everything looks great so far. I've been using Mederma on the scars and it does a great job of reducing them. I honestly don't know why everyone is so up in arms about having a scar anyway. Does everyone here have secret modeling contracts?


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## carter1 (Jan 30, 2004)

I have a grade 2 A-C separation, just happened last Saturday in Pisgah (ended a long overdue mountain trip early). Went to ER, got the x rays. Spoken with a couple of Dr. friends, they said take it easy for the first couple of weeks, then use it as I can. Not much of a lump yet, but I hear that will come with the scar tissue. 
The part that really sucks is the thought of dragging that damn trainer out of the attic so I can get some pedal time in.
Good luck to those in my boat. At least cold weather is almost upon us.
c


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## freemanhoodlum (Feb 1, 2011)

funny that this is my first post on mtbr......but i joined the club.........1/31 i took a jump on my bike, front wheel hit the mud on the landing, stuck and sent me flying. luckily for me my right shoulder was kind enough to take the fall for me. went to er and then to ortho next day. unbelievable pain - ortho says stage 3 w/no surgery and 6 weeks to recover (not be completely normal by then but really light activity till then). my wife wants me to have the surgery because she is worried that 30 years from now i won't be able to move my shoulder due to the lack of ligaments. what do i tell her?

enjoy, jason


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## twistedlizard720 (Apr 3, 2006)

freemanhoodlum said:


> funny that this is my first post on mtbr......but i joined the club.........1/31 i took a jump on my bike, front wheel hit the mud on the landing, stuck and sent me flying. luckily for me my right shoulder was kind enough to take the fall for me. went to er and then to ortho next day. unbelievable pain - ortho says stage 3 w/no surgery and 6 weeks to recover (not be completely normal by then but really light activity till then). my wife wants me to have the surgery because she is worried that 30 years from now i won't be able to move my shoulder due to the lack of ligaments. what do i tell her?
> 
> enjoy, jason


Here is my suggestion. Talk with your ortho again and see what the differences are between surgery now and surgery one year from now or even beyond that. Then make a decision.

A little input. I saw an ortho two weeks ago and he told me they could have reconstructed the joint within the first 6 weeks (which my ortho 14 months ago failed to mention). Now my only option is the Weaver-Dunn procedure which he explained is more of a patch job. The thing I didn't like was the ortho said surgery may solve my issues completely or just ease the pain a little. It wasn't a firm answer like I was seeking. I am 14 months post injury and if I knew about reconstruction then, I would have had surgery right away.

I am in a position where I can go either way. I tend to be on a constant rollercoaster. Pain gets worse, I do PT and it bets better. It has really been bugging me lately (again) and plan to start physical therapy (again). I'm going on a short deployment here in a couple weeks. That will give me a good idea if I can hang as is, or need surgery. It really puts a damper on my activities I enjoy.

I am curious what results everyone else has had long term with their choice, and what kind of pain they have, if any?

My bump now


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## Sonoran_Flyer (Sep 22, 2008)

I would go see an Orthopedic Surgeon with a Sports Medicine background.

My AC was a grade 3/4. The clavicle had penetrated almost thru the skin.

I had Anatomically correct tight rope procedure. 
It has a long recovery time, but is one of the strongest repairs. 

It will take about 1 year for full recovery. 

I am very happy with the results.


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## AntiNSA (Oct 29, 2009)

I dont know about surgery. I was pretty ****ed up. It was embarrasing and painful. I couldnt **** by my self or even move my arm for like5 days. After the wreck, I had to try to gather my shti so the villigars wouldnt rob me or see my injury as a sign of weakness and rob me.

I got to the hospital. Seen some poor gu with a broken back. No pain medication , insurance or money. He was in pain. At one point I cried a little ( I should say that at that time I had sleep deprevation, like sleepng 3-4 hours a night for months) shouldnt have been on a 30 krede to work...

Hells no I didnt want to have an operation on a serious part of my body like that. With all of mankinds so called expertise. I had a serious brace. Kept my arm immobile for about a week. Sometimes would but this horse collar brace on to alleviate the pain. Now, more than a year later... Everything is pretty cool. Sometimes wearing a back pack is not so comforatble as before.. but I cant say for sure.

I am having thoughts of joining the French foreign Legion. At one point in my life I joinded the US af special forces team, and know that its a good workout. I am wondering if my shoulder could handle the training.

It sure would be nice to hae a new identity from some country other than the US that would provide social benefits for my children.


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## freemanhoodlum (Feb 1, 2011)

i thank you guys for the replies...i believe i have an appt w/the ortho in 2 days at which point it will be 2 weeks from the injury. i am progressing pretty well - range of motion coming back but no real strength - except for sleeping which has to be done upright w/pain med. and the achiness! man i went w/out the sling for the most part of yesterday and by the end of the day my entire shoulder was tired and aching. i guess that's just part of the body adapting to no ligaments in the shoulder area?

thanks for all the info on this thread.

jason


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## AntiNSA (Oct 29, 2009)

I would advise against operations. MAny sports doctors dont recommend operations, and the specialists I shpwed my exray also recommended healing naturally . I have no bumb. yyou can see my xrays earlier in this thread. The doctors locally in China said I needed them and would never be able to use my arm to reach up. They were wrong.Im good. Save your money. It hurts like hell and will for a while, but youll bounce back.


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## freemanhoodlum (Feb 1, 2011)

i spoke w/the ortho surgeon's office again today and they advised against surgery as well unless it was absolutely needed. their rationale being that why operate if you can return your shoulder to acceptable levels w/out it. when i asked about 30 - 40 yrs down the road their answer was the same as mine - deal w/that then IF it's a problem

how long did you guys stay away from other cardio; i.e. running/eliptical/etc

thanks again,
jason


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## AntiNSA (Oct 29, 2009)

MAn I dont know how bad yours feels.. Id say like the first 3 days I couldnt move it, It happened on a friday if I remember....For the first day it hurt pretty bad. Ive never broke a bone so I cant compare... on Monday I had to take a day off work as a teacher. I couldnt afford to take off tuesday, it was hell. Had to take the bus instead of my bike. I had this figure 8 collar brace type thing that I wore fora week... and only after when the pain was returning. o had a sling for the first week... but mainly couldnt move my arm. I cant recall how long... read back through these posts. I took it pretty easy for a couple of weeks before getting back into it. Just whatever you do dont push it. I had no therapy, other than life.


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## freemanhoodlum (Feb 1, 2011)

yeah, mine was probably the worst pain i've ever felt - and i've broken plenty of bones - it nearly made me pass out and throw up several times. the hospital here gave me pain med - i don't know how you made it w/out it! it seems my range of motion is coming back pretty well - i'm actually surprised - but don't wanna screw something up and set myself back! i've had the sling on for the better part of 2 weeks now. heck, i can actually type w/my right hand now (moving the arm around) compared to when it first hapened i couldn't even walk w/out pain for the first 3 days and that was w/pain meds! i guess i'll start slowly here and see how it goes!

thanks!


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## AntiNSA (Oct 29, 2009)

Yeah I can remember hearing your description. Whatever you do dont push it. I wouldnt try any therapy. When it hurtsm stop moving it. Try to rest it in a position you want it to heal in. Take a lot of some kind of standard pain med... advil like... youll heal. The body is amazing.


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## lytleric (May 4, 2006)

I got the same advice with my Grade 3 AC separation. In fact I saw three different docs and they all said the same thing - let it go on its own and see how you do. (One of the doctors actually had the same injury on BOTH sides.) Do I like the permanent deformation of my shoulder? Heck no - at times that makes me wish I could have had it fixed. However, almost four years later, it functions at 99% of what it did. 

Took about 3 months of rest/recovery before I got back on the bike. 6 months I was back to 90% of strength/motion. One year later I was at about 98% back to normal. It looks bad, but it works fine.


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## carter1 (Jan 30, 2004)

We gave my grade 3 12 weeks of therepy, it didn't heal. Saw the (highly recommended and referred) doctor group yesterday, we're scheduling the surgery today for a couple weeks out. I'm really looking forward to getting this fixed, most painful, annoying, debilitating injury I've ever had. 
c


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## freemanhoodlum (Feb 1, 2011)

carter1 said:


> We gave my grade 3 12 weeks of therepy, it didn't heal. Saw the (highly recommended and referred) doctor group yesterday, we're scheduling the surgery today for a couple weeks out. I'm really looking forward to getting this fixed, most painful, annoying, debilitating injury I've ever had.
> c


i hate to hear that. one way or another it will be good to move past this injury. i would have never thought how much a shoulder injury could affect everything you do until this happened! good luck w/the surgery.


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## freemanhoodlum (Feb 1, 2011)

well, update, i'm a month out of grade 3 separation and did not have surgery. i can do most things normally, w/about 80 - 90% rom, but my strength is slow to recover. i am doing rehab at home w/the "rubber bands" (which work quite well, btw), have begun riding again on easier trails and felt completely comfortable. i ran for the first time yesterday and was pain free. i can't sleep on the side at all and haven't tried. stillhave the nasty bump on the shoulder, but that's ok. 

i can do most exercises w/very little weight and can do push ups from my knees w/out pain. all in all i'd say God is good to me  the clunky shoulder is a bit wierd to get used to but i barely notice it now.

good luck to all in recovery!

jason


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## g00mba (Mar 9, 2011)

Hi all,

I'm 6 days into my grade 3 separation, and cant get over the amount of contradictory information out there. It's like opinion on every aspect of it is 50/50 (early rest v active PT, surgery or rehab, sling or no sling, healing ligaments vs non-healing). Even doctors don't seem to agree.

I think there's some *myths about AC separation*, the biggest being that *AC ligaments can't heal*.
*This isn't true*. They are just like any other ligament. that's not to sat that they will heal well, or completely in all cases, but they don't just snap and that's the end of it. That's why some say the best time to operate is the first 10-14 days following the injury as this is before the healing process is too far underway.

The operation itself is designed to move the bones closer together in order to heal better, this is why they usually remove screws post-operatively after about 12 weeks because by this time the ligaments have usually knitted back where they are supposed to be.

info on ligament repair mechanism here

For those of us electing to go without surgery, I think we can do a few things to put the odds in our favour. I'm not a doctor, and this is the first AC separation I've had, but this will be my approach based on the idea of allowing the ligaments time to heal in alignment.

*immobilize the shoulder for 3 weeks*
use PT tape to support the joint, and pull the clavicle down into position. Use a sling and spend as much time in a position that reduces the bump. avoid standing as much as possible as the weight of the arm increases the gap between the clavicle and acromion. I find when I lie down and push my elbow up, the bump almost disappears. In this position is where I want to heal and where I want to spend as much time as possible.

*start light physio in weeks 4-8*
Keep the arm immobilised as much as possible but also do some exercises that will keep the joint moving. very light movement. Absolutely no movement above shoulder height. Some light riding may be possible. put the arm in sling when not using it, the ligaments are still knitting together.

*Remove sling increase physio and start light off-road riding week 8-12*

*build strength 12 weeks +*
after 8-12 weeks the ligaments will be as good as they are going to get and its time to build strength and get out riding again

Of course, all may not go to plan, ligaments may not heal properly, or I may still have chronic pain, but I think it helps me to have recovery plan and some milestones.

I'll keep you posted on whether this works or if I got it all wrong.

-G


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## JefPol5 (Mar 23, 2011)

*My Story*

So I injured my shoulder in July 2010. I though I dislocated my shoulder when I drove myself to the hospital. They xrayed my shoulder and said that it wasn't dilocated, it was separated (type 3). The er doc put me in a sling and told me to see an ortho for surgery on Monday.

I went to the first ortho and the first question she asked me was what I did for a living. She then told me that I didn't need my shoulder for my line of work and that I should let it heal on its own. I wanted a second opinion.

Went to second doc who also asked me what I did for a living. He also said that he doesn;t rec surgery and I should let it heal on its own. i tried to push for surgery but he convinced me to wait 8 weeks to see how it heals. 8 weeks later I went back and still wanted surgery. He sent me to a third doc.

Third doc also asked me what I do for a living. I replied, "Why does my vocation dictate my course of treatment? I want my shoulder fixed." This doc performed a modified Weaver-Dunn. He used surgical tape and shaved off a little from my collar bone.

I am 16 weeks post surgery. No bump, big scar (so what), and full range of motion. I am slowly getting my strength back. I'm at about 60% There is still some movement/instability in my shoulder.

My advice to anyone in this situation....
DEMAND surgery immediately. I wasted 16 weeks before I got surgery. I believe I would have been so much better off had they gone in and fixed me immediately.

DEMAND SURGERY. (screw the scar.)


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## qkenuf4u (Jan 24, 2009)

good luck with it is all i can say.. got flipped over the bars on my bike back in april 07... landed square on my shoulder (230lbs of me),,,,,,, collar bone was about an inch high out at the arm (humerous/scapula)... by the time i got to the hospital in the back of the bumpy ambulance it had popped about half way back into place... they put ice on it and by the time the doctor seen me it was pretty normal looking..... 
so anyways got a ride home with my ex at the time, it hurt pretty bad and was really hard to get out of the cushy couches we had at the time.... 
so i took that week off work and just kept using it how ever much i could (being nice to it)... had to go back to work the following monday and didnt have a choice but to use the arm.... it got better EVERYDAY i used it.... within a couple weeks it was fully movable and only gave me pain every so often...
the collar bone is still about a 1/2" high now but works fine w/ no pain .... it took about 6 months or so before i stopped haveing twinges of pain at certain postions of my arm...
good luck with it and do what ever you think is right...
oh and this is the *MOST PAINFUL INJURY *IVE EVER HAD    !!!! (head truma, broken cheek bone,concusion x 3,wisdom teeth all at once)


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## idahodirt (May 6, 2010)

Well, I just joined this club 3-31-2011. My experience seems a bit different here so far. I am 49 and have been abusing my self for some time now. I took a spill on a paved bike path in a city park. I won a class III full AC separation. It hurt bad the first few hours. What struck me was how familiar the pain was. I realized I have been tearing away at these ligaments for some time. The last time I hit them hard was around 14 months ago when I dismounted from an ATV on an ice covered road. No big crash, just landed right on the shoulder. It hurt like hell for a long time, but no visable separation so I just toughed it out like always. When I had this last bout, I must have been down to a very low percentage of ligament left because the pain is subsiding very fast. I crashed on a Thursday night and was back in the mountains riding with a pack and all on Sunday. Would have been Saturday but it was rainy and cold. Back at work hanging commercial cabinets on Monday. Still some pain but way less than last time. X-ray showed a 40mm or so drop of the shoulder but no broken bones. I know we all talk about the "bump" but it really appears that the clavicle is where it is supposed to be and the rest of the shoulder has dropped, because it is no longer supported by the clavicle. I am working out of town so I have not had a chance to consult an Ortho yet, but will soon just to make sure I know all the options.
Has any body else had the same result of relatively low pain and quick recovery? If I didn't have the obviuos deformation, I wouldn't have thought twice about this. 25 years of racing through the rocky and steep mountains and I get this in a city park:skep:


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## freemanhoodlum (Feb 1, 2011)

[Has any body else had the same result of relatively low pain and quick recovery? If I didn't have the obviuos deformation, I wouldn't have thought twice about this. 25 years of racing through the rocky and steep mountains and I get this in a city park:skep:[/QUOTE]

i didn't have the cool part of your injury, that being little pain in the beginning - because it was awful. but i have had a bad shoulder for many years. but when the pain started going away, it went away in huge chunks. i'm a little over 3 months out of my injury and have been back to complete normal aside from about 5% reduction in r.o.m. for over a month and a half. strength's back, everything. no surgery here, just simple rest, then rehab, a bunch of prayers, and the doc said i was good to go. he said from the word go that if it didn't hurt i could do it and that sounds like where you're at! good luck!

jason


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## radials (Jan 22, 2009)

I caused this same exact injury to my left shoulder about 5 years ago as well. I say caused because my dumbass grabbed too much front brake and went head first over the bars at about 20-25 mph. Luckily my reflexes are quick and instead of hitting my head, I rolled quickly to land on my shoulder. 

I will tell you that I never had any surgery and I was back to "normal" within about 3 months. I still to this day have the "bump" where my clavicle sticks up, but I have no pain, ever, and I military press with 80-85 lb. dumbbells to this very day.

The pain will be with you for quite some time, but it will go away and you WILL get back to feeling great again.

In fact, I recommend a supplement called "Osteobolin C" or "Osteosport." Both are made by the same company, and as far as I'm concerned it's a miracle supplement for joints, ligaments and tendons. I used to have tendonitis about and tennis elbow to the extreme when I started lifting again about about 2 years ago. I started taking Osteobolin C and could INSTANTLY feel relief day by day. Now, I don't even take it anymore and I have ZERO pain from tendonitus. I'm not a sales rep for them by any means, but I can assure you the product works. The key ingredient in it is called "cissus." You can find a ton out about it.

Anyhow...that's my rant...


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## jimmydean012 (Mar 31, 2007)

I had a Grade 2 (self diagnosed) separation while doing some gravity riding. Digger into a rock garden at about 15mph, landed right on my left shoulder. Immediate pain, weakness, general nausea. Could get even lift my arm above my belly button. Stopped on the way to get a sling, and rested. Day after hurt even worse, for about 2 weeks I could not use my left arm at all. After the initial inflammation went down, I started doing some diagnostics. There are many resources online to research (although I always recommend talking to licensed medical professionals), and I diagnosed with a Grade 2 with subscapularis tear. I could feel the unstable AC joint when pushing on my scapula, and I used the degree of pain to judge how healed the joint was. When I felt it was strong enough to try some light rehab, I immediately worked in some VERY light rotator cuff rehab. This was about 2 months after my initial injury. I could do light riding at this point, just no serious movements or hard pulls on the bars. I was 95% after 4 months. It is now about 6 months later, and except for another real light reinjury of the same joint, my shoulder is 100%. The labral tear on my right shoulder, however, is another story.

Bottom line, take it easy, get your diet dialed, and your body will do its thing.


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## carter1 (Jan 30, 2004)

The doctor released from me from the sling today! Still a long way to go, but at least I've shed the last of the "bandaging." Doc says the healing has gone well-the past 6 weeks of misery has paid off and I'm ready to start more movement and strengthening over the next 6 weeks. 
Be careful out there.
c


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## carter1 (Jan 30, 2004)

and now......it squeaks, not an exaggeration-it really squeaks when I move the shoulder back and forth. I guess that's better than not being able to move it!
c


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## radials (Jan 22, 2009)

carter1 said:


> and now......it squeaks, not an exaggeration-it really squeaks when I move the shoulder back and forth. I guess that's better than not being able to move it!
> c


Get some White Lithium Grease, put it in a syringe, and inject in sockett! LOL!

No, seriously look into the Osteobolin C supplement I was talking to...it will work wonders for you.


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## tracerprix (Dec 26, 2009)

radials said:


> Get some White Lithium Grease, put it in a syringe, and inject in sockett! LOL!
> 
> No, seriously look into the Osteobolin C supplement I was talking to...it will work wonders for you.


What does the Osteobolin C supplement do?


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## radials (Jan 22, 2009)

tracerprix said:


> What does the Osteobolin C supplement do?


I don't want to drop any spam on the forums, but if you'll Google "Osteobolin C by Applied Nutriceuticals" you will find their site. In fact, I advocate just about any product they sell. I am a weight lifter amongst other activities (MTB, longboarding, swimming, etc). I used to have tendonitis VERY bad, and now I no longer have it due to, I believe, taking the Osteobolin C for about 3 months.

Here is an excerpt from their website:

*"Osteobolin-C approaches joint support from a completely unique angle. The primary ingredient in Osteobolin-C is Cissus Quadrangularis, a powerful Ayurvedic herb that has been proven in published laboratory research to promote bone and connective tissue repair.

The active phytosterols in Osteobolin-C also promotes healthy muscle tissue due to the pronounced anti-catabolic effects of blocking cortisol. Osteobolin-C users experience dramatic reduction in joint pain and increased mobility, along with accelerated recovery time after rigorous training or injury."

* Aids in the recuperation and regeneration of cartilage, tendons, and joints
* Suppresses cortisol and promotes nutrient delivery into connective tissue
* A potent anti-catabolic that speeds recovery and supports lean muscle
*


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## tracerprix (Dec 26, 2009)

I'll try it.


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## carter1 (Jan 30, 2004)

*I'm back!!!*

My buddy that drug me out of the woods and to the hospital turned 40 Saturday and did a 40 mile all surface ride to celebrate. I got permission from my PT to ride 5 easy miles on the road with the group.

A little sore, nothing a beer couldn't take care of. Unbelievable how your perspective changes after 6 months off of a bike (after 45 year of riding). One of the best rides of my life. It will be a while before I'm off road, but at least its a start.

c


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## ICAsh (Sep 24, 2009)

Mine is minor compared to you guys. Washed out on a corner on a road ride mid-February on some sand/salt and landed on my right shoulder. ER said minor separation, didn't give me a grade. Put me in a sling and basically told me it would be fine in a week or two. No bump, 2 1/2 months later there is a small one and it's very tender. Riding normally doesn't hurt, putting the bike on the truck/wall rack hurts a ton. Limited range of motion; I can't take a shirt off normally. Due to being a poor grad student with state funded health insurance, there was a wait to get into another doctor. Have an appointment in a couple weeks.

Should a separation that the ER doc said was so minor really not feel any better after 10 weeks?


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## propguy (Oct 2, 2008)

@ ICAsh - You should have good to full range of motion and maybe some minor pain when your arm is extended high over your head. I suffered a Grade 2/Grade 3 separation in a race Feb. 13th of this year. Doc said NO sling - need to keep it moving. Started riding week 3. I now have full range of motion with some minor pain at full extension over my head. Some minor clicking/popping that's not painful just annoying. Nice large bump to scare off the kids. Others I have talked to said it takes a long time before pain goes away, but it will for the most part. Everybody is different. Don't worry and keep moving your shoulder and keep riding! Good luck.


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## snellvilleGAbiker (Apr 30, 2009)

*Grade V-VI ac separation*

Here is my Xray








No surgery for now per Dr.Karas, the shoulder Guru of Atlanta. In 3 months IF i am not happy w/ the recovery, he then can perform surgery. We'll see. It's only been 3 weeks and i've ridden on the road and trail. I'm going to PT tomorrow.


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## g00mba (Mar 9, 2011)

I tried a lot of taping to the shoulder in the early weeks to reduce the joint after reading this thread:
http://www.wakeworld.com/forum/showthread.php?t=776955&highlight=joint

I was really hoping I'd get lucky, but It didn't work for me, but it may be worth a try. I still tape it now after 10 weeks in the vain hope that scar tissue will keep the shoulder down. My bump is very prominent. My x-ray looks like the one above. although my bones seem to overlap more.

I'm able to do pretty much everything now, but with some pain. Riding a bike is pretty good, but pulling up on the bars or braking hard is painful. I started off-road riding after 5 weeks and each ride feels better than the last. I've not taken a tumble yet, and I'm riding on flats just so to give myself a better chance if I go over.

I've seen 2 surgeons, The first said leave it and see how it goes. 8 weeks post-injury the second surgeon told me it was a pretty bad separation and that he thought that I'd be back at some point to get it fixed. In the UK the waiting list is 6-12 months.

The recovery after surgery is much longer than the non-surgery route. My surgeon told me 6 months to a year before it feels normal. 4 weeks in a sling, 4 weeks of no movement above shoulder height, then lots and lots of therapy.

I think I'll go for it though. I hate the bump and so does the wife. It doesn't make me feel tough or cool. It just makes me feel sick


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## ICAsh (Sep 24, 2009)

Update. Crashed in mid-February directly on my right shoulder. ER doc said minor separation (didn't give a grade), put me in a sling, and told me it would be better in a couple weeks. I felt like it was a "here's a bandaid, quit being a baby" response, but my insurance sucks so I had a wait to visit a primary care doc. I finally had an appointment yesterday. 

They did a new set of xrays and said it was probably tendonitis, and sent me to physical therapy today. The PT told me that Ortho had looked at both new and old xrays, and since the new ones were at a slightly different angle, they could see a collarbone fracture that you can't see in the original ones. So, no wonder I'm still hurting. It's healing, and small enough that they wouldn't have treated it much differently, but it would have been nice to know, and I probably could have started PT sooner. And the separation is still there.

My insurance lets me do 60 days of PT as often as they want to see me, so I have 3 appointments in the next 2 weeks and we will assess from there. Got a big dose of anti-inflammatory via iontophoresis (2 more next week), and I'm supposed to take 1200mg of ibuprofen a day, plus ice and some stretching exercises. Luckily riding doesn't bother it, so I'm not off the bike. Focus is getting the inflammation down so I can regain some strength and range of motion. I just want to be able to lift my bike up onto the truck again!


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## snellvilleGAbiker (Apr 30, 2009)

*Sucks*

ICASH...It sucks that you had to wait that long to start PT. My suggestion is to do the PT religiously.

Update on my condition....I saw the shoulder surgeon this morning and he cleared me to do whatever i want. I started PT a week after i injured my shoulder. So i did three weeks of PT 2x/week and the improvement on my strenght and ROM is obvious. I'm getting stronger and will continue to do PT at home. Good luck to those in the same boat and do your PT.


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## carter1 (Jan 30, 2004)

first single track ride yesterday since my injury last November. Longest my bikes have been out of the woods in a long long time-6 months and 2 weeks. Walked stuff I haven't walked in 35 years of riding in the woods! It's ok though, I rode
be careful out there.
c


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## snellvilleGAbiker (Apr 30, 2009)

Carter... i hear what you're saying bro. I walked stuff that i was like "really?" but at least we r riding in the wood. Yeah, be careful and be safe.


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## pooOnU (Feb 14, 2011)

Hello all, so about three to four weeks I took a little tumble and ended up with a concussion and a grade 3 AC seperation. I could barely move it for about a week but once I stopped using the sling it started to feel so much better and I started getting my range of motion back. Now I have all my range of motion, a little lump on my shoulder and it only hurts when I lay on it. 
The doctor told me basically not to use it for 2 to 3 months but that seems like a very long time. I was just curious how long you guys waited before lifting again and any good strength training exercises to start with? I am so tired of only doing legs at the gym. 
I also went for my first ride today since I injured it. It seemed ok but I cant help but feel that if I fall directly on my shoulder or an out stretched arm it will hurt like hell. Since so many of you guys seem to have experience with this type of injury I was wondering if it is the type of injury that I can expect to be reoccurring injury every time I fall on it wrong?
Any input would be greatly appreciated


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## g00mba (Mar 9, 2011)

Hi poo,

I'm 3 months into my separation I think mine was a grade 5. My shoulder had dropped about 3 inches.

I taped it down nearly every day for 3 months and now I only have a 1/2 inch bump. I will continue to tape until I think that there's no more point. I would highly recommend doing this. I use zinc oxide tape in 5cm widths and strap it down hard, get someone to help you.

I rode very carefully at 4 weeks and built up from there. Now I ride all trails but not as confidently as before. I have had a crash recently, put my arms out to save myself, and the shoulder did hurt like hell, but is better after a couple of days. Many of the top riders in our sport have this injury. Personally I'd avoid putting yourself in a crash situation for 2-3months, but will depend on you. I still can't do a press-up, maybe you can. Perhaps consider getting some road miles in for fitness.

I tried doing weights at about 5 weeks, but I didn't like how it felt so I stopped. Will give it a try again in another 2 weeks, but will start with really light weights. I think weights are a good idea to give the shoulder some extra support, but give yourself a bit of time to heal.

Surgery is an option, but you will be out of action for months. Personally I now wish I had it done straight away.

Everyone is different, and what may work for some won't for others. There's a lot of opinion on this injury out there even among professionals, so do your own research. All I'm doing here is sharing my experience.


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## Turbo78 (Jun 14, 2011)

*Undecided on shoulder surgery:*

Hello all. I stumbled upon this forum and have found that a lot of you have had a similar experience to my own. I actually separated my shoulder Approx. 10 years ago. There was never a real event that I know of to cause the separation. I played college soccer and I was always struggling with minor injuries. My girlfriend (now wife) noticed the clavicle protruding and asked me about it. I honestly had not even noticed at the time. Eventually I started to get sore and went to see an Ortho doc about 10 years ago. He took x-rays, said it was separated, but no surgery b/c the surgery was too painful and I should wait until I'm older and in more pain before I go that route. I don't know the grade of the separation. My guess is 2, maybe 3 at the worst. Fast forward 10 years. I've gotten pretty active with lifting weights and riding. The shoulder is starting to hurt more now. Sometimes it takes several minutes in the hot shower in the morning to reduce stiffness. I'm having trouble deciding when enough is enough. I don't think my separation is as serious as a lot of the ones I've read about in this forum. I do have the slightly unsightly bump on my shoulder. I was hoping there had been some medical advances in this amount of time. Any guidance would be appreciated.


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## Chrisf_999 (Aug 15, 2008)

Carter, I'm a week out of surgery for grade 5. How long were you off even a road bike? I haven't been able to pin down my Doc...too early still. I'm 44 and the thought of losing all my conditioning is incredibly depressing. Thanks - Chris


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## g00mba (Mar 9, 2011)

Turbo,
You need to find a really good surgeon who will talk you through your options. There are apparently over 100 different types of surgery to deal with this injury. The success rate is around 90% according to my surgeon, but I've seen lower statistics. There's still not much agreement on what the best method actually is, so I guess the procedure will be down to your surgeon.

I'd do some searches on AC separation or shoulder separation, and get up to speed. There's a lot of voices against surgery, but they are mostly from those who didn't try it. I think most of those who had successful surgery probably don't bother trolling forums for AC separations like the rest of us do.


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## Turbo78 (Jun 14, 2011)

Thanks g00mba. I think I'm going to spend the summer getting up to speed on these surgeries. I didn't know there were that many types of surgery for this. I also don't really want to ruin good times at the lake and pool with my daughter this summer. I agree in that I'm much more likely to give feedback on something when I'm upset than when I'm satisfied. After my research I think I will have some serious talks with some surgeons in the fall. Sorry for the reasons you guys are on this forum, but I appreciate your posts.


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## g00mba (Mar 9, 2011)

No worries, very sensible to wait until summer is over. I'll be doing the same, and I'm looking forward to picking up the kids again without considering how much its going to hurt all of the time.

After surgery The recovery time is several months depending on what procedure you have and who does it. I'd like to link some articles, but I haven't made enough posts to provide links. Here's some searches instead:

About the success rates of different types of procedures:
"Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: A review of published literature"

About the different types of procedures (there are lots and lots of variations, but this boils them down to just a few types):
Shoulder doc.co.uk Stabilization of the Acromioclavicular Joint

In a nutshell, the first article reveals that whichever type of procedure you have, the results are similar, but notably that 1. screw fixation carries a higher risk because the screw can break, detach, and migrate to other parts of the body, and that 2.non-disolvable threads used to tie the bones together can cause bone erosion.

There seems to be a preference for modified Weaver-Dunn procedure, and from what I have read, people seem most happy with this procedure. It involves removing the end of your clavicle and attaching a redundant ligament to keep it in place. It sounds brutal, but to me seems like the best option. In the US Cadaver tendons are used to help keep it in place, and this sounds like a good idea to me as long as you don't mind the idea of it. They will dissolve slowly while the ligament transfer heals. 

People who have had Weaver Dunn surgery seem the most content, while those that seem the least content are those that have had a k-wire to hold the bones together. These seem to pull through the bone more frequently. I read somewhere that using two k-wires is a much better option, but I can't remember where I read that.

Of course I'm not a doctor, but I have spent 3 months obsessing over this injury and have therefore done many hours of reading, but the key to success I think is to find an experienced specialist surgeon who understands sports injuries and has had plenty of practice at fixing people.

Hope this helps.


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## PaulJ (Mar 23, 2004)

About a year ago I was going through a rt hand sweeper; narrow path lined w/ pine trees, flat hardpack, so speeds were fairly quick (around 20mph), my rt arm & shoulder clipped a 'misplaced'  tree on the inside of the turn which pushed me & the bike upright, partially tossing me off the bike. 

My left shoulder hitting a pine tree on the outside of the turn is what stopped me. I don't remember the degree of seperation, but here's the xray (remove the spaces to use the link since I don't have enough posts for links yet)

http: //i4.photobucket.com/albums/y143/pj350/Xrays. jpg

I went to a few secessions of PT, but at over $40 a visit I refused the remainder and started doing the exercizes at home. The doctor and the PT people placed a huge emphasis on maintaining a full range of motion and to fight through all but the most severe pain to do so even if it ment using my good arm/hand to pull my left arm through its full range; as it would preserve the range of motion as the healing process occured.

After 1-2 months of not being able to move my arm on it's own without extreme pain I was weight training with very light weights, then progressed to 'full weight' weights a month or two ago. Regarding the current situation, every so often there is a little grinding/popping, and what feels like minor joint weakness; but since I continue to do weight training, my shoulders have never been stronger.

I also have the satisfaction of having a good story... having to ride 3 more miles through twisty singletrack and 6 miles back home just using one arm


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## g00mba (Mar 9, 2011)

Did it look like this:

http ://s1109.photobucket.com/albums/h430/grantbroome/?action=view&current=shoulder-public. jpg

Great trick with the spaces!


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## PaulJ (Mar 23, 2004)

Thankfully my dislocation was much less severe (a grade 2-3), just a small bump remains on top of my shoulder. 

I still can't ride at speed with the same confidence as before, just knowing what another "off" could mean for my health and job; then again it's much safer not going 10-10ths.

Some great info in this thread!


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## xcguy (Apr 18, 2004)

This is my reply fully 20 months after my injury. And it's aimed at those in some serious job/family situations where losing time at work is a big deal.

I am finally back to 100% but still not riding. I guess I got to the age (I ain't telling but I bet it's more than you) where injuries were more severe than before 'cause of the healing ability and time. This is the longest stretch of time I've been injury-free for about 4 years and I love it. I'm strong in the gym, I don't hurt much, I'm not recovering from my latest injury (read: going back to zero in my fitness only to start again only to be hurt again etc etc).

What I'm saying to you older riders is, as addicted as I was to riding, I'm addicted to being in one piece and functional these days. You gotta consider your obligations outside riding and family obligations is a lot. Who here has a job that allows you to be laid up for months every year? I don't.


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## socalMX (Oct 31, 2009)

Just took a spill yesterday trying to work my way out of a rut on a downhill,got chucked in the air and landed on my shoulder!OUCH,separated shoulder!!! I am amazed that I was sent home from the ER same as I walked in,there was nothing they could do for me.A shot of Morphine and a splint is all.I always thought a shoulder could be popped back into place??? My next step is to see a specialist and get an MRI done!


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## Chrisf_999 (Aug 15, 2008)

A dislocated shoulder is what's popped back in. A separated shoulder is where the ligaments that hold the clavicle in place are damaged. I just had surgery, so its all still pretty fresh in my mind.


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## socalMX (Oct 31, 2009)

Oh,o.k...Was your surgery from a dislocation or separation?Most people opt for not having surgery,yours must have been bad!Here is a pic of my Nomad,im 210 lbs. and crashing down on my shoulder sucked!Hopefully I will be able to ride again REAL soon!!!


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## g00mba (Mar 9, 2011)

Chris, can I ask a few questions?

1. How long after the accident did you have surgery?
2. What procedure did they do? Weaver Dunn?
3. What have they told you about the recovery time? I've read its quite long. 

Can you also let us know how long you need a sling, are you allowed overhead lifting etc...

Thanks.

Grant


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## Chrisf_999 (Aug 15, 2008)

I had a grade 5 separation. The ligaments were completely torn. I had surgery 1 week after my crash. I have to wear my sling 24/7 for 6 weeks and then might be able to start a little PT. I was told 3 to 6 months before I could get on a bike and probably 12 months before "unrestricted mtbing". I was released last week (2 weeks from surgery) to ride a stationary recumbent and do computer work and hiking. I'm progressing faster than expected, so I hold out hope of mtbing earlier than 12 months. 
I'm not sure of the name of the procedure, but they used a cadaver ligament to pull the clavicle down and drilled two hole in the clavicle to thread the ligament through. Then put two screws in the holes. Also, I have an anchor on my shoulder for the end of the ligament. By the way, I saw two docs before having the surgery. I went to a sports shoulder specialist in Dallas, TX for the surgery.


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## Shawnie Shawn (Nov 7, 2006)

Chrisf_999 said:


> I had a grade 5 separation. The ligaments were completely torn. I had surgery 1 week after my crash. I have to wear my sling 24/7 for 6 weeks and then might be able to start a little PT. I was told 3 to 6 months before I could get on a bike and probably 12 months before "unrestricted mtbing". I was released last week (2 weeks from surgery) to ride a stationary recumbent and do computer work and hiking. I'm progressing faster than expected, so I hold out hope of mtbing earlier than 12 months.
> I'm not sure of the name of the procedure, but they used a cadaver ligament to pull the clavicle down and drilled two hole in the clavicle to thread the ligament through. Then put two screws in the holes. Also, I have an anchor on my shoulder for the end of the ligament. By the way, I saw two docs before having the surgery. I went to a sports shoulder specialist in Dallas, TX for the surgery.


Almost the same exact deal for me. Grade5, had surgery two weeks from accident because that's the soonest the Dr. could do it, Sling for 3 weeks post surgery(I see yours is six which is a bummer), I am just over 4 weeks post surgery and starting PT next week. I have been able to improve my range of motion alot during the last week but still hurts real bad at the arm just above parallel point any direction. Not supposed to lift anything more than coffee cup in that arm (very hard to keep from doing that without sling). Was told off bike for three months and then very slow when I can. Can't ride hard for about year without increasing risk. I had the same surgury you did with cadaver ligament. My Dr. is Sports Medicine Dr. who specializes in shoulders only. This whole deal completely sucks but I have to move on and be positive like everyone elseI


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## Shawnie Shawn (Nov 7, 2006)

Chrisf_999 said:


> I had a grade 5 separation. The ligaments were completely torn. I had surgery 1 week after my crash. I have to wear my sling 24/7 for 6 weeks and then might be able to start a little PT. I was told 3 to 6 months before I could get on a bike and probably 12 months before "unrestricted mtbing". I was released last week (2 weeks from surgery) to ride a stationary recumbent and do computer work and hiking. I'm progressing faster than expected, so I hold out hope of mtbing earlier than 12 months.
> I'm not sure of the name of the procedure, but they used a cadaver ligament to pull the clavicle down and drilled two hole in the clavicle to thread the ligament through. Then put two screws in the holes. Also, I have an anchor on my shoulder for the end of the ligament. By the way, I saw two docs before having the surgery. I went to a sports shoulder specialist in Dallas, TX for the surgery.


Almost the same exact deal for me. Grade5, had surgery two weeks from accident because that's the soonest the Dr. could do it, Sling for 3 weeks post surgery(I see yours is six which is a bummer), I am just over 4 weeks post surgery and starting PT next week. I have been able to improve my range of motion alot during the last week but still hurts real bad at the arm just above parallel point any direction. Not supposed to lift anything more than coffee cup in that arm (very hard to keep from doing that without sling). Was told off bike for three months and then very slow when I can. Can't ride hard for about year without increasing risk. I had the same surgery you did with cadaver ligament. My Dr. is Sports Medicine Dr. who specializes in shoulders only. This whole deal completely sucks but I have to move on and be positive like everyone elseI


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## socalMX (Oct 31, 2009)

Man,my recovery sucks so far,grade 3 with no sergury required! I feel for you guys,im sure for you as well,the biggest pain is not doing the things you love to do!


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## jimsandler (Jun 22, 2011)

It's been 24 days since my grade 3 shoulder separation. I was out of the sling after only 6 days and have been very disciplined in doing lots of PT on my own since then. I figured that if I was able to go out and ride for 3 hours then I can find 90 minutes a day to speed up my return to the trails. I do lots of pendulum arm circles while leaning over, a huge series of partial strengthening exercises with resistance bands (like just the final push of bench press with injured arm already fully extended or a small lat pulldown movement without ever bending my elbow), also internal & external rotation work for my rotator cuffs with the resistance bands, shoulder shrugs with dumbbells, and lots of stretching work either against the wall or with the assistance of using a wooden stick which I hold with both arms so the healthy arm can help the injured one. So it's lots of strengthening, stretching & range-of-motion stuff, then I ice it for 30 minutes, do it all twice a day for 45 minutes at a time. It's a long process ... my injured side is noticeably more functional every single day but also still a long was from full healing.


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## pk123 (Jul 18, 2011)

About 2 months out from a grade 3, no surgery. Strength and range of motion improving, but small movements like brushing my teeth or washing my hair causes poping/clicking in my shoulder. Anyone else go through that? Does it go away? More rest or more PT to get rid of it?


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## Burning Matches (Mar 14, 2011)

Yep -- four years since my grade 3 separation, no surgery, strength and range of motion are 99% of pre-injury, but yes I have a clicking/popping in that shoulder with basic movements. Hasn't really bothered me much, but it's always there.


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## jimsandler (Jun 22, 2011)

today is 6 weeks since my grade 3 separation ... yeah, i had a lot of that popping/clicking with little movements like washing/drying hair, brushing teeth, shaving, etc., especially early on, while i was building up my strength, flexibility & range-of-motion. but the situation improves more everyday ... just keep at it ... stretch it constantly, massage it, use resistance bands while twisting rotator cuffs in every direction, lean forward over floor and do pendulum arm swings, use light dumbbells to do shrugs, shoulder rows (without bending elbow), shoulder bench press (without bending elbow), hold a light medicine ball with both hands and SLOWLY draw circles or figure-8's with your arms, be creative & persistant ... it's just a matter of time.


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## Speedjester (Jul 14, 2011)

I had a complete separation on my shoulder...my clavicle actually moved down almost 2" into my upper chest... I was in the middle of nowhere so slowly manipulated the clavicle back up into position... Picked up a bag of ice at the store and headed home.. Next day was at ER... Dr tells me I separated my shoulder big time... He explained my surgical options and concluded by stating that I might not have a problem do to my muscle structure.. Well iced it for about two weeks then right back to the gym...Working shoulders hard..

It's been two yrs... I can bench press 445lbs shoulder press 235lbs Only issue are flys, shrugs and dead lifts... (I can do them but sometimes it looks like the clavicle is going to pop through the skin ) ohh and the bump is hardly noticeable 99% of the time..

My buddy suffered basically the same injury had surgery last yr... He still can't throw a ball..

I'm glad I waited and didn't jump at a surgery I really didn't need..


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## qkenuf4u (Jan 24, 2009)

pk123 said:


> About 2 months out from a grade 3, no surgery. Strength and range of motion improving, but small movements like brushing my teeth or washing my hair causes poping/clicking in my shoulder. Anyone else go through that? Does it go away? More rest or more PT to get rid of it?


4yrs later since my seperation.... all pain is gone, full range of motion, still have some poping/creaking in it every so often.. doubt youll ever get rid of it all... just give it some time...


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## jimsandler (Jun 22, 2011)

Speedjester said:


> My buddy suffered basically the same injury had surgery last yr... He still can't throw a ball..


yeah, that is something i'm really looking forward to doing again. as of now, i can only throw a pebble 12 feet!


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## socalMX (Oct 31, 2009)

4 1/2 weeks after my grade 3 and im ive been doing some lite XC...My pain is still there but minor.I attribute my speedy recovery to being a gym rat prior to getting hurt! I have also spent alot of time in the jacuzzi stretching and working on range of motion.Im actually doing some triceps/biceps workouts at the gym now!


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## seegmiller (Dec 27, 2005)

I got mine the evening before 911, by showing off and hitting hard after an endo. The doc said, you can pick a big bump or a big scar. I picked the bump. I was hurting when 911 unfolded, and it gave me an excuse to stay in bed and watch TV. But in six weeks, I was back riding, and bump and all, have not slowed down since.


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## g00mba (Mar 9, 2011)

Nice to see some good results with the non-surgical route. I wish I had the same experience.

After 5 months I decided enough is enough and booked myself in for surgery. I started riding again at 3 weeks, and gradually did more and more and I've just come back from a week in the alps. The shoulder works well on the bike apart from pulling up hard on the bars, where it just feels loose, but picking up the kids, pushing a wrench, attempting to do a press-up or tying my shoelaces just aggravates the injury and causes me pain. 

My separation is quite severe (grade 5) with zero stability. I can move my clavicle over an inch in any direction, I can pull my arm in towards my body so far that the tip of my clavicle protrudes further than my shoulder, this also happens when I sleep on my good side. I don't get much popping or grinding because the tip of my shoulder sits below the tip of my clavicle.

The surgeon is going to use a Nottingham surgilig to replace the CC ligaments. From what I've read its a very successful technique and eventually becomes as strong as the original ligament. Movement and exercise is encouraged after only 2 weeks, but heavy lifting should be avoided for 3 months.

I wish I could have avoided surgery, I gave it 5 months, but its time to bite the bullet and to be honest, I'm also looking forward to getting rid of the lump. I'll let you know how I get on.


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## jimsandler (Jun 22, 2011)

g00mba said:


> Nice to see some good results with the non-surgical route. I wish I had the same experience....


Good luck with that, g00mba, keep us posted on your progress. Today is 8 weeks since my grade 3 separation. I've mostly been keeping active with 3-hour hikes, 35-mile road rides and this week I touched weights for the first time since the injury (could only flat-bench 35 pounds and lat pull 70 pounds) and of course doing a ton of PT. I'm planning to return to mountain-biking next Wednesday with an outdoors group I've gotten involved with (coincidentally lands on the exact two-month anniversary of my crash, lol). But I'll be wearing a jersey from Troy Lee Designs that has 28 protective pads in it since I still can't manage any kind of a crash otherwise yet.


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## g00mba (Mar 9, 2011)

Thanks Jim. Good luck with your ride and rehab. A padded shirt sounds like a very good idea. 

I guess that on the plus side if you have a grade 3 separation you can't really damage it much more than it already is (although there are grades 4,5 and 6 to consider), but you still have to go through the pain. I've had a couple of minor spills on that shoulder or outstretched hand, and they all hurt. Best idea is to take it easy and walk the bike rather than fall off. This is easier said than done when you are out on the trail though 

It seems that lots of people are making a near-full recovery after their injuries without surgery, so I hope you do too. It's worth giving it some time to see how you get on, but for me, although I've been active over the past 5 months my recovery reached a very low plateau (I'd guess 30-40% strength and constant residual pain between 1-3 on a scale of ten) and I needed to do something about it. 

Hopefully my surgeon knows what he's doing. He's a shoulder specialist and using one of the latest techniques, so I'm fairly confident he can put me back together


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## criblo (Aug 6, 2011)

Hey all. This is my first post. On July 2nd I took a tumble on asphalt going 40-45 mph. I ended up with a grade 5 separation. It is raised to far up that it pulls my neck to that side. A good 3 inch or more drop in my shoulder. I had an internal battle whether or not to do surgery (3 docs highly recommend that I do.) and opted to have it done. I will go in Monday. I would have done it earlier but the surgeon wanted my road rash and broken ribs/arm to heal a little first. Right now I am VERY weak on that side and have like 75% range of motion. Pain is substantial when reaching across and reaching up especially when there is resistance. They're throwing some cadaver ligaments in me, slicing off the end the the clavicle, drilling holes in it and anchoring it to the coracoid. I'll post an update post surgery.


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## socalMX (Oct 31, 2009)

Pretty banged up!Good luck with that sergury!What were you riding/driving on the pavement?


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## robdeanhove (Dec 8, 2005)

I did mine too, "just" a grade 2, here's a pic of it with me doing my best to hold it all in position to minimise the pain:

SEE MY BLOG HERE










12 weeks on and I just won a 24hr race with my girlfriend! Had to drop out of ones at
5 weeks and 10 weeks after though as the shoulder couldn't take it :-(

Here's me getting taped up before trying to race 24hr solo at 5 weeks - a tad optimistic it turns out!










A really nasty injury an AC separation


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## herbn (Sep 17, 2005)

*the road bike heals*



carl1266 said:


> I had a type 3 seperation in spring last year. My doc told as long as I don't experience any pain I can do whatever I wanted. After 10 days I was back on the road bike and after 6 weeks I did some easy trails. About 3 more weeks and I could ride everything I did before. Today I have no pain or any issues, just a lovely cycling lump.


i've always thought that once i can get back on the roadbike and or exercise bike , that just about any injury would heal quicker, due to improved circulation.Hell it might just be that it makes the down time from mountainbiking pass quicker,i'll take that.


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## ChrisfromNC (Aug 18, 2011)

*Grade 3 on May 11, 2011*

Took a bad fall on a trail and got my grade three certification in May of this year and was very down and depressed for a few days (I also had a broken rib, collapsed lung and dislocated fingers). I then read this whole thread and it did me a world of good to see others bouncing back. I went to the Doc and it turned out he was THE shoulder doctor for an NHL team. I got lucky on that one! He told me to keep my arm in a sling, but take it out if I was comfortable doing it. He said to move it and let the pain let me know if I am doing too much. I joined the gym and kept my legs in shape with a recumbent bike. At first, my arm seemed to be stuck in a downward position, but each day it gained a little more range of movement. But I had to sleep sitting up for about two months, which wasn't easy at first, but later it almost seemed normal. I only wore the sling for about the first 3 days. I was back on my mountain bike after about 1 1/2 months riding very gentle roads. Rode a 64 mile race about 2 1/2 months after the accident, but I was extremely careful not to take another fall. I have a nice bone sticking up on my shoulder, but other than that, I think it will be ok. I am now almost to the point that I forget that I have it. My dislocated fingers are another story. I lost a great deal of flexibility with them and pt hasn't helped. I have to wrap an ace bandage around the handlebar to be able to fully grip it. I only have a few more months and then scar tissue will keep the fingers from getting any better. But ride I will!

Thanks for your posts. They gave me a lift when I really needed it.


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## Bozeman (Aug 25, 2011)

Like many others before me, it was a relief to stumble across this thread. I landed on my shoulder in a ski crash (it's winter in New Zealand) nearly three weeks ago - the result was a class 3 separation. The bump on my is ugly as can be but at least I'm in good company...


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## Bozeman (Aug 25, 2011)

Continuing from above... Reading through the stories above, I find the personal variation in the injuries to be quite interesting. As for myself, although I have this hideous bone trying to pop out of my skin, I actually have very little pain and a nearly full range of motion. And this has been the case since about Day 3. Maybe because I had been doing regular shoulder exercises prior to the injury?

Sleeping has been a pain but I can now sleep on the "bad" side for at least short bursts. I was worried about being able to run and did lay off for a couple of weeks. I'm back at it now with no problems.

Even though the bump grosses my wife out, I have not considered surgery. Good luck to all!


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## jimsandler (Jun 22, 2011)

Today is 11 weeks since my grade 3 separation. I went back to road biking & hiking after just a few weeks ... and finally 2 1/2 weeks ago (on the 2-month anniversary of my crash), I started mountain-biking & weightlifting again. Thanks to endless PT, I've got good strength, flexibility & mobility ... it's the "stability" that's still a problem. Like I can only bench-press 50 pounds nine times right now before my shoulder feels like it might collapse ... and hitting the bottom of a ditch on my bike after even a small hill while my chest & collarbone are leaning way forward gets a quick wince out of me. But I just keep at all my exercises with the resistance bands, medicine ball & constant stretching, getting a little stronger everyday ... tick, tick, tick ... I know that I will eventually get completely back!


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## zlander79 (Sep 1, 2011)

About a year and half ago I got on my friend's road bike and since I hadn't ridden a bike in years decided to see how fast I could go, 40mph later I was on my way to the hospital. Lots of stitches due to gravel and I couldn't remember the day leading up to the point where I opened my eyes to blood coming out of my face. Good times.

After that I kept riding and eventually got my cannondale f8. I was only off for roughly two months. The doctor said I didn't have to get surgery for it since "you're no tennis star". I wish I had been more proactive about getting it fixed since it is still not properly attached. Aside pain (gets sore quickly) which I've gotten used to my only concern is hurting it again, which has lead me to use my face and other arm to break a few falls. 

I also have the lump thing although the size of it varies. It's covered a big puffy purple scar too.


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## jimsandler (Jun 22, 2011)

zlander79, yeah it's true that ligaments that are completely torn do not re-attach so you have to build up all the surrounding muscles in your shoulder deltoid muscles (anterior, posterior & medial), your upper back (rhomboid & trapezius) & rotator cuffs to keep everything in place. I've done TONS of physical therapy with resistance bands & medicine ball but my shoulder still gets really tired after just 90 minutes of mountain-biking. This is 12 weeks since my injury and I'd really prefer to ride about twice as long. And yeah, I am still totally afraid of falling again but I have not yet so I haven't had to use my face. Good luck!


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## carter1 (Jan 30, 2004)

Chrisf_999 said:


> Carter, I'm a week out of surgery for grade 5. How long were you off even a road bike? I haven't been able to pin down my Doc...too early still. I'm 44 and the thought of losing all my conditioning is incredibly depressing. Thanks - Chris


Sorry for the late reply. I did a couple of short rides at around 8-10 weeks, but was really too weak. I've done a few decent mtb rides, but am still extremely cautious. I'm still unable to pull on the handlebars. I did a 12 mile mtb ride last night with my old riding group and struggled desperately to keep up, and didn't do that good of a job. I used to be near the front of the pack. Unfortunately, I lost a LOT of fitness.

I had CC re-construction and a SLAP repair. 
This past Monday was my 6 month surgery anniversary, I was released from surgeon's care and PT this week. They want me doing light weight lifting and continued ROM exercises. If I do this, they say I'll back to "normal" in another 6 months.

Good luck!

c


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## Ikeraya (Jul 27, 2011)

Grade 3 with a torn trap muscle. 

OTB on Paradise Royale 3 hours from the ER. After the shock of the accident wore off, I found my clavicle sticking way out. ER docs in Garberville told me there would be no surgery. I thought because it was a one room hospital in the Heart of the Emerald Triangle that there'd be other answers out there... After I got home, I researched solutions on the internet only to find the same. Two days later, an ortho doc also confirmed the non-operative rehabilitation.

I pushed for a second opinion and exactly one month from the accident I was operated on. 

I wondered if I had made the right decision. There were so many people who chose the non-operative route with great success stories about how well they had recovered. I read about a guy who was able to do chin-ups right after separating his shoulder. I read about a woman who was a tri-athlete who returned to her sport successfully with a regimented rehab. Further pushing the doubt was my awesome recovery in-between the accident and the surgery. I was able to do push-ups right before the surgery, I was finally able to sleep on my injured side all night, I had complete range of motion and I could throw a football. Did I make the right choice?

The doctor who performed the surgery is fresh out of his residency at UCSF. He had only done one AC surgery before but I was quickly sold on him. He told me that he would get the surgery done if it was him and that he would consult with his mentors. UCSF? Does it get any better?

It has been a week and a half since surgery. Doc was happy after the surgery. He said that I had grown massive amounts of scar tissue that he had to cut away to sew up my ligaments. Yep, no Weaver-Dunn or Tightrope, just sewn ligaments. I thought that I was for sure going to have some holes drilled in my bones and that healing ligaments would be out of the question. Pretty stoked.

I'm going to be sleeping in this recliner for a long time. I often wake in the middle of the night with pain in my deltoid. I'm supposed to be in a sling for 5 more weeks. Sometimes I feel like I do too much with my arm... buttoning my pants or my shirt or holding jars in my hand. I went to the A's game today and I started clapping my hands to cheer. Dumb.

I'm keeping a blog if you want to follow my recovery. Gauchowork.blogspot.com

ike


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## TahoeBC (Apr 11, 2006)

Fack, I just joined this club last Sunday, seeing my Orthopedic Surges tomorrow. Doctor I was riding with at the time believes it was a class 3


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## BeanMan (Jul 6, 2006)

I joined the club on a solo night ride 2 weeks ago. Grade 3 and no surgery. So far so good, I'm still in the sling for another 3 weeks. I started PT this week and am planning for the best. Ski season here I come.


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## criblo (Aug 6, 2011)

Okay I am a month out of surgery for my grade 5 separation. Day one was terrible because the nerve block 100% failed so I spent the day popping oxys and sleeping. After day three there was really no need for narcotics and ibuprofin was sufficient. I was supposed to do range of motion exercises from day one. After a week and a half I felt better than I did before the surgery (which was performed a month after the accident.) Now at 4 weeks I am out of my sling, have close to 100% range of motion, practically pain free unless a lot of weight is applied towards that shoulder. It was about a 4 inch incision but definitely beats what it was before.


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## g00mba (Mar 9, 2011)

Criblo, what surgery did you have?


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## criblo (Aug 6, 2011)

It was one with cadaver grafts. He cut off the end of the clavicle, drilled two holes in it tied it together with the shoulder blade, stitched the ligaments together with the cadaver graft. It was not any name brand technique such as tightrope or graftrope but seemed to work well. 4 weeks after surgery and i am able to go to the gym and strengthen it will little problems..


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## TahoeBC (Apr 11, 2006)

So Doc said grade 3 separation, prescribed 4 weeks of PT. Said really the only reason to get surgery was if I was a pitcher or quarterback and really I'd just be trading a scar for a lump in the shoulder. After some research beforehand I had pretty much decided this was the way I wanted to go also, seemed like the quickest way t get back on the horse so to speak.

Got in my pool yesterday and found my arm can float up pretty much pain free and I can move it around with out the pain of gravity bothering it, seems like that will be good for rehabbing besides the PT, Doc agreed.


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## socalMX (Oct 31, 2009)

USE THE POOL...Jacuzzi if you have acess,thats what I did! 2 months into it now and im almost at full strength,even in the gym with weights!The weightlesness in the water does wonders for the range of motion.I didnt even go to PT and I ditched the sling after a week!


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## twebeast (Mar 30, 2008)

I stuffed mine last Wednesday, so I'm in day 9. Absolute pain at the time, I had to drive myself an hour to A&E, sit around for 2.5 hrs "and all I got was this lousy sling". That's A&E for you.

Yesterday they confirmed I had a Type IV and suggested I have surgery sharpish.

Having had initial dispair of smahing my shoulder up, the rapid restoration of mobility over the past week had really got my hopes up that I would be fixed up in a couple of months, and had mentally awarded myself a Type II, so the recommendation to have surgery came as a bit of a shock.

I'm getting a second opinion today but suspect for me it's more a question of what kind and who does the surgery.

What I've learned so far:

1) If the ligaments are completely torn, they are not going to grow back on their own.

Your muscles can grow to adapt; however folk who are particularly active (that means you if you're on this forum), are more likely to aggravate it and never fully get back what you had using just Rest & Recover approach.

It does make me wonder how your shoulder's going to be in old age when you can't constantly condition it however?

2) Everyone's injury is different, so make sure you listen to your doc, not just the forums. Getting a specialist opinion and preferably more than one specialist's opinion is probably the best thing you can do early on.

3) If you opt for surgery there is a difference between acting fast or acting later:

i) If you act fast, some procedures allow for the ligament to grow back around an artifical substance (such as tightrope ACJ procedure). The longer you leave it, this stops being an option I think?

ii) This forum has alot of reports of folk taking several months to recover using non-surgical approach. And of that, quite a few then either go for surgery or wish they had.

My view is that I'd rather recover once than twice, which is what you will have to do if you leave it and then decide to operate later. Since I'm in grade IV camp the weighted opinion seems to be to go for surgery anyway, so that perhaps makes my decision easier. But from what I've seen, even grade II and III sufferers could/ should at least consider it as an early option.

4) Quite a good website for ACJ dislocation is this one:
ACJ Dislocations

Len Funk is apparently a leader in this subject field.

They do an iphone app called shoulderdoc aswell, for the biker geeks amongst us.

5) Recovery from surgery looks like a monster downer. This looks like the biggest draw back.

I've not really seen much on the 10% of "non-successes" (or failures) that reportedly happen with surgery. I'm hoping to learn more on that later today.

Anyways, thanks all for your commentary on this forum; if nothing else it makes me feel part of a very large community! And slightly less stupid for doing it.

...now where's the helpful person who stuck a log around that corner...


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## twebeast (Mar 30, 2008)

Hilarious, well I got my second opinion, which was that I've type II to III and that shouldn't have surgery... what to do heh!

I asked about long term effects of not fixing it (re my point about relying on muscles when you're older), and it seems as long as it is pain free, you don't get arthritis or any other age related problems from relying on the muscles.

In terms of what the surgery failures are, the failure rates I've been quoted are in the region of 10-15%. And a failure tends to mean the op isn't entirely successful, ie. the tightrope, or whatever else is done to pull the bones together, loosens a little after the operation so doesn't achieve quite what it set out to; so it's not as if that 10-15% is a high impact risk. 

There are other possible generic surgery complications, associated with anesthetics, infections or trapped nerves I would guess.

Anyway, the fact I've received an entirely contradictory view between two specialists in the space of just 24hrs suggests to me that this is a fairly inexact science and open to alot of debate :-/

As for my next steps, I'm going to push for an exchange of X-Rays between the two specialists and see if either will adjust their position to a point where I have something a little more consistent to work from.


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## bloodpuddle (Jun 15, 2007)

No offence, but this was one club I wasn't planning to join.

Unfortunately, yesterday a momentary loss of concentration has landed me here. Oh well.

I'm interested in what experience anyone's had with getting back to *long distance swimming* after an AC separation. While mtb is my first love (sport-wise), I'm a keen distance swimmer and terrified I've just killed that...


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## Burning Matches (Mar 14, 2011)

bloodpuddle said:


> I'm interested in what experience anyone's had with getting back to *long distance swimming* after an AC separation. While mtb is my first love (sport-wise), I'm a keen distance swimmer and terrified I've just killed that...


I'm not a distance swimmer by any means but did swim competitively in my younger days and now occassionally churn out laps during the off-season to stay in shape. I can say that after recovering from my grade-3 separation, swimming was different and took a while to get used to. I could definitely tell that everything was not connected the same as it used to be on that side. At times it felt like my collarbone was going through my neck.

After a while however, I got used to it and don't even really notice much anymore. Maybe my stroke adapted, or I regained my strength, etc. Basically I think you will be fine eventually but it will be different at first, that's for sure.


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## bloodpuddle (Jun 15, 2007)

Burning Matches said:


> I'm not a distance swimmer by any means but did swim competitively in my younger days and now occassionally churn out laps during the off-season to stay in shape. I can say that after recovering from my grade-3 separation, swimming was different and took a while to get used to. I could definitely tell that everything was not connected the same as it used to be on that side. At times it felt like my collarbone was going through my neck.
> 
> After a while however, I got used to it and don't even really notice much anymore. Maybe my stroke adapted, or I regained my strength, etc. Basically I think you will be fine eventually but it will be different at first, that's for sure.


Thanks, that's reassuring, although I'm still coming to terms with having done damage that is actually permanent.

Saw the orthopaedic surgeon today and it seems I have a low grade 3. I was a bit surprised actually, because I'm not really in much pain now (day 3) and seem to have pretty good movement back already.

Anyway, surgery isn't indicated, at least for the time being. Need to get some physio for the next 4 weeks along with regular NSAIDS. Then re-evaluate. The doc said I had a very good chance of being back to riding and swimming in 6-8 weeks, albeit with more caution required...


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## TahoeBC (Apr 11, 2006)

Pretty happy with my recovery 1 week out. Been hitting the pool several times a day seems to be helping a lot. ROM is coming back and did a 10 mile hike yesterday.

Hope to start doing some easy road rides in a week.


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## teckyb (Sep 13, 2011)

Happy to say i am now part of this club. Not sure why i am happy about it but at least there is this forum for hope and information - seems to be a lack of it on the internet.

I done mine 16 days ago wish i could say how but i was extremely influenced by alcohol and when i woke up in the morning i couldn't raise my arm in the air.

2 weeks in the swelling has gone down and now i can see the dreaded bump! Haven't got it xray'ed as seemed very little point as ROM/Pain started to improve and there didn't seem like a bump so i thought it was just a grade 1 but now the bump and i get a little bit of a popping nose if i retract my shoulder blades gives me the impression that it is grade 2 plus the fact that i can't do any weights (bench/chin ups) without pain. Add in a delt strain and a trap strain for good measure

As one of the other members said its a joy when you can wash your hair or put your tshirt on without pain, i am not 100% there but its getting better every day.

Just started to tape my shoulder to see if it will push the clavicle back down (got every fingers and toes crossed) but not sure how successful this will be but will give it a go.

Been doing my PT - i am in the profession so designed my own one - and can't believe how weak all the muscles are compared to my non injured side add to the fact that there looks like a bit of atrophy as well on the injured side.

Will upload a couple pics from day 2 and now so you can see the difference. Getting it xrayed tonight just so i know the extent of the damage, wish i done it sooner to be honest but to suborn.

Thank you for everyone story its reassuring to know that you get back to full recovery even it takes a while - 2 weeks before this i fractured my wrist so its going to be a good few months in total before i can do any sort of lifting


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## teckyb (Sep 13, 2011)

Just had it xrayed, not good. He said visually doesn't look bad added with the fact that i have full Range and good strength but the xray suggests another story and for that i am booked into see a shoulder specialist next week. 

Thanks to work i can't see them sooner as they wanted me in this week but can't make it. Will keep you updated.

Not the best news i wanted to hear


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## Shawnie Shawn (Nov 7, 2006)

teckyb said:


> Just had it xrayed, not good. He said visually doesn't look bad added with the fact that i have full Range and good strength but the xray suggests another story and for that i am booked into see a shoulder specialist next week.
> 
> Thanks to work i can't see them sooner as they wanted me in this week but can't make it. Will keep you updated.
> 
> Not the best news i wanted to hear


Bummer, Sorry to hear. I am at about18 weeks after surgery and have been out for a few rides. I am going real easy as I don't want to have gone through all this to f*ck it up again! I just surrendered to the fact that I would be off the bike for a while and not be able to ride like I want to for 6-9 months. I let go of the "I can't wait to ride" thing after a while and know that if I do everything I am supposed to do, I will be back to myself and my riding before you know it. Don't rush anything with the recovery. Good luck!


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## teckyb (Sep 13, 2011)

Thanks for the reply Shawnie.

What surgery did you have? How long you out for? And is it a big scar? 

My job is extremely active - picking up weights/coaching people in the gym etc so if i am out for a while means not good news - Plus i love to work out and at the moment i can't even do a press up. Hammering out some rehab stuff everyday.

What are peoples experiences with taping it down? I am going to try it tomorrow to see if it reduces the bump for good, anyone experience good progress? Only concern i have is that i am a bit late and its started to heal in this position you know?


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## bloodpuddle (Jun 15, 2007)

teckyb said:


> What are peoples experiences with taping it down? I am going to try it tomorrow to see if it reduces the bump for good, anyone experience good progress? Only concern i have is that i am a bit late and its started to heal in this position you know?


I have no personal long term experience to report yet (day 5), but my physio today told me that taping won't do anything to reduce the bump, and that the research is that it makes no long term difference to appearance (my ortho dr said that too).

Makes me kinda pissed that in the ER, on the day of the injury, I had two of them simultaneously hauling down on my shoulder with tape. Hurt like #$&%. :madman:

Having said all that, the physio did tape my shoulder up today, but for the purposes of taking some of the weight off the shoulder muscles & joint and providing a bit more stability. It didn't involve yanking down on the clavicle or anything horrible.

It did, however, involve me shaving down my chest - I thought real mountain bikers didn't shave down anyway... 

I think my liberal use of emoticons today reflects my far more upbeat mood about the situation - I feel noticably better and stronger than just a couple of days ago. And I caught myself looking at new bike gear again, so I must be on the mend.


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## teckyb (Sep 13, 2011)

Yeah from what i have read it will not do much but i have read the occasional one that says it changed everything and there is no bump.

I will carry on as you say it takes the pressure off the joint and actually feel a lot more pain free when its tapped down. Only problem is find someone to do it for me daily.

It is amazing how quick you start to feel better, still have pains washing my hair or spraying deodorant but getting a lot better. Can actually put weight down on it, take my covers off my bed - which used to be the most painful thing in the world or reach over and pick something up - still a bit painful but a lot better.

Hopefully i will get some off your optimism bloodpuddle


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## TahoeBC (Apr 11, 2006)

Well 10 days out I was on the trainer yesterday bored out of my mind and since things felt ok sitting on the bike I took it for a real spin, 19 flatish miles. Felt great to get out and this morning there have been no bad side effects from doing it, so I'm stoked to be able to ride again, even if it is just the road bike, be a few more weeks before I get the nerve to try the mountain bike.


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## Shawnie Shawn (Nov 7, 2006)

teckyb said:


> Thanks for the reply Shawnie.
> 
> What surgery did you have? How long you out for? And is it a big scar?
> 
> ...


Had a grade 5 separation. They repaired what they could of the existing ligaments and looped a cadaver ligament around clavicle for extra support. Tightened up the joint and sewed me up. Nice size scar a little over 2 inches long which I could care less about. I have been able to work because my job doesn't require lifting but I have to avoid lifting anything more than a coffee cup with that arm for several weeks. Much better now in terms of being able to lift things etc. Basically full range of motion back but have to be careful still. Can probably get back on single track at around 16 weeks post op.


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## teckyb (Sep 13, 2011)

Well its 3 weeks today when i fell over and i am looking on the whole picture a bit more brightly. Well i took the tape off yesterday and my skin is raw lol so i left it off all day and the bump hasn't got any bigger or smaller so i am not going to tape it today.

My gf says she can hardly see it and that the fact that i have big red raw tape marks on my skin is the only obvious marker. Just have a nagging feeling about it all, soon as i look in the mirror i can see it but i think its because i know its there. Hopefully if i add on a few kilos i have lost through not working out i will look normal - in my eyes.

Still seeing the surgeon this week just to assess all my options. Very annoying here in the UK as there is a 3yr window once a week to see a shoulder specialist and when i said i couldn't make an appointment the amount of grief i got of the nurses was incredible, how about you do a more realistic window of appointments and i might be able to make one of them!

All i am now concerned about is that i can return to full fitness and be able to push myself like i used to before the accident and hopefully not get any signs later down the line. A friend said she still gets issues 3 yrs later alas she never done any rehab so hopefully all the work i am doing now will help.

Great to hear you are back out on the road TahoeBC!


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## pigdog (Feb 7, 2011)

bloodpuddle said:


> I'm interested in what experience anyone's had with getting back to *long distance swimming* after an AC separation. While mtb is my first love (sport-wise), I'm a keen distance swimmer and terrified I've just killed that...


Did my Grade 3 sep skateboarding rolling of the deck of a pool and free fell to the flat after a kid in the bottom screamed at me (should've just taken him out...) I would rather surf than anything else in this world - did mine in early Sept. after training my ass off for Fall / Winter. I was beyond bummed - knew I was shot for at least Fall. Family friend / doctor was the Portland Trailblazers ortho guy at the time and he was against surgery of any kind - the fix is a screw through the collar back to the scapula. I was super paddle fit and that was a big help in recovery. That was a few years ago - I'm now back to probably 95% on that side, funny it actually feels better than the intact one at times. Put in some marathon paddling sessions without any issues. I also swim in the pool regularly. My bet is you'll be fine.

Funny sidebar - my entire chest and side was bruised. The bruise migrated down and eventually pooled up in my ankle (!!!!) Six months after this I was in shorts and a lady saw my ankle and commented that it looked horrrible, my ankle must be very painful. I just smiled and laughed, didn't bother to explain.


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## teckyb (Sep 13, 2011)

Did you get pain while swimming? Did you do freestyle or avoid that?

Thinking of doing some this weekend as a form of rehab for it


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## bloodpuddle (Jun 15, 2007)

Thanks, pigdog. Reassuring.

Saw a 2nd ortho dr this week whose recommendations re non-surgical route confirmed what the 1st dr said: no point for me to rush into surgery, and chances are I'll get back to normal - with a humpy shoulder - just with exercise and physio.

He wants me to start breast-stroking (in the pool) at week 4, keep that going for 4 weeks and, assuming no problems, freestyling (in the pool) at week 8.

Funnily enough, he said he'd be happy for me to ride the bike pretty much now (day 11), since the pressure from holding the handlebars would actually be pushing the shoulder back to a more normal position. He told me I couldn't fall off, however, which is something I've never managed to achieve in the past...


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## TahoeBC (Apr 11, 2006)

bloodpuddle said:


> since the pressure from holding the handlebars would actually be pushing the shoulder back to a more normal position. He told me I couldn't fall off, however, which is something I've never managed to achieve in the past...


I've found this to be quite true, I'm more comfortable riding the bike than just walking around, I'm am staying on the road bike as I really fear falling on it again right now. But 17 days out an I've logged nearly 200 road miles in the last 6 days. I continue to swim also. it's helped a lot.


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## SaltySprocket (Nov 26, 2010)

Well, back in a sling again. Separated my right shoulder 2 years ago...it still hurts from time to time, but, it's not that bad. Separated my left shoulder Wednesday evening...now 2 days later, hurts like a mother. I have been advised against surgery.....for now, I'll take that advice. It is a good thing that I am a desk jockey most of the time....
gotta find a new hobby......maybe bird watching....hahaha


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## teckyb (Sep 13, 2011)

Had physio the other day for the first time, was bloody painful to say the least. Felt great after and the bump had actually dropped down a bit after, so probably tight tissue pulling it up. May get it strapped down next appointment and see if the scar tissue will help keep it down.

Feeling a bit better this week, could actually do one full press up without too much pain. 4 weeks today so still pretty early, i am aiming for 6 weeks back to weight training.

This board has been invaluable for info and knowledge that it will get better


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## G-reg (Jan 12, 2004)

I'm at 3yrs now, no surgery. I can't throw very well, the clavicle slams into the process it was attached to. The only other thing that bothers me is if I sleep on that side. 

That said, don't worry about reducing the bump. Whatever you do.... It's probably not going to make a difference. You actually want some distance between ends of the former joint as those bits coming into contact is what hurts after things heal.


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## TahoeBC (Apr 11, 2006)

3 weeks to the day, I returned to Dirt, fairly easy 1 hour ride, hopefully I can do a more extended ride next weekend.


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## bloodpuddle (Jun 15, 2007)

TahoeBC said:


> 3 weeks to the day, I returned to Dirt, fairly easy 1 hour ride, hopefully I can do a more extended ride next weekend.


Great stuff! I'm also coming up to 3 weeks this weekend - planning a cruisey road / firetrail ride to celebrate.

Went for a fast walk today, but after about an hour my shoulder was feeling a bit achy. Had been planning to jog, but that's definitely going to be too bouncy at this stage.


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## TahoeBC (Apr 11, 2006)

bloodpuddle said:


> Great stuff! I'm also coming up to 3 weeks this weekend - planning a cruisey road / firetrail ride to celebrate.
> 
> Went for a fast walk today, but after about an hour my shoulder was feeling a bit achy. Had been planning to jog, but that's definitely going to be too bouncy at this stage.


I have found riding to be easier than hiking as long as your not taking big drops 

Here are a couple pics from yesterdays ride, planning a much bigger dirt ride this weekend.


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## bloodpuddle (Jun 15, 2007)

*A growth experience?*

Great pics. You're lucky to have local trails with views like those. :thumbsup:

I got back on the bike for the first time today(day 20): rode about an hour, mostly on the road but also some easy singletrack. Shoulder felt fine the whole time except when I forgot I was protecting it and yanked up on the bars to climb a small step. Even that didn't really hurt but the twinge reminded me that things are still a bit rotten in the state of Denmark.

Speaking of luck, this whole episode has made me realize how lucky I am that I didn't do more damage in my crash. When I think about how high and fast I was going and how mentally disengaged i was from what I was doing when I crashed, I realize just how bad this could have been. In a way I'm now kinda glad I've had this injury, cos it's made me realize how much I'd been taking for granted.


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## Burning Matches (Mar 14, 2011)

bloodpuddle said:


> Speaking of luck, this whole episode has made me realize how lucky I am that I didn't do more damage in my crash. When I think about how high and fast I was going and how mentally disengaged i was from what I was doing when I crashed, I realize just how bad this could have been. In a way I'm now kinda glad I've had this injury, cos it's made me realize how much I'd been taking for granted.


I feel the exact same way about my injury. When it happened, I was screaming down a long ski slope during a race, hit a large hole with my front wheel, flew over the handlebars, and landed FIRST on my head, then my shoulder. I sat for a minute, then got up and walked away from that crash with only an AC separation. I could have been paralyzed or dead. The guy behind me said we were going about 30 miles an hour at the time. That was about 4 years ago, and I am still lucky enough to be riding today.


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## G-reg (Jan 12, 2004)

I don't know who the Rider Down Mod is, but since the OP hasn't posted since 2007......Could be turned into a poll? Surgery-Happy/Unhappy, No Surgery-Happy/Unhappy. The thread won't die and it would be nice to have a graph of posters as to how their recovery has gone without reading 300 posts.


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## bloodpuddle (Jun 15, 2007)

I found reading others' posts very helpful - much more info than a poll could deliver.


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## caskifun1230 (Oct 2, 2011)

I am 9 weeks post Grade III injury. Been doing PT for almost 2 months with range of motion almost completely restored. The only pain I have sometime is a muscle spasm around the shoulder blade area after exercising. PT thinks I may be overworking muscle. Seems like it may be dimishing as I heal but had another episode today. Has anyone experienced this??


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## kaneman (Jun 5, 2011)

Well i joined the club this morning. I over shot a decent sized table top bailed and landed on my right shoulder. all in all I have a class 3 separation. luckily though this was the first day that i got to use my full face helmet which pretty much kept me out of the ER for brain damage, because my head was next to hit the ground hard and i blacked out (i think, i dont really remember that part lol). once i collected myself i walked me and the bike back to the car so i could drive to a more visible spot to meet an ambulance because my car is standard and shifting wasn't fun and i was alone.

Only question is how do you guys sleep, every move i make hurts my shoulder when laying down and its keeping me up which is why im posting this at midnight.:madman:

ps: great thread sooooo glad i found it, it has kind of put my mind to ease about recovery and stuff, so thanks again


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## bloodpuddle (Jun 15, 2007)

kaneman said:


> Well i joined the club this morning. I over shot a decent sized table top bailed and landed on my right shoulder. all in all I have a class 3 separation. luckily though this was the first day that i got to use my full face helmet which pretty much kept me out of the ER for brain damage, because my head was next to hit the ground hard and i blacked out (i think, i dont really remember that part lol). once i collected myself i walked me and the bike back to the car so i could drive to a more visible spot to meet an ambulance because my car is standard and shifting wasn't fun and i was alone.
> 
> Only question is how do you guys sleep, every move i make hurts my shoulder when laying down and its keeping me up which is why im posting this at midnight.:madman:
> 
> ps: great thread sooooo glad i found it, it has kind of put my mind to ease about recovery and stuff, so thanks again


Welcome!

Sleeping gets easier pretty quickly. I found the first couple of nights uncomfortable, but what helped was lying on my back propped up against several pillows, so that my upper back and shoulders were both supported and my torso was elevated from horizontal. I woke up plenty of times during those first nights to shift around a bit, but still slept ok in between times like that.

The pain in my shoulder dropped hugely within 24 hours, so hopefully by this time tomorrow you'll be (a) a whole lot more comfortable and (b) asleep!

I stopped sleeping elevated on the pillows after about 3 nights. The next few days I slept better but still woke up several times a night to shift from lying on my back to lying on my left side (like you, it's my right shoulder that I stuffed up).

Since the end of week 1 (I'm now approaching the end of week 4 from a grade 3), I've been sleeping pretty well and the last few days I don't think I've woken at all. I found trying to sleep face down uncomfortable until about a week ago, but now it's fine.

Hopefully some of that is helpful for you too.



Burning Matches said:


> I feel the exact same way about my injury. When it happened, I was screaming down a long ski slope during a race, hit a large hole with my front wheel, flew over the handlebars, and landed FIRST on my head, then my shoulder. I sat for a minute, then got up and walked away from that crash with only an AC separation. I could have been paralyzed or dead. The guy behind me said we were going about 30 miles an hour at the time. That was about 4 years ago, and I am still lucky enough to be riding today.


So, I'm curious then whether this has changed your riding style, the risks you'll take etc?

My regular riding buddy is sending me the usual vimeo links etc to get me psyched and pushing myself again, but I honestly can't see myself hitting jumps again in a big way. I feel like this has been my warning that I'm not so young anymore (38) and not quite as indestructible as I thought I was.

Just getting the confidence back to tackle tricky terrain is going to be a battle, I think.



pigdog said:


> I also swim in the pool regularly. My bet is you'll be fine.


As of today, I know I will be too. Did a couple of tentative laps of breaststroke last weekend, and today did 600m of breastroke without any pain. Also did some gentle, stationery freestyle movements in a standing position and didn't have any pain. Yeeha!


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## Burning Matches (Mar 14, 2011)

bloodpuddle said:


> So, I'm curious then whether this has changed your riding style, the risks you'll take etc?
> 
> My regular riding buddy is sending me the usual vimeo links etc to get me psyched and pushing myself again, but I honestly can't see myself hitting jumps again in a big way. I feel like this has been my warning that I'm not so young anymore (38) and not quite as indestructible as I thought I was.
> 
> Just getting the confidence back to tackle tricky terrain is going to be a battle, I think.


I would say it has. Not so much with the risks I will take, but I am now a better, smarter, and more in control rider than I was at the time. I was simply going way too fast and did not maintain proper control of my bike and speed when that accident happened. I've since learned how to maintain the right level of control for the trail conditions and my speed.


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## kaneman (Jun 5, 2011)

bloodpuddle said:


> Welcome!
> 
> Sleeping gets easier pretty quickly. I found the first couple of nights uncomfortable, but what helped was lying on my back propped up against several pillows, so that my upper back and shoulders were both supported and my torso was elevated from horizontal. I woke up plenty of times during those first nights to shift around a bit, but still slept ok in between times like that.
> 
> ...


THANKYOU, thats how i ended up sleeping after a while it seemed to work alright even though i still woke up a few times because i move a lot when i sleep and i end up rolling onto my shoulder.


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## bloodpuddle (Jun 15, 2007)

kaneman said:


> i still woke up a few times because i move a lot when i sleep and i end up rolling onto my shoulder.


Sorry. Forgot to mention that I also put a pillow along the right side of my body to discourage me from rolling onto that side.


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## kaneman (Jun 5, 2011)

bloodpuddle said:


> Sorry. Forgot to mention that I also put a pillow along the right side of my body to discourage me from rolling onto that side.


lol all good im just glad i managed to get some sleep :thumbsup:


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## teckyb (Sep 13, 2011)

Well i am about 6 1/2 weeks post injury.

Seen the surgeon and he said surgery was pointless and rehab/PT would be enough. So i have been seeing a PT (physio here in the UK) for about 3 weeks only for a 30min session. Generally she attacks my upper back/neck and rotator cuff along with sorting out my front of my shoulder.

It has got a hell of a lot better since the physio, annoyed i didn't go sooner, and the strength is returning. Its mad what difference a day or a couple of days make in the pain scale on certain exercises. I can no do press ups albeit still with some pain but loads better than before. Funny enough if i do them inclined off a step they feel a lot better. Bench press feels really weird, my shoulder blade feels trapped and can not move properly and i haven't got the stability yet to do Dumbbell press. Apart from that most exercises are fine.

Sleeping on it is now much better, still have pain but i can actually lie on it for a bit but not my favorite position. I generally don't notice it through the day anymore if i pull my shoulder blades back i feel like a stretch and a pain in my joint but apart from that full ROM is back with little pain at all, only when i fully cross my arm over my body.

Went on a friends scooter today messing around and hit some rough ground, boy did my shoulder feel that! a while yet till i get back on the bike for sure. I give it till 10-12 weeks before i am back to 90-100% - mine was a grade 2 if anyone is interested


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## wsmac (Sep 5, 2010)

I don't think I shared mine here yet, but I went OTB off a 30ft high(the other rider with me obviously can't gauge distance and keeps saying it was more like 2ft ) platform, landing smack onto my right shoulder and tearing my AC and CC lig's.

After hiking all the way back to my friend's house 14miles (again.. in his erroneous thinking, he says it's only 1/4mile... yeah... right dude :madmax:) uphill on slippery shale in the dark...
I went to the ED, got some 'happy juice' and after some xrays, went home with a sling... that was mid-February this year.

The local Ortho suggested waiting 6 wks, then after that I told him to cut, he said to wait until the new guy came in (experience in sports medicine/surgery... AND... it turns out he's a MTB'er too!) 2 weeks later.

I was this guy's first surgery since he arrived and it seemed to go well until...
I got out of surgery and found out I have a poor tolerance to the anesthesia they gave me :nonod:

Two weeks later the fix was sagging and he opened me back up, repaired it again this time putting me in a solid brace instead of a soft sling/pillow (everyone at the hospital told him he wouldn't be able to hold me still very well ).

Basically, the surgeon looped allograft ligament (cadaver) around my coracoid process then passed the ends up through two holes drilled through my clavicle, then held in place with synthetic screws.

The first repair stretched, but the second one has held well since April.
I started PT on my own, then made a few visits to our PT'ist at the hospital getting advice on other movements I could do along with strengthening exercises later on.

I had my brace taken off after a full 6 weeks (I had already 'biked' some on my trainer at home watching MTB videos.. only problem was getting into the action and trying to 'jump' when they jumped in the vid :nono: j/k)

My surgeon, being a MTB'er too, knew how hard it had been for me to remain compliant all that time, so his advice when the brace came off... "Now dont' go out and do anything STUPID... even if that IS your middle name!" He rides with me now... I think he's just tagging along so he can claim "First Dibs" on another surgery when I go down... err, I mean.. IF I ever go down again ... just wish he'd quit calling me GRAVY TRAIN :madmax:

For the past few months now, I have been gradually working on my stretching, ROM stuff, and strength building. I do all the usual shoulder stretches, and I also lift dumbells and do assisted pull-ups and regular pushups and dips.
I'm gettin' there! :thumbsup:

Been back to riding all this time as well.... NICE... 
The first few times I tried bunny-hopping, jumping, and manuals I could definitely tell my shoulder wasn't ready for too much of that so soon, but it just keeps on getting better.
Me: "Hey Doc! Will I be able to ride a MTB really well after the surgery?"
Doc: "Could you ride a MTB well before surgery?"
Me: "Uh, well... I'm here aren't I... duh!" :smilewinkgrin:

I have the slightest bump to my shoulder, but considering what I did to it... I'm really happy with the outcome. I would have rather had surgery from the get-go, but in retrospect, it was worth the wait for the new guy. The older surgeon is great, but the new guy took a different approach to the repair that I'm happier with.

The *first* pic is my x-ray pre-surgery... *second* is my shoulder during the 1st 6 weeks (without the 2 lig's attached, my shoulder is actually drooping. It looks to folks like the clavicle has raised instead)... *third* is the first surgical repair and my soft sling/pillowblock. This didn't keep me from moving the arm around, taking it off for showers, etc. = me bad patient... *fourth* is the first surgery catching some slack. The picture is reversed... it's NOT my left shoulder! That one is still in good shape so I land on it now instead of the right one :cornut:... *fifth* is my second surgery and new brace which worked MUCH better! The trophy was put together by me and some friends at a LBS.


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## wsmac (Sep 5, 2010)

At first, when I got the new brace... I realized it was in the PERFECT anatomical position for riding! Since it was so rock-solid, I knew nothing was going to happen should I fall on that side again while wearing it!
If you were at the RedBull Rampage, you probably saw me tearing it up on the course STILL IN MY BRACE!
I... AM... SO... RAD! :cornut: :yesnod: _does anyone use that term anymore???_

eta: my pics are still reversed... bleh


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## Crawl Away (Oct 15, 2011)

I severed my ac ligament when I was 18 (31 now) thanks to an endo jump on my dirt bike. It took years before I could function similar to before. Now, the shoulder can routinely come in and out if of socket if manipulate it, but feels pretty good. It probably took a solid 3 years before it really stopped bothering me.


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## caskifun1230 (Oct 2, 2011)

Hey Crawlaway,

What kind of issues did you have? I'm 12 weeks post ac sep injury. PT went well but I get those horrible knots in my back, clicking during basic movements and straps on shoulder irritate it.
Did you have any of these problems? I am trying to locate someone at this forum who had any of these experiences.

Thanks!


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## Crawl Away (Oct 15, 2011)

Lots of dislocating and pain sleeping. I had a hard time carrying heavy loads and had lots of grinding. The worst part was the sleeping. I would sleep on it and wake up with everything stretched out and in pain. I still get lots of popping and grinding, but it doesn't really hurt anymore.


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## caskifun1230 (Oct 2, 2011)

Thanks for responding CrawAway!

I heard from someone that there is a magical 2 or 3 year period where a lot of nagging stuff goes away.
What Grade level was your injury? Do you have more strength now and full range-of-motion?


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## Crawl Away (Oct 15, 2011)

caskifun1230 said:


> Thanks for responding CrawAway!
> 
> I heard from someone that there is a magical 2 or 3 year period where a lot of nagging stuff goes away.
> What Grade level was your injury? Do you have more strength now and full range-of-motion?


I don't know the grade; it has been too many years. However, the ac ligament was completely torn and never healed or was repaired. I have strength in it and it is almost as strong as the other side. I am a little more cautious with it, but it works and seldom gives me any trouble. However, the more extreme the angle of the shoulder, the weaker it feels.

I have a full range of motion and, in fact, have a little more flexibility on the injured side because I am no longer bound by the severed ligament.


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## bloodpuddle (Jun 15, 2007)

Thought I'd post a little update FWIW...

I'm now exactly 6 weeks out from a grade 3 in my right shoulder, and it's really feeling strong.

I've been pretty conscientious with the rotator cuff, scapula, bicep and tricep exercises (about 10 mins twice a day) that my physio gave me, as well as stretching and concentrating on my posture.

I've got no pain at all, and near normal range of movement.

Lifting heavy stuff (eg. my 4yo son who weighs about 23kg) with the right arm is a bit uncomfortable, but less and less so every day.

I've been swimming a couple of times a week since week 3. Started with breaststroke, but quickly found freestyle was ok too, so now I'm doing 1500m sessions which are about 40:60 breastroke:freestyle. And that's getting easier every time too. In yesterday's session, I did some fairly fast freestyle laps without pain. 

As for riding, I've been back on the road for several weeks and today went for my first proper dirt ride. It's a mostly XC track with a few bigger obstacles, none of which were ever a problem before (just bombed straight down/over them), but today I was really freezing up, riding tentatively and basically not riding well. None of it is because my shoulder won't let me, just that my confidence has definitely taken a hit after the crash. 

Anyone got any jedi mind trick suggestions?


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## NJMTB (Aug 1, 2010)

*Did my G3 AC right side two weeks ago*

Went down at Whistler, concussion, broke a rib and a finger too. Figure I'm lucky and it could have been much worse. Doc in the ER and my Ortho said no surgery. Don't even think about it. Had a Doctor friend at a teaching hospital ask around, all the Orthos agreed, do the rehab and get on with it.

I've had two other major joint injuries. Left rotator cuff tear and surgery in high school that took six months to heal and a year to be back to "normal", about 90% of before. Back then they didn't do it as a minimally invasive, they cut through all the muscle in the front of my shoulder, and I permanently lost a lot of strength from that. Now they do that with minimally invasive methods and the muscle damage and recovery time are so much less. That's something to think about here - from what I can see they still haven't totally figured out the AC repair (there are competing methods and approaches) but they're making a lot of progress so maybe that's a reason to wait.

I also had a right knee ACL tear (basketball), just barely still attached, that was ten years ago. I never had surgery, and except for no more basketball or long distance running it's been fine.

So for me surgery is out. So what if I have a bump? I know from my rotator cuff that with shoulders if the muscles are strong, the joint works well. After two weeks the swelling is minimal, I'm in the gym doing light exercises and I'm riding a little (not trails yet).

I have to say I was feeling kinda down, like why do I love this sport so much if it's so dangerous? Then I was reading a sports illustrated at the doctor's office on "The Lost Art of Tackling" and they were talking about the new rules to prevent injuries in football. Troy Polamalu had a quote about how they shouldn't regulate too much, because facing our fears is what makes us men. Riding fast and hard, and doing it well, is only so much fun because there are consequences for making a mistake. I'll be back out there as soon as I can, with maybe just a bit more caution :thumbsup:

Thanks to all who posted here this was a great source of info!


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## wsmac (Sep 5, 2010)

NJMTB said:


> ... talking about the new rules to prevent injuries in football. Troy Polamalu had a quote about how they shouldn't regulate too much, because facing our fears is what makes us men... I'll be back out there as soon as I can, with maybe just a bit more caution :thumbsup:


I agree that over-regulation can be more detrimental than allowing people to learn limits through experience. Not so sure about it "making a man" out of me since I am already a man 

After my shoulder surgery, I did take it a bit easy, but I've found that I don't even think much about my shoulder at all now. If anything, I've been trying to focus on lessons learned. In my case though, it may be more about having my accident doing something off-trail instead of on a bomber run.

Perhaps if I had injured myself as speed on a trail I might be even more cautious today...
but, once I feel the air pushing harder against my body/face as I increase speed, as my mind slide into a more hyper-focused state as the ground features hurtle at me almost quicker than I can pick them out, and as the bike absorbs then pushes off bumps, waterbars, and features sending that energy up through my legs and arms... well, I just lose all sense of possible impending doom and ride the ride.

Mmmmmm... gotta love it all!:thumbsup:


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## #1Hammerhead (Jan 1, 2007)

Shoulder separation back in July. Off all bikes until 2 days ago. Shoulder felt fine, not completely healed, but good enough to ride. Did 2 road rides this weekend, shoulder doesn't hurt, just doesn't feel quite right. Must be time for some rehab/strengthening. Anyone have a link to a great separated shoulder rehab workout?

Thanks!


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## kaneman (Jun 5, 2011)

guess ill post an update. I am just over 4 weeks out from a grade 3 ac tear (no surgery). 1st week was good because every day i got noticeably more and more movement back in my arm, 2nd week was also good because i got noticeably less pain every day in my arm. 3rd week sucked because i had 99% movement back, with about 95% pain free but any force behind that movement hurt like hell, so i felt good but still couldn't do anything. But last weekend (27 days after accident) i went on a ride and could handle everything pretty well, just not as fast as before (it was actually my wrist which i also broke that hurt more than my shoulder), I stayed away from big drops/jumps though. So all in all im happy with my recovery at the moment, ill try to remember and update this in a few months .

luckily I dont have the bump that everyone else seems to have and my shoulder only sits 1/2 to 3/4 of an inch lower that my good shoulder.


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## scottwest (Oct 8, 2011)

wsmac said:


> At first, when I got the new brace... I realized it was in the PERFECT anatomical position for riding! Since it was so rock-solid, I knew nothing was going to happen should I fall on that side again while wearing it!
> If you were at the RedBull Rampage, you probably saw me tearing it up on the course STILL IN MY BRACE!
> I... AM... SO... RAD! :cornut: :yesnod: _does anyone use that term anymore???_
> 
> eta: my pics are still reversed... bleh


Thank you wsmac, your action photo made me feel much better!


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## b52doc (Jun 18, 2011)

Not sure what grade this is, but I am guessing a 3; looks like 2 of the 3 ligaments are torn. I have dislocated my shoulder and broken my collar bone but this was by far the most painful. It's been 5 days and I have about 50% of the range of motion back. Just feels really really weak and my shoulder gets fatigued fast.

My experience so far:

1. It hurts a lot when the joint absorbs any type of shock or vibration. Driving my truck down a crappy road is enough to make me grind my teeth. I won't be riding anytime soon.

2. My trapezius on the affected side is almost always in a tight knot because of the bone pushing against it. I wasn't expecting the referred pain to be in my upper back.


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## wsmac (Sep 5, 2010)

scottwest said:


> Thank you wsmac, your action photo made me feel much better!


No problem... I'm glad to help people understand they can still do the BIG stuff after incurring shoulder injuries! 

Lately I've been nursing a broken 5th rib, minor pneumo, and possibly a type I shoulder (left side this time).
I was just sorta riding... a bike... all innocent-like in the woods, when I came upon this interesting dirt gap jump and... err, sorta rode the bike... over it. Fast and Hard!:thumbsup:

The first time was great! I landed it alright and rather enjoyed it.
The second time was not great! Another lesson in human anatomy/physiology, physics, and aging issues.

At least I've lived up to my promise to NEVER land hard on my expensive shoulder (the right one I had operated on).
Only trouble is... NOW I'M OUT OF SHOULDERS! Not sure what to land on now instead of my shoulders?
My head perhaps?
That might help me learn to stop doing stuff harder than my experience, nerve, weight, etc etc, will allow. LOL :madman: 

I can say for sure that the year 2011... has been a very ODD year for me!
I had a pitbull bite my arm just a week earlier... luckily he was a nice maddog and only bit me once, and my girlfriend in the back of her leg once.
My arm got infected (interesting red streaks almost to my armpit the next day), and I got I.V. antibiotics for the next three days.
Heck! I've spent more time in my E.R. as a patient than I do when I'm working!:nono:
Too many injuries for just one year... I figure I'm off the hook for a few years now... time to heal up and get back out there and RIDE!:madmax:


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## wsmac (Sep 5, 2010)

b52doc said:


> Not sure what grade this is...


DUDE!
Your AC is G...O...N...E! ADIOS SUCKA! ASTA LA VISTA BABEEEEEE!
Perhaps your CC is gone as well, but I'm not a real doctor... I just pretend to be one online... hehehe

Seriously, you have taken out your AC for sure from the xray you posted.
That huge a gap between your clavicle and ac process makes it appear your CC ligament is injured as well or completely torn.

Since you have an xray of it, you should have some word from a doc about the extent of the injury.
What have they said, what are your options?
I can tell you I am glad I had mine operated on. You will see from some of the comments here and elsewhere though, that some folks live on without getting their shoulders 'fixed'.


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## b52doc (Jun 18, 2011)

wsmac said:


> DUDE!
> Your AC is G...O...N...E! ADIOS SUCKA! ASTA LA VISTA BABEEEEEE!
> Perhaps your CC is gone as well, but I'm not a real doctor... I just pretend to be one online... hehehe
> 
> ...


I am 99% positive I need surgery; the distal end of the clavicle is displaced up and posteriorly into my trap muscle and the pain it causes is unbelievable. Today I made the mistake of bringing my injured arm across my chest and I nearly blacked out from the pain. I have tried a couple times to push the clavicle down and out to reset the loose end against my skin. I can't bring myself to try again and my gf won't do it for me lol.

Despite what the xray looks like and what is common for this injury, I don't have any lump on my shoulder; you can't see the end of the clavicle pushing against the skin because it's pushing into my trap instead.

The NP at the urgent care gave me a referral to an ortho surgeon but I haven't gone yet. 
I am being optimistic about the injury because it's the only thing I can do; can't afford to take months off of work to rehab from surgery. My gf recently lost her job and we are barely getting by on my salary alone.

It sucks but that's life.


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## bloodpuddle (Jun 15, 2007)

b52doc said:


> I am 99% positive I need surgery; the distal end of the clavicle is displaced up and posteriorly into my trap muscle and the pain it causes is unbelievable. Today I made the mistake of bringing my injured arm across my chest and I nearly blacked out from the pain. I have tried a couple times to push the clavicle down and out to reset the loose end against my skin. I can't bring myself to try again and my gf won't do it for me lol.
> 
> Despite what the xray looks like and what is common for this injury, I don't have any lump on my shoulder; you can't see the end of the clavicle pushing against the skin because it's pushing into my trap instead.
> 
> ...


I feel for you. My advice though, is get professional advice, get it early and then follow it. It will cost, but - speaking purely from my own experience - it is the way to go.

And given what you describe with the position of the clavicle, pain you're getting etc, I'd say it's even more important in your case.

I went to two ortho drs and then had pretty intense PT for about 5 weeks (two visits a week). I obsessively and fanatically did all the exercises etc that were recommended.

I also got back into the pool early (breaststroking at about week 3) with the blessing of my physio, and have been swimming twice a week since then. I think the swimming has been a major factor in my recovery. Breaststroke in particular seems a perfect exercise for a separation since it really works your upper back/shoulder blades as well as your shoulders.

I'm now 8.5 weeks out from the injury. In my case, surgery wasn't indicated. I have 100% motion back and strength is getting there too. I'm back to swimming freestyle at my previous pace over decent distances, too.

I'm back on the bike too - riding as much as I did before (did a race last weekend). I'm not attempting any major jumps though, but that's because I'm now more wary of the risks not because my shoulder couldn't handle it.

Good luck with it. Don't forget to share your experiences on this board - I've found it invaluable (thanks all!). :thumbsup:


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## twistedlizard720 (Apr 3, 2006)

b52doc said:


> I am 99% positive I need surgery; the distal end of the clavicle is displaced up and posteriorly into my trap muscle and the pain it causes is unbelievable. Today I made the mistake of bringing my injured arm across my chest and I nearly blacked out from the pain. I have tried a couple times to push the clavicle down and out to reset the loose end against my skin. I can't bring myself to try again and my gf won't do it for me lol.
> 
> Despite what the xray looks like and what is common for this injury, I don't have any lump on my shoulder; you can't see the end of the clavicle pushing against the skin because it's pushing into my trap instead.
> 
> ...


I knew I needed surgery at about 4 months most injury after following Dr advice. I waited 15 months before going under the knife and looking back, should have done it much sooner. Don't wait too long.


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## wsmac (Sep 5, 2010)

b52doc
Your clavicle doesn't actually rise all that much... there's no mechanism for pulling it up in that direction.
What's happening is that your shoulder is actually falling because it's not connected correctly to the clavicle any longer.

Because your clavicle is loose at one end, you can move your clavicle around by pushing on it, but it's actually the rest of the shoulder being unsupported that makes the clavicle 'pooch' up as much as it does and create the bump many people wind up with.
This is why you should be in a sling right now.
You need to support the rest of the shoulder as well as your arm since the clavicle can't.

Hope that makes sense.:thumbsup:

When someone suffers a type 1 or 2 injury to the AC, if the arm/shoulder is supported by a sling, there is no further pulling on the torn ligament and this allows it to heal and often pull back to a more normal state without the bump.
If the weight of the arm and shoulder is left on the torn ligament, healing won't be as fast or as complete.

Until you can get in to an Orthpod, go to a drug store and buy yourself a cheap sling. Nothing fancy. You might even get two so you can shower in one, switch to the dry one and let the other dry in the meantime. Sometimes a thrift store has them for $1 or $2.

If having your arm lie flat against your body is too uncomfortable, you need to add some space between your body and arm. Some slings come with a large foam block to help create a better angle to the arm and relieve tension in the shoulder so you feel less pain.
You can make your own block or buy a sling that has one with it.

If you look at my pictures a page back, I had something called Ultrasling, which had the block. Only thing is... the sling did not keep me from moving my arm around on my own, nor did it keep me from removing it easily and leave my arm hanging again... which did not help my first surgery 'take' at all.

My surgeon put me in a firm brace after he went back in to fix my shoulder the second time. This was more stable all around, and even though I could still remove it if I wanted, I was less apt to do so.

Do something for it as soon as possible though. No reason for you to live with the pain like this.


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## J-ay (Nov 22, 2011)

*AC Joint Separation alternative solution?*

Hi guys! I just took up MTBing this year but have been doing road since 07. Well, I had a very nasty spill last Saturday and went OTB on a downhill portion of a trail. I tried to roll on my shoulder but as I was still clipped to the bike it fell down on me and I heard this sickening SNAP as I landed.I wasn't in much pain and after checking my collar bones, which were whole, I noticed this lump sticking out of my shoulder. Went to the ER and had x-rays done which I've attached (just as an aside, I used a spare inner tube as a sling to immobilize my hand, comes in handy during emergencies).

I didn't really feel much pain except that the ER put me on a sling, which was uncomfortable. I went to see a couple of Orhto's already and they both said that I don't need to have an operation done. I'll be able to retain full range of motion eventually and be able to swim again. Unfortunately, there will be that ugly lump sticking out of my shoulder for life, which I can live with.

The 2nd Dr I saw said I can take off the arm sling but suggested that I put on a sling bag (or man-purse) loaded with books and sling it across my body with the strap resting on affected clavicle and then keep on shrugging my shoulder. He says that this will help put the clavicle closer to the scapula as the scar tissue forms, making the bump less noticeable. Needless to say it's a b***h to have to constantly have the bag on (i think it weights around 6lbs) which he says i have to do for 4 weeks.

My question is, have any of you done this type of method or encountered anyone using this method to heal the bones closer together?

Thanks!

Jay


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## twebeast (Mar 30, 2008)

Hey bad luck with doing that in your first year! Sounds like you're pushing yourself, which is to be commended ;-)

None of the ortho's I saw had any specific recommendations for helping it heal along those lines, just wear a sling until you no longer feel you need to, and no need for special exercises, just wait until it feels strong enough before getting back on the bike.

Can't say the advise your ortho have you sounds great personally: it's going to be impossible to apply a constant pressure so you're going to just move it up and down more (as well as stressing your back); but I'm no ortho.


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## G-reg (Jan 12, 2004)

J, get a second opinion! The bump is more from your shoulder drooping, not your clavicle sticking up.


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## wsmac (Sep 5, 2010)

G-reg said:


> J, get a second opinion! The bump is more from your shoulder drooping, not your clavicle sticking up.


HA! I just noticed this was THE AC separation thread... thought it was a new one.

Anyway, I agree with G-reg.
I'm no doctor, but I have A&P training and medical experience going back a ways.
The clavicle may move upwards when detached from the scapula (the most common injury is damage to the AC and CC ligaments) but not to the degree most people seem to think... especially when looking at the bump.

Your arm and scapula are suspended from your clavicle, so once released, they actually drop pulling the skin downward. The clavicle may rise somewhat which pushes against the skin. The combining actions form the bump.

The degree of detachment dictates the size of the bump.

Minor tearing of the AC ligament can heal to a state where the bump does not exist (if one was present in the first place), while moderate or severe ligament damage will leave a lasting bump should you decline one of the many operations designed to bring the shoulder back to a more normal state.

All this is specific to AC and CC ligament injuries... rotator cuff is something else (many people seem to link rotator cuff with any mention of shoulder injury).

You can keep on seeing Orthopods for as long as you or your insurance will pay, but eventually you need to decide what you are willing to live with.
Shoulder injuries are common enough that there is a plethora (always wanted to use that word :thumbsup of information on the internet.
To make sense of your xrays, we would actually need to be able to do some measuring of the gap between your clavicle and the ac process. Not so easy with the small pictures you have.

The idea about suspending weight across your clavicle sounds a bit radical to me. I have never heard of anything like it before.
Again... it's not that the clavicle alone is flying upwards all loosey-goose... the scapula and arm are dropping.
I just don't see how you can pull your clavicle down enough to help the ligament heal properly.

Generally, slinging is the treatment whether or not you have surgery down the road.
The idea is to bring your shoulder back to as normal a state as possible while the damaged ligaments heal.
Slinging does what your clavicle normally would do... suspend the arm.
If you can take the pull off the injured ligament, it will be more likely to heal to a more normal state.

I mentioned in another post here that it may help to move your arm out a few degrees away from your body.
Putting a towel, pillow, or block of foam between your arm and body can create that angle.
I can't tell you what angle this is precisely, and the block should go between your forearm and body, not the upper arm and body.

You may find comfort with your slung arm more towards the front of your body, or right at the side of your body.

This is the sort of stuff an Orthopod or Physical Therapist would know better than me.

Hope this helps.


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## J-ay (Nov 22, 2011)

Thanks twe,beast, G-reg and wsmac. You're right and I think the ortho did mention that my shoulder is drooping. I went to a 3rd Ortho yesterday and the first thing he said was..."Oh wow, that's a type 6. Let's do surgery while it's still fresh. We'll just skewer a pin through the end of the clavicle bone" Yikes! After discussing with him though, although it was his first reaction, he said i can get the full range of motion back even if i don't do surgery, so that is that. 

I asked him about using the bag slung across my shoulders and he said that among all, that will be the most helpful but it will not be exactly back to normal. I'm not a medical pro but i think the 2nd ortho mentioned the clavicle popping/locking into place. My best guess is that keeping the clavicle into that position as long as possible will create a "hole" of some sort that the bone can rest in and eventually heal into. He did say though that I don't need to use the sling if i don't need to, but then again, it helps keep my shoulders into a "shrugging" position and the protrusion is not as bad. 

Wsmac, how long do i have to be in a sling? It's a b***h to wear, specially if I don't need to be using one . Oh, and i'm attaching a clearer image of my x-ray.

Thanks!


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## wsmac (Sep 5, 2010)

J-ay said:


> Thanks twe,beast, G-reg and wsmac. You're right and I think the ortho did mention that my shoulder is drooping. I went to a 3rd Ortho yesterday and the first thing he said was..."Oh wow, that's a type 6. Let's do surgery while it's still fresh. We'll just skewer a pin through the end of the clavicle bone" Yikes! After discussing with him though, although it was his first reaction, he said i can get the full range of motion back even if i don't do surgery, so that is that.
> 
> I asked him about using the bag slung across my shoulders and he said that among all, that will be the most helpful but it will not be exactly back to normal. I'm not a medical pro but i think the 2nd ortho mentioned the clavicle popping/locking into place. My best guess is that keeping the clavicle into that position as long as possible will create a "hole" of some sort that the bone can rest in and eventually heal into. He did say though that I don't need to use the sling if i don't need to, but then again, it helps keep my shoulders into a "shrugging" position and the protrusion is not as bad.
> 
> ...


I'm quoting you so I can read your post while I type my reply...

I agree with something you said a post or so before... that intermittent use of a weighted bag would seem to allow the clavicle to spring back-and-forth as you take the bag off-and-on various times of the day. It won't do you any good sleeping unless you sleep in a straight-up position .

I am not doctor. I have been an EMT since 1978, an airborne medic, worked in E.R. and EMS situations, etc etc...

In no way do I wish to contradict any of the Orthopods you've seen so far. They do have more specific training and experience than I do in this matter.

Okay... disclaimer over... 

I can see where downward pressure... ala the weighted bag... could help, but only if you could keep that pressure constant throughout the healing process. Once the lig's are solid again (and in your case it sounds like they ain't gonna be :nono:.. at least on their own), removing the weight wouldn't pose an issue.
Guess I'm not seeing what the docs are seeing in recommending that approach.
Seems to me you will be unweighting your shoulder numerous times throughout the day by sitting, just getting tired of the weight and accompanying discomfort and intentionally taking some of the load off the shoulder, sleeping, showering...

As far as the surgeries go... 
There are several to choose from. If you ask each of the Ortho's you have seen about the various methods for surgical repair... you may get completely different recommendations.
What I'm hearing around our hospital lately is a move towards less metal installation.
I haven't read up on this, but I know some docs feel they are seeing more arthritis in people who have had certain metal hardware repairs done.

Other options for shoulder repairs utilize synthetic "ligament" with metal buttons, cadaver ligament with synthetic screws, and there are more.

The clavicle is a pretty sturdy bone, but as we see just here on the forums, a hard enough impact can break it or definitely damage the connecting ligaments.
Any repair will necessitate drilling holes in the clavicle. It's not the same as other long bones in that it isn't "hollow" like, say, your arm or leg bones. It's also the only long bone that lies horizontal in the human body... for what that's worth 

In my case, my surgeon decided on a repair that I was happy with. I looked at the other options, and we even discussed one other option he had experience with but was moving away from.
Unfortunately, the first repair didn't work so he had to go back in and put larger synthetic screws in the second time. Those two holes in my clavicle mean a possible catastrophe if
I ever land hard on that shoulder again. Basically... major reconstruction with current methods.
This is why I now fall on my left side only... the cheaper side :thumbsup::skep:

I know of two people who elected not to have surgery after grade III (1 guy might have been a grade IV I think) injuries. They have normal shoulder function with the bump, but they do feel a difference in their shoulders. They both mountain bike (and road bike), and one of them I ride with so know how he rides... fast and furious.

It really seems to be a toss-up as to whether a person should have surgery or not, if there is no obvious medical need to. It boils down to personal comfort, how well your body heals, how well you follow any physical therapy recommended to you...

I chose surgery (my shoulder was a type IV), largely because I like the idea that things are as close to normal as possible.
The reality is that my clavicle is only secured to the scapula by one ribbon of cadaver ligament from below at the coracoid process (the process below the clavicle), and not the acromion process (the one that the lateral end of the clavicle joins to).
It's far from 'normal', but I like a bit more secure attachment than none at all. Since I do not have the ligament between the end of the clavicle and the acromion process, the surgeon cut a bit off the end of the clavicle to give a bit more 'space' between the two.

I worked really hard on my ROM exercises, stretches, and strengthening exercises.
In fact, my current broken rib is driving me crazy because it's still hard to do the exercises I want. But... today I did pull out the bike and give her a spin around the yard with success  I hate being sedentary!:madmax:

About the sling... and I know I'm a bit long-winded in my posts but I'm almost done :madman:

The recommendations I have heard (and been told) say to wear it all the time (out of bed that is) for several weeks. This could be up to 6 weeks, but it could be shorter.
In your case, none of the docs seem to recommend the sling and I'm supposing that's because you have no ligament attachment at the AC and CC, so there's no ligament healing that necessitates taking weight off injured parts. Hope that made sense.

If you just had torn ligaments, the sling would keep the tear from being pulled upon and allow it to heal better. Since you've blown your ligaments (which it sounds like), the sling would only be taking weight off the muscle and skin surrounding your clavicle. In that case, nothing is going to change without surgery. You can put the sling on and take it off all day long and you won't be accomplishing much, or so it sounds.

Difficult choice for some... easy choice for others.
You will hear from docs that your shoulder can be 'repaired' anytime in the future though.
They can cut you open and do whatever magic fix is current in the future should you decide you hate the way your shoulder feels/functions/looks.
Just a caution though...
If you think you might want surgery... and you have insurance now that will help pay for it... I'd seriously consider doing it. I did partly because I have great insurance.
My bill for the first surgery was initially billed around $40K, the second just under that.
Counting in the ED visit, meds, xrays (and radiologist fees for reading them)...
I am lucky to only have to pay a few thousand.
The original bills were negotiated down between the insurance company and the hospital/providers, which is the usual process from my understanding.
I also had the extra benefit of having all this done through the hospital I work at and we get certain considerations for being employees.

If you choose to have surgery down the road... who knows how you will cover the costs?
That's something for you to consider.

I wish you well no matter what you decide!:thumbsup:


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## J-ay (Nov 22, 2011)

Thanks for the reply, Wsmac! Quite comprehensive and informative. :thumbsup: I've already set my mind to no-op as long as I don't need it. Range of motion is getting better every day. Will see the Dr again next week to see how I'm progressing. 

One thing I've been doing is using the "10 lb man-purse" remedy. What I did as an extra is to fasten the straps under my armpit on both sides with a race belt to keep the strap as secure as possible over the bone jutting out. I shortened the strap length to a minimum so I still wear it while seated. According to the ortho, the muscles relax when we sleep so it's ok not to have it at night. I'm just super tired at the end of the day from having to carry this extra load. In any case, will report back to the forum if it works.

Oh, also, now I wear the sling when I go out in public or go to meetings. It prevents people from grabbing my hand and shaking it violently or from tapping me on the affected shoulder. I forgot to do so yesterday and someone said "Hi" by tapping me on the shoulder and then shook my hand violently :yikes:


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## wsmac (Sep 5, 2010)

J-ay,

You really read all that tripe I spewed upon these hallowed pages?ut:

Get rid of the MAN-PURSE... IMMEDIATELY! I thought you meant something like a messenger bag and college text books... although 1 good Bio book would be all the weight you need... I think my last one was 35lbs.

Seriously... you need to ditch the bag.
Instead... strap your bike to your shoulder!
I mean it!

By incurring such an injury with the bike, you obviously need a constant reminder how DANGEROUS this activity is and wear that symbol of foolish youthfulness around your neck like a ball-and-chain until you have learned the err of your ways!:madmax:

However old you are... you're TOO DAMN OLD... for stunts like mountain biking!



Sorry, I was having a flashback of my co-workers and their brainwashing attempts on me whenever I come to work.
This is the kind of stuff I get as a 51yo geezer who keeps coming into work with new evidence to the real FUN one can have in life through mountain biking!
...
well...
.....
after one heals, that is..... :madman: 

Glad to hear about the increased ROM... keep it up!
I've decided that Black Friday is my day to finally go for a ride! Just no jumps yet... I think... we'll see tomorrow


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## Wheelbender (Nov 28, 2006)

*Life is not a journey.....*

"Life is not a journey to the grave with the intention of arriving safely in a pretty and well-preserved body. But rather, to skid in broadside, thoroughly used up,totally worn out, and loudly proclaiming .... WOW what a ride." :thumbsup:


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## J-ay (Nov 22, 2011)

Wsmac, 

LOL :lol:! Switched it to a computer bag as it has more padding in the sling. Have a good ride :cornut:


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## wsmac (Sep 5, 2010)

J-ay said:


> Wsmac,
> 
> LOL :lol:! Switched it to a computer bag as it has more padding in the sling. Have a good ride :cornut:


ALRIGHT! You're back in the gang!:thumbsup:

It was too wet and muddy (more clay than good dirt) to ride... so I just slid everywhere 

Do you sleep on your side? Just curious... nothing kinky... :nono: 

I used to sleep on my side a lot... but I can't do that comfortably any more on my right shoulder.

Once my injury on my left side heals, I hope I can still sleep on that side. My girlfriend is getting tired of me being injured such that we can't spoon. :frown:


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## NJMTB (Aug 1, 2010)

*Update - No Surgery Six Weeks Recovery*

This is an update from a guy who decided NOT to have surgery after a Grade III.

Crashed on October 9th. Hit the gym doing very light exercises two weeks later. Rode my first trails on November 3rd, but easier stuff (Backbone and Sage at Pt. Mugu if anyone knows them).

For Thanksgiving, I had two friends in town and we rode three days straight, Pt. Mugu, Elings, Romero Canyon, and Jesusita here in Santa Barbara. Rode every section of every trail, and faster than ever. I seem to ride with a little more focus these days... 

Basically six weeks recovery time.

Happy trails.


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## wsmac (Sep 5, 2010)

NJMTB said:


> This is an update from a guy who decided NOT to have surgery after a Grade III.
> 
> ...Crashed on October 9th...
> 
> Happy trails.


So how's the shoulder feel?
How is sleeping and other normal life activities?

I don't sleep all that well on my right shoulder (the one operated on), and I'm still nursing a grade I or II on my left shoulder from my most recent crash, so there's some pain, and it's too annoying to sleep on that side unless I sleep with my arm straight down my side... which is unnatural for me and puts pressure on my ribcage (broken rib).

I get away with it for a while, then I flop onto my back for the rest of the night.

I've been back to doing my stretching, and I'm starting weights again really soon.
I'll try pushups, but pullups are out for a bit longer I think.

GAWD I HATE GETTING FAT AND OUT OF SHAPE!

That's really the worst thing about getting injured to me... decreased activity!

My operated shoulder can basically handle all the normal stuff I used to do and it's been since... eh... April? I think from the last surgery.

Like I've said before, I know at least a couple of MTB'ers who opted out of surgery and live with things the way they are. No complaints, and at least one guy rides just as aggressively as ever.


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## J-ay (Nov 22, 2011)

Hello fellow daredevils! It has almost been 4 weeks since my fall and ROM is pretty good. Drs are advising not to do any lifting still for another 4 weeks. I have a nasty looking bump from my drooping shoulder which looks pretty bad, specially from the back. Looks like I have a gremlin growing. 

My clavicle is still moving up and down freely (any experiences how long this will last?) I laid off the heavy weight for a week as I just got tired of it. The resulting x-ray today showed that my clavicle moved up a bit/separated more than my previous x-ray 2 weeks ago when I was carrying the weighted bag. :sad: So My doctor has recommended to do a PRP injection to speed up the healing while using the bag. Does anyone have any experience with this? Basically he wants to get the gap to be as close as possible or i might have problems with arthritis in the future. 

Thanks!


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## dkolinski (Apr 3, 2007)

Hey, I'm new to your 'club', with a class 3 separation! I always thought it would be mountain biking that would do the first major damage, but in my case it was skiing (first run of the first day of the season, figures).

I am seriously considering repair surgery, so I want to hear from those that went that route. Most of the posts here have been from those that went without.

So, if you had repair surgery, how did it turn out? How long can I expect to be at a low level of activity? Will the area be less vulnerable to arthritis down the road than without the surgery? Will the shoulder be able to take a fall again, although hopefully at a lesser impact?

Any information would be very helpful, as I have to make my mind up soon. The main reason I am considering the surgery is because I want to try to minimize future problems. Like Wsmac posted above, I have the insurance to do this now, but I will not likely have the same insurance later. I'd hate to develop debilitating arthritis in ten years and drain my bank account to reconstruct the joint.

Thanks for your help.


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## bloodpuddle (Jun 15, 2007)

I haven't had surgery and was told that with my grade 3 I didn't have a greater risk of arthritis. The reason given was that grade 3 is clean separation so that there's in fact less contact, friction etc than with a grade 2 and therefore a lower risk of developing arthritis.

I was told that surgery wasn't going to change those odds for me.


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## J-ay (Nov 22, 2011)

bloodpuddle said:


> I haven't had surgery and was told that with my grade 3 I didn't have a greater risk of arthritis. The reason given was that grade 3 is clean separation so that there's in fact less contact, friction etc than with a grade 2 and therefore a lower risk of developing arthritis.
> 
> I was told that surgery wasn't going to change those odds for me.


Thanks! :thumbsup:

As an aside, I was trying to find out more info on our injury and stumbled upon this guy who taped his clavicle down and was successful in keeping it down. There's hope for the newbies in the group. I'm going to try the taping instead of the weighted bag as it still pops up whenever I take off the bag.


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## pacing08 (Jan 15, 2008)

*1 year 8 months later grade 4-5 no surgery*

I separated my shoulder April of 2010 going down a narrow chute. I switched jobs and did not have insurance just yet so decided not to see a doc.I diagnosed myself with grade 3. Pain eventually went away and got full range of motion so felt no point in seeing a doc anymore.

Finally saw sports injury doc 3 months ago because I wanted to start lifting weights again and was paranoid without expert opinion. He saw my x-ray and his reaction was of surprise cus it look like grade 4-5 to him. He says that if I saw him when I first was injured he would have had me have surgery during the acute phase of injury. He does not see importance now since I have no pain/discomfort and have full range of motion and I'm not in acute phase.He says getting older won't make it worse.

I've been back on bike for a while now and shoulder feels fine. I could bunny hop, wheelies and do drops etcs. I can lift weights including shoulder work outs and there is no pain. I can swim etc.

If I had the choice I would have done surgery during the acute phase of injury just so that it can be close to 100%, but surgery would not benefit much anymore. I had to get over the self consciousness of the deformity. People really don't notice the shoulder unless I point it out to them.

If you decide to get surgery make sure you make that decision during the acute phase if not surgery will help minimally. Otherwise when pain goes away and full range of motion is back lift weights and make surrounding muscles stronger. You'll have to deal with the aesthetics of the droopy shoulder.


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## gbumgardner (Jul 25, 2008)

*AC Surgery, Frozen Shoulder & Sometimes Trees Suck*

I found this thread last month shortly after injuring myself back in November. I was surprised at how long this thread has been around, and how many people have had almost exactly the same experience that I have.

I wrecked my right shoulder when I screwed up and rolled onto a wet bridge going a little too fast - the bike slipped out from underneath me and I went over the side and hit a tree. One of those "I think I've really hurt myself" moments. Luckily I was riding with a friend and it was only one mile walk to the trail head.

The X-Rays showed Grade V AC separation. Doctor suspected that I had also injured the rotator cuff. I had surgery one week later. They inserted the temporary hook plate and performed arthroscopic repair on the rotator cuff. The hook plate comes out in 3-4 months. I've since learned that there are other surgical procedures that might have worked better than the hook plate, but too late now.

I've since developed adhesive capsulitis (frozen shoulder) and have been going backwards for a few weeks now. The shoulder felt and looked better a week after after the surgery than it does now. The pain from the capsulitis is much worse after a few hours of on and off sleep. I'm burning through Vicodin and NSAIDs and had to go back to "sleeping" in a Lazy Boy chair. The Doctor prescribed PT after the frozen shoulder diagnosis, but that won't start for a few weeks.

I went through the frozen shoulder/impingement thing once before on this same shoulder when I was 30. It was two years of stretching and weights before I could do a push-up, but I did manage a full recovery. I'm 50 now and must admit that I'm not sure I can motivate myself to do what is necessary this time around. I was in great cycling shape before the crash, so it's a little discouraging to think I'll probably be starting over once I get back on a bike.

Heat from a hot shower seems to help. I'm thinking of replacing my broken hot tub/spa with a new one. They're not cheap, but I don't think I'll have any problem rationalizing the purchase. I'm just curious as to whether some time in the spa will make for less painful ROM exercises.

Anyway, I just wanted to unload. Thanks.

-g.b.


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## davidhaile (Nov 27, 2006)

This is a great and timely thread! Glad to find it. I wrecked 3 months ago and think mine is grade 4 or 5. It doesn't hurt but still clunks around with loose bones after 3 months so I revisited the ortho doctor yesterday. He's recommending surgery. I'm shocked at the cost! I'm going to live with it and try to keep it very, very still for a few weeks and see if I can get the tendons to start reconnecting. What's the worst thing that can happen? I don't need a lot of mobility in this shoulder as long as I can still ride.

Dave (52 years old)


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## ScottyJ7 (Dec 18, 2011)

If anybody ever needs an honest no BS answer about their shoulder or knee injury either call or send and email to this guy. He is one of the best ...he specializes in shoulders and knees and getting athletes back on their bike quickly...

I went to him to have him repair my broken clavicle...back riding in 6 weeks

Sports Injuries, Motocross Injuries | Houston Orthopedic Surgeon

Scotty J.


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## gbumgardner (Jul 25, 2008)

davidhaile said:


> This is a great and timely thread! Glad to find it. I wrecked 3 months ago and think mine is grade 4 or 5. It doesn't hurt but still clunks around with loose bones after 3 months so I revisited the ortho doctor yesterday. He's recommending surgery. I'm shocked at the cost! I'm going to live with it and try to keep it very, very still for a few weeks and see if I can get the tendons to start reconnecting. What's the worst thing that can happen? I don't need a lot of mobility in this shoulder as long as I can still ride.
> 
> Dave (52 years old)


Dave,

I had been riding with no insurance for about 8 yrs, but just switched from working as a consultant back to working a salaried position. Holy s**t am I glad I have insurance now. The bill so far for the shoulder is ~35K and I still have PT and a second surgery to look forward to.

-g.b.


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## dkolinski (Apr 3, 2007)

Just an update. I opted not to get surgery for my class 3 separation (the orthopedic surgeons left the option open for me, but they indicated that it would almost be for purely aesthetic reasons, as the range-of-motion and strength should return to pre-crash levels without it).

So, about 5 weeks later, I have made great progress towards recovery. I can curl almost as much weight as before, my range-of-motion has nearly returned, and I have very little pain. I can't yet do many push-ups or sleep on the bad shoulder for very long, but its still encouraging. 

The residual bump is no big deal. I obviously wish I didn't have it, but it certainly wasn't worth the risk of surgery to get rid of it! Good luck to you guys, too!


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## JackStephen (Jun 29, 2010)

Hi there, can I join the club? 

It was last sunday. First time doing serious downhill, I was tire-to-tire with guys supposedly better than me, I got too confident and by the end of the first run something went wrong (but cant remember due to a -later discovered- hit in my head). Never went unconscious, but have no memories from few seconds before the impact and 30 to 40 minutes later. I "woke up" inside an ambulance while a paramedic was putting a temporary bandage on my right shoulder. 

Went to ER, X rays taken, Grade 1 almost 2 AC Separation diagnosed, along with several bruises and rashes in my body. I already knew, but was afraid about the degree of the injury. Sling on, anti inflammatory pills and go home. Next day went to the ortho specialist, who confirmed the grade of the separation, gave me some treatment to the bruised muscles around the shoulder and sent me home.

I am taped now (ortho's recomendation) and the bump in my shoulder is almost unnoticeable and hope it remains that way. Still hurts like hell! I don't want to even imagine what you grade 3+ guys have gone through.

Next ortho visit in 12 days, let's see what goes on.


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## Broncstad (Aug 4, 2009)

JackStephen said:


> Hi there, can I join the club?
> 
> It was last sunday. First time doing serious downhill, I was tire-to-tire with guys supposedly better than me, I got too confident and by the end of the first run something went wrong (but cant remember due to a -later discovered- hit in my head). Never went unconscious, but have no memories from few seconds before the impact and 30 to 40 minutes later. I "woke up" inside an ambulance while a paramedic was putting a temporary bandage on my right shoulder.
> 
> ...


How is it?


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## JackStephen (Jun 29, 2010)

Broncstad said:


> How is it?


Tomorrow will be a week without the sling. Last friday arrived an EVS Shoulder Brace from JensonUSA:










This thing is great, it supports my arm while allowing some movement, and the detachable velcro thing can be placed over the collarbone to exert downward pressure and help putting the bone back in place. The bump is at 1/3 the height it was the day after the accident.

I'm out of painkillers and anti inflammatory pills now. The only thing I'm taking is Super Cissus RX, it´s supossed to help healing joint, tendon and muscle injuries.


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## davidhaile (Nov 27, 2006)

Update for future MTBR shoulder injury people: I'm a 52 year old once/week fair weather mtb rider. Initial x-ray on 10/20/2011 showed a standard separation of clavicle (collarbone) from the shoulder. Doc said it was a common injury and likely to heal on its own given enough time. Bump will always remain. 3 months later (1/20/2012) my shoulder bones were still rattling around on certain shoulder movements so I visited an ortho doctor. Further x-ray and mri says both ligaments on the clavicle are gone and it is highly unlikely that they'll regrow. Surgery is the only option. Plus - the mri also showed I had a torn rotator cuff on the same accident. I had no idea since my shoulder hasn't been that useful for 3 months. I haven't had any significant pain since a week after the accident. All will be repaired in one long surgery in 9 days (2/10/2012)! Doc said 6 weeks of no muscle activity on that shoulder followed by 6 more weeks of light use before I can do anything that requires strength with my right arm. Rehab starts within a couple of days of the surgery and involves someone else moving my arm around around for me. I won't be allowed to help! The clavicle tendon repair requires a tendon from a cadaver. Yuck. I hope he/she was a caring liberal.


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## gbumgardner (Jul 25, 2008)

*+1 for Physical Therapy*

A follow-up: I've been making good progress the last few weeks. Semi-weekly physical therapy, exercises, and lots of ice has definitely helped - gained almost 20 degrees flexion in just over two weeks. Having some issues with nerve impingement that I hope will clear up when I get the plate removed next month.

I'm on the trainer now (YUCK!), will probably get back on the road bike soon, and am hoping to get back on the MTB in May. Feeling much better about things now.

Good Luck All,

-g.b.


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## wsmac (Sep 5, 2010)

davidhaile said:


> ...Doc said 6 weeks of no muscle activity on that shoulder followed by 6 more weeks of light use before I can do anything that requires strength with my right arm. Rehab starts within a couple of days of the surgery and involves someone else moving my arm around around for me. I won't be allowed to help! The clavicle tendon repair requires a tendon from a cadaver. Yuck. I hope he/she was a caring liberal.


I don't know if you read my earlier post... http://forums.mtbr.com/8532201-post13.html

Even though I work in the medical field... I am a very poor patient :nono: 
I believe part of why I had to have my second surgery was due to my 'cheating' while in the sling and soft pillow set-up.
Getting the hard brace helped me be much better at complying with my doctor's orders and therefore healing in the proscribed time.

I feel a bit guilty at wasting the first Allograft (cadaver ligament), but the second one has been holding up just fine!
I've even taken some tumbles on trails and I have no extra issues because of my previous injury.

I am glad I had the surgery... err... both of them :madman:  :thumbsup:


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## J-ay (Nov 22, 2011)

Sorry to hear about your need for an operation, David. Like you, the prognosis on my tear is that both ligaments are torn and that they wont grow back, unless i go for the surgery. Unlike you, I don't encounter the rattling sounds and I have no other injuries to go with it. 

Just an update to my recovery.

It's been 2.5 months since the fall. My bump is pretty ugly, it's like i have a golf ball on my shoulder at some angles, but there's no pain at all, only some slight discomfort at times. On the positive side, I started a TRX program 3 weeks ago and, amazingly, have regained a lot of strength back. I can now do some push ups on the TRX or while holding on to a swiss ball. 

I've been swimming a bit and did 3.5KM yest. In fact (call me crazy), I plan to join a 10KM open water swim next week. I might not finish the whole thing but I'll probably be able to do at least 6KM. 

I've posted a picture of how it looks. Sorry about the resolution as I just used my phone for this. It looks worse than how I actually feel but aside from being conscious about it, not a lot of people notice it once I wear a shirt on. 

Good luck to all of us who's suffered an ACJ injury (or two). Ride safe!

Jay


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## davidhaile (Nov 27, 2006)

No - didn't read it. But thanks for the warning! Tomorrow morning I have my final visit with the Doc to consent to surgery and review everything that he's going to do the following Friday. Yikes!

Sorry - no time to find the link (am at work), but did you see the other sling that someone posted here? It looks great and I'm sorry that I don't have one already. I've wondered why the doc doesn't put a cast on it if it is that easy to ruin the effort.


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## bloodpuddle (Jun 15, 2007)

*Go swim!*



J-ay said:


> I've been swimming a bit and did 3.5KM yest. In fact (*call me crazy*), I plan to join a 10KM open water swim next week.


Not at all. When I first did my AC (grade 3, Sept 2011), one of my biggest concerns was having screwed up my swimming. Have always wanted to do my local 11km open-ocean swim (Bondi-Watsons Bay).

In fact, I attribute a significant part of my quick recovery (non-surgical) to getting back in the pool early (week 3 from memory) and getting strength and mobility back into the shoulder quickly but gently.

I'm now back to swimming twice a week for about 2km each time, and my pace is pretty much the same as it was pre-injury.

I won't have time now to train up for the May 2012 Bondi-Watsons Bay, but 2013 I'm doing that race. :thumbsup:


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## Broncstad (Aug 4, 2009)

Tomorrow it will be 2 weeks for my grade 1. I was riding within 4th day with miner pain. Still today it's about the same. I hope riding isn't injuring it more. I know grade 1 is small, but I got to start somewhere. You think it's ok to ride if there is almost no pain? I still have pain when I reach across my chest or if I reach out to the side while bent at the waist.


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## g00mba (Mar 9, 2011)

I tried taping and there was a definite improvement for me, but not a total fix. Also its hard to say whether the bump would have got smaller by itself or not. who is to say. I see a huge improvement when I look back at the photos of the day followign the injury. I still have a 1 inch bump which I'm going to get fixed next week with a new procedure called a Nottingham surgilig. My injury was a year ago.

I'm getting it done because the shoulder is really weak and aches as well as looking deformed. I figure if I live for another 40 years, then I may as well get this done now.

To those that say that there is no point trying to hold the bump down, I don't think that's right. The arm is drooping, but the clavicle is also raised by the muscles on the traps that are attached to it. Bringing the clavicle lower (by using weights or tape) might help them heal closer to an ideal position.

Good luck everyone.


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## dynamicz (Sep 14, 2007)

Hi guys,

Glad I was able to find this thread. On Monday (2/20) I was at the dirtjump features and crashed otb hard on my left side. ER took these x-rays and I went to the othro doctor yesterday (2/21)... he is saying its a grade 3/4 and recommended surgery since I am an active person; less chronic pain long term and less side effects in general.

Currently in a sling with shoulder immobilizer and pain meds.

I do no look forward to the surgery route and will seek a second opinion today. Is there other questions I should ask? like taping technique, shoulder braces? I appreciate all the help and suggestions.


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## JackStephen (Jun 29, 2010)

Last weekend, after 6 weeks of my AC, went and rode my new hardtail in the woods. No pain but my shoulder muscles got sore after 3 hours of riding. Legs were burning too. Took it easy, the way down was much slower than the last time, I don't want to crash or fall since the injury is still healing and don't want to screw things up.


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## g00mba (Mar 9, 2011)

Dynamicz:

Mine is like yours and I'm getting it done next Tuesday 28th. I had the injury a year ago and I taped religiously for 3 months which may have helped a bit, but I still have a huge lump like yours and its massively unstable. I wanted to see how things go, but with hindsight, I wish that I had the surgery straight away as now I have to recover twice.

Find a shoulder specialist who has a good success rate and avoid k-wires as these seem to fail regularly from what I read online - take that for what its worth. I'm getting a Nottingham Surgilig which according to my surgeon has a 95% success rate. We will see.

Surgilig AC Ligament

I'll post back after the op with some pictures.


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## davidhaile (Nov 27, 2006)

dynamicz said:


> Hi guys,
> 
> Glad I was able to find this thread. On Monday (2/20) I was at the dirtjump features and crashed otb hard on my left side. ER took these x-rays and I went to the othro doctor yesterday (2/21)... he is saying its a grade 3/4 and recommended surgery since I am an active person; less chronic pain long term and less side effects in general.
> 
> ...


The amount of separation between your collarbone and shoulder is amazing! There's a lot of open space between the two ends. I'm 52 years old and augered into the dirt with my right shoulder at 15 mph last October on a flat section of trail AFTER having ridden 6 miles of tough steep trails. My ER doc said it should be fine and didn't recommend surgery. 3 months later the bones were still knocking together when I moved my arm so I went to the ortho doc. Xrays and an MRI showed missing ligaments in the middle of the collarbone. The middle one never heals itself. I'm online because I'm off work and surgery is in 2 hours! Dr Z is using a ligament from a cadaver. He'll drill a hole in my collarbone and tie a knot in the new ligament then tie the lower end to something else so it will regrow. I also had rotator cuff damage so he'll be doing 2 surgeries today. 2.5 to 3 hours!

In my opinion, if your ER doc says cat 3/4 and looking at that x-ray with the large amount of separation, I'd recommend going with it and doing the surgery ASAP. Surgery or not, the recovery time for a shoulder injury is very long. It is better to have only one recovery period so the whole year isn't shot. Get the surgery done ASAP so you can be back on the bike for summer!

Another uneducated ignorant suggestion --> if you don't get that collarbone near the shoulder so it can start regrowing the ligament, you're not going to have a useful shoulder. I wondered whether I had taken the effort to strap that collarbone down if it would have reconnected on its own. The Dr says the middle ligament won't do that because it is inches shorter than it was when it was connected.

Here's what my recovery looks like: Surgery today on my right shoulder, 2 weeks of no shoulder muscle activity at all. The rehab nurse will move my arm for me during those two weeks. 4 more weeks of very little movement, though I can probably raise my hand high enough to work on the computer (I'm a software engineer). I'll have a total of 3 months before I can start at even a minor level of old geezer strength improvement. It will be 6-9 months before I'm back to where I was before the accident.

After the initial pain of my injury subsided within a few days (maybe a week), I could still ride the bike. The pushing-down strength was not compromised. I couldn't lift anything much heavier than a 12-ounces. I haven't had much pain at all since then. It is a shame that I have to go through it all again in 2 hours!


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## dynamicz (Sep 14, 2007)

Thank you for the suggestions and information. I have taken notes and will be asking the ortho doc for his advice and recommendations. I want to make sure that I consider ALL my options. For those that will have their procedures done soon, good luck to you and on a speedy recovery.

I am rushing to get all these consults and dr’s opinions done so I can figure out the best route and get it done as I know the body is already in healing mode… would rather it be the best path to take.

David, you are as surprised as I was when I compared my x-rays to others in Google images and in this thread, I was like, “Why is the gap as big as the gap I (almost) cleared?” Anyways that could be attributed to the speed and height I was travelling from the dirt jump. 5ft-ish high by 15ft-ish far and landing VERY front heavy in a decline tossing me over the bars and I landed full force all on my left side before tumbling. (Found out that high psi in main chamber and fast rebound on shock will catapult the bike like that.) On top of the left AC, I also got a sprained left ankle, big bruised quad, sprained fingers and welt on my left temple as well as various scraps and bruises. Luckily I was wearing gloves, knee, elbow, 661 core saver and of course helmet; it would’ve been worse w/o them.

I didn’t like the hear that surgery would be imminent in my situation but at least I know what to expect from your feedback. Keep them coming as I will need as much info before the 4p pst appt. Thanks a lot for the responses.


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## willawry'd (Oct 3, 2005)

Wow Dynamicz, that is a lot of separation.

Injured mine last March. First Doc said it was type 2/3 with recovery from 6 to 9 weeks and didn't recommend surgery. Second Doc said type 3 with recovery from 6 to 9 months with rehab and only recommended surgery if I still had discomfort thereafter (since I have full range of motion).

Resumed riding within 5 months with some pain that would somewhat subside after 15-20 minutes into the ride. Still couldn't bunny hop without sharp pain though. Mainly while shifting weight from the rear to front and into the landing. Purchased a suspension fork 3 months later to replace the rigid which helped a lot.

Last month was the first time I could sleep on the injured side without the pain waking me. Still having to either keep my arm extended under my head or support my head with an extra pillow to take some weight off the shoulder though. And it's weird how some of the simple tasks like washing my hands or taking showers are when most of the discomfort occurs. Feels like something (muscle, cartilage..) is moving (grinding,popping) over the end of the clavicle.

So now it's 11 months out with 6 months of physical training and I'm still feeling discomfort. Probably going to continue with the PT through the spring and fall and get a third opinion with the intention of having surgery in the off season.


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## davidhaile (Nov 27, 2006)

post surgery typing with left hand - excuse mistakes and short sentences!

arrived 11:30a, pokes n prods n iv, operating room 1p, didnt get out until 7p! wake up, sit up, stand, etc to prove brain was ok, free to go 8:30p in windy snowstorm (n wyoming). kids had flowers and get well cars for me. i dont have the post-op overview of why it took 4 hours longer than expected. will get that next week. there are strange blood blister-type marks near my neck which makes me wonder if my collarbone needed work on that end. i have a thank you card to write to the family who donated the cadaver tissue for the rebuild.

arm is starting to ache. no shower for 4 days. rehab in 5 days - pendulum movement only. drugs are complicated. gabapentin to limit muscle spasms, oxycodone for pain, 1000mg tylenol for aches.

if dr recommends surgery, get it done soon so you only have one recovery period.

i am online for the next few days! plz post back your experiences.


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## davidhaile (Nov 27, 2006)

the bone movement that you are feeling is what i had. it prompted me to visit ortho dr then surgery yesterday. yours may never heal without surgery.


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## dynamicz (Sep 14, 2007)

Many thanks for the healing vibes, it must have worked since I got good news yesterday in my 3rd opinion ortho appt.

Dr. F looked at my x-rays and listened as I explained to him the opinions of the other docs I’ve seen. Before he gave his insights he noticed there was an angle missing from the x-ray that no one bothered to take before. This was of the view from the armit up (or shoulder down, however you see it). Got another round of x-rays (already up to 10 shots this week) and he examined them, good news.. collarbone didn’t displace forward or backward meaning that this injury was not a Type 4, yah! Another good bit of news.. the swelling subsided just a bit to where the separation is not as extreme as the ones I posted; maybe 1/3 less worse.

So I am looking at a solid Type 3 AC separation and surgery is not the first option, from his recommendation (this is because I am not left handed dominate or occupation is not a weightlifter or care if I have a lump in one shoulder). There were several routes and the best option in my opinion was just to let it heal on its own with PT and much rest and in 3 months come back to see if it still bothers me.

Dr. F. actually recommended against getting surgery for Type 3 only because there are (small) risks that can result from the procedure in the months following than compared to getting the surgery months after when it has healed itself, so at least I have that option. And I am just hoping that I heal up the first time successfully and not have to worry about surgery. Fingers crossed.

So today I will go to the gym and soak in the hot tub and steam room and just do small movements to prevent shoulder freeze and ice the shoulder up to reduce any more swelling. Slow and easy.

Btw Dr. Farac is the Ortho doctor I saw, he was born and raised in Vancouver and a fellow North Shore rider. On top of that, his specialty and interest is in surgical ligament procedures in the shoulder (with a whole bunch of research background too). He didn’t even push surgery as my first option as with the other docs I saw and rather I listen to what options I had. Pretty cool. This pretty much made me content with this advice.


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## dynamicz (Sep 14, 2007)

davidhaile said:


> post surgery typing with left hand - excuse mistakes and short sentences!
> 
> arrived 11:30a, pokes n prods n iv, operating room 1p, didnt get out until 7p! wake up, sit up, stand, etc to prove brain was ok, free to go 8:30p in windy snowstorm (n wyoming). kids had flowers and get well cars for me. i dont have the post-op overview of why it took 4 hours longer than expected. will get that next week. there are strange blood blister-type marks near my neck which makes me wonder if my collarbone needed work on that end. i have a thank you card to write to the family who donated the cadaver tissue for the rebuild.
> 
> ...


David, hope you have a good recovery and that you are back up and riding not to long.


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## willawry'd (Oct 3, 2005)

davidhaile said:


> the bone movement that you are feeling is what i had. it prompted me to visit ortho dr then surgery yesterday. yours may never heal without surgery.


On the bright side, it got me back into the gym and I can now fit in tighter places. 

Please keep us updated and hope you have a speedy recovery.


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## willawry'd (Oct 3, 2005)

dynamicz said:


> Dr. F. actually recommended against getting surgery for Type 3 only because there are (small) risks that can result from the procedure in the months following than compared to getting the surgery months after when it has healed itself, so at least I have that option. And I am just hoping that I heal up the first time successfully and not have to worry about surgery. Fingers crossed.


That's similar to what my Docs have said. One of the possible risks I remembered was a limited ROM. Not sure what the chance of that occurring is but he was obviously against surgery for my situation.

Hope PT works for you. And please let us know what rehab exercises they have you do. Been rehabbing on my own (friend's wife is a physical trainer) for a 6 months now and I'm just now starting to see modest improvements.


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## davidhaile (Nov 27, 2006)

good news! i'm looking up info on the oxycodone the dr put me on. scary stuff! i'll definitely wean off it after the worst is over. i'd rather have a little pain than take a chance of addiction.


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## g00mba (Mar 9, 2011)

Had long awaited surgery this morning. Doc made 3 inch incision and replaced cc ligaments with artificial one.

Arm was numb due to nerve blocker. Taking Naxopren? And codiene. Also have Tramadol in case I need it. Doc removed end of clavicle and noted that it had gone soft. Probably due to non-use. 

Will be in a sling for 4 weeks, but can remo
ve for washing and PT.
Full recovery expected to be around the 3 month mark.

I'll post some pics up tomorrow.


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## xcguy (Apr 18, 2004)

g00mba said:


> Had long awaited surgery this morning. Doc made 3 inch incision and replaced cc ligaments with artificial one.
> 
> Arm was numb due to nerve blocker. Taking Naxopren? And codiene. Also have Tramadol in case I need it. Doc removed end of clavicle and noted that it had gone soft. Probably due to non-use.
> 
> ...


Take the long view. "Full recovery" at three months is a stretch. Just take it a day at a time. Whenever you get to the point where you feel you're able to push your workouts because you feel so good, give it another two weeks. Setbacks take longer to come back from than just a slow steady recovery.


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## wsmac (Sep 5, 2010)

I just rode a rough and rocky trail yesterday and my shoulder (posted about it a few pages back) never let on that I had it operated on last year.
As I've said before in this thread, I know a couple of folks who opted to not have surgery and they still ride hard, but in my case I'm glad I had the surgery.
I work out with. o issues, and I e taken some spills with no problems concerning my shoulder. Of course... now I just crash on my non-operated side  lol
Get yourself se good mtb DVDs and a trainer for your bike, then when you're able to, get in your ride time indoors while you heal. That's what I did and I'm glad I did!
I was riding the trainer even after my second surgery with my arm in the rigid brace.
I was using my road bike, btw.
If you do this, just be careful and don't get so involved with the vids that you crash while attempting to jump when they do! LOL
... or at least make sure there aren't any glass coffee tables in your fall zone!


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## dkolinski (Apr 3, 2007)

Another update: I'm 3 months out from a class 3 separation with no surgery. I would say I'm back to 99%! I went on a 15 mile road/trail ride with no pain at all, and I can throw a rock nearly as far as before. I still have to be a little careful with my sleep position, but even that has become much easier. So, don't fret...your ROM should come back.


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## g00mba (Mar 9, 2011)

xcguy that sounds like good advice.

Pic of how the shoulder looked before the op is at the bottom of the post.

Its the left shoulder. The first image is mirrored.
I'll post some more when the sling is off.

I think there will still be a bit of a bump left, but the main benefit for me is strength and stability (assuming all goes well). That shoulder was pretty shot.

Its important to remember that there are degrees of separation. Mine was a grade 5 (Rockwood scale) which would forever be unstable. If I had a grade 3 or less, I might not have opted for surgery, but I felt that the bone sticking out like it did along with decrease stability and softening bone was a bit of a liability in our sport.

***update*** 14 November 2014

Here's a bit of an update 2 years on, sorry I didn't put anything up before, once I got it fixed I stopped obsessing about it. That's worth bearing in mind, that people who get successful surgery sometimes forget to come back and say that they were happy with it.

The picture below is from pre-op. I don't have any post op pics and too lazy to put them up but my fixed grade 5 looks like most peoples grade 3 pics as the surgeon used a surgilig that was too long. however, in general I'm much happier with the result and can do everything that I could do before.


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## davidhaile (Nov 27, 2006)

3/7/2012 Update: It has been 2 weeks since the operation. My right arm will continue to be in a sling and I'm not to use my shoulder muscles for 4 more weeks. Sleep is still difficult - probably because I hate to think that I could be dependent on drugs. I stopped the Oxycodene 4 days after surgery. I use Tylenol at night but would rather live with a dull ache the rest of the time than take anything for it. I'm a software engineer and can type OK with the keyboard on my knees. Last week I built some cables which requires two hands and wire strippers, screwdrivers, etc. At Monday's Ortho appt the xrays showed a little more distance between collarbone and shoulder from how the Dr set it during the operation. He said it was because of the handwork! So - I'll be more careful and hope it doesn't move any further. The shoulder is stiffening up this week - a bad sign and a harbinger of a rough rehab once the first 6 weeks have passed. I visit rehab 3 times a week and will continue for another 12 weeks.

I don't have the total bill but just the hospital portion alone was $22k! That doesn't include the ortho surgeon. I anticipate the total above $40k. Insurance is paying for everything above $3500. Sheesh! Glad I have insurance and glad I've saved a little in the HSA account!


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## xcguy (Apr 18, 2004)

davidhaile said:


> 3/7/2012 Update: It has been 2 weeks since the operation. My right arm will continue to be in a sling and I'm not to use my shoulder muscles for 4 more weeks. Sleep is still difficult - probably because I hate to think that I could be dependent on drugs. I stopped the Oxycodene 4 days after surgery. I use Tylenol at night but would rather live with a dull ache the rest of the time than take anything for it. I'm a software engineer and can type OK with the keyboard on my knees. Last week I built some cables which requires two hands and wire strippers, screwdrivers, etc. At Monday's Ortho appt the xrays showed a little more distance between collarbone and shoulder from how the Dr set it during the operation. He said it was because of the handwork! So - I'll be more careful and hope it doesn't move any further. The shoulder is stiffening up this week - a bad sign and a harbinger of a rough rehab once the first 6 weeks have passed. I visit rehab 3 times a week and will continue for another 12 weeks.
> 
> I don't have the total bill but just the hospital portion alone was $22k! That doesn't include the ortho surgeon. I anticipate the total above $40k. Insurance is paying for everything above $3500. Sheesh! Glad I have insurance and glad I've saved a little in the HSA account!


And so post op begins. I don't like taking pills any more than you do but my doc told me to "stay ahead of the pain" which required taking my pain pills regularly. Yes, I did start to wean myself off of them three to four weeks after surgery but your body (as they told me) uses more energy fighting the pain than healing so you're doing yourself a disservice by "righteously" not taking the pain pills.

About the time I stopped taking the oxycodone I got one last 'script for 40 pills. I still have that full bottle as a reminder. I wouldn't have hesitated taking some of them at the time if I thought I needed it. Good luck in the months ahead.


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## DreamingDog (Mar 13, 2012)

*Got One Today. Booooo!*

Hey everyone!

I was searching for information on AC separations via mountain biking and found my way here. I wish I were posting under better circumstances.

Took a jump earlier today off kilter, flipped over the bars, and landed straight on my right shoulder. I saw an MD today who diagnosed an AC separation after a few x-rays. He doesn't know enough to rate the grade as he was a Family Practice guy at a walk-in clinic. I have an appointment with a Sports Medicine specialist tomorrow at 11 a.m. so I'll update when I know what I'm working with.

Judging by the posts from you guys on grades, I probably only have a grade 1 or maybe a grade 2. Any advice on managing the pain and getting back to full strength as quickly as possible? I got some naproxen (Aleve), Icy Hot, and some Ziplocs for ice. Any other recommendations?

Talk to y'all later.


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## bloodpuddle (Jun 15, 2007)

Hey D Dog

Bad luck and welcome to the club. There's lots of good info on this thread, so have a read.

Obviously, you should speak to a professional about your particular circumstances, and not just follow what other people have done/said.

I found the acute pain disappeared fairly quickly: much better after 24hrs and then again after 48hrs. I was completely off pain killers for my grade 3 within a few days.

I went to a physiotherapist regularly for the first 3 months, and found that a big help, as much with advice on what I could/should do to rehab my shoulder without exacerbating the injury.

Based only on my own experience, I'm a big believer in hydrotherapy. A couple of weeks out from my injury the physio had me in the pool doing arm raises to the side and in front, and some upright stationary breaststroke motions. About a month after the injury I was doing laps of breaststroke (not freestyle), and after about 7-8 weeks I was doing laps of freestyle. 

I was also back on the bike & trails after about 8 weeks (did a 50km race at 8 weeks, in fact). Took me a while to get my confidence back for anything technical, however.

Good luck, and post your experiences.


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## Broncstad (Aug 4, 2009)

DreamingDog said:


> Hey everyone!
> 
> I was searching for information on AC separations via mountain biking and found my way here. I wish I were posting under better circumstances.
> 
> ...


Immobilize. Sling and ice is super important. I'm pretty sure I had grade 1. I rode on the 4 day because I could tolerate it by then, but it's been probably 6 weeks and I can throw the stick/ball for the dog pain free today. I have been using it way to much during recovery. House chores and sh!t. Mild xc riding was just about the only thing that would bother me. So the only thing I have to add is immobilize without compromise


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## scottwest (Oct 8, 2011)

DreamingDog said:


> Hey everyone!
> 
> I was searching for information on AC separations via mountain biking and found my way here. I wish I were posting under better circumstances.
> 
> ...


That sucks! All I can say is ice, ice, and ice


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## mattyj (Mar 13, 2010)

Was glad to find a thread with so many experiences & comments to help with dealing with this shitty injury!

So I'm at day 5 after i suffered a grade 3 AC separation. Happened to me after i clipped a pedal when sprinting through a rocky section of trail. Threw me on my head & shoulder before i knew what happened.

Im opting to see how i progress over the next week before looking at surgery as an option.

I kept a sling on 24hrs a day for the first 3 days but started to let my arm just sit on my lap while sitting on the couch 2 days ago. felt good just to let my elbow extend!

Today i used a bunch of KT tape on the shoulder for support & took my sling off. Just letting my arm hang by my side. Cant really move my shoulder, nor have i tried but i feel like its a necessary step to keep range of motion. definitely going to keep the sling on for sleeping or if i leave the house, just to protect the shoulder.

Not doing any physical activity was driving me nuts so yday & today spun on a trainer for 30 minutes with my sling on. Not by any means a workout but felt good to pedal & do something other than sit around.

Going back to ortho tomorrow to see what he thinks & hopefully get a plan going for PT. I want to be back on my bike asap!


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## guero grande (Jul 10, 2008)

I busted mine (3rd degree separation) on a saturday back in November 2009. I visited the ortho on the next Monday and received a novacaine shot and cortisone shot that day. Both helped the pain in a major way. The doc offered surgery but didnt think it was necessary and i decided against. He then took me out of the sling that day, and sent me home only with a padded strap device to keep the shoulder immobilized for sleeping. I was also on Vicodin for a week afterwards. I was back to riding in January and back up to full speed riding in February. It might have gone quicker but my wrist was also in a cast from a fracture.

2 years later, i still have discomfort doing bar dips, and getting out of pools. But that's about it. I still make the rubber band physical therapy movements a part of my workouts once a week and think my shoulders are in better shape now because of it.


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## DreamingDog (Mar 13, 2012)

Hey guys. Thanks for the replies.

The Sports Medicine specialist diagnosed a grade 2 separation on Tuesday, the day after my crash. I was "prescribed" a shoulder immobilizer and declined his offer of a pain medication prescription. He also gave me a pamphlet with a list of exercises and therapy I could do on my own to help the healing process. 

The really crappy thing is that I have to go to work to keep up with my bills. I'm a 26 year old college student and I pay for everything on my own so skipping work equates to bad things. I called in the day after the accident, had the next day off by coincidence, and returned on day three.

I came back to this thread because work is really aggravating this injury. I try to use my right arm as little as possible but it's still unavoidable. By the way, I deliver pizzas right now and my car is a manual so that sucks. I feel like continuing to work is going to draw out the recovery process but there's really nothing I can do. I do have the next two days off so that's good.

It's really hard being inactive. I like to lift weights and run and that's totally out of the question. I just tried to do a push up and that was totally impossible. I could support my weight in the resting position but once I began to lower myself, it hurt very badly.

Well, this is just an update. I empathize with all you guys that are going through this or who have gone through this. Later y'all.


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## yowza (Mar 25, 2012)

*Another member of the sperated shoulder cycling club*

A week ago I had never heard of a shoulder seperation, now, & thanks to all the posters on this thread I am better informed & the wiser. I was on my road bike riding home from work at c30kmh & a girl on another bike appeared in fornt of me coming the wrong way out of a side street with no right of way. I T boned her back wheel & got catapaulted violently into the road (paved with concrete paving slabs), - 3 days in hospital, 4 broken ribs & a seperated shoulder, self assessment says grade 2 or 3, with 4 badly broken ribs its hard to know where pain from the ribs stops and pain from the shoulder starts. Initially horrified by what I read but then reassured from the collective wisdom of folk who have suffered the same deal. I am a very physical person and my physical life is my life so I need my body to work..............
I am in a sling for 2 weeks then got an appointment with the specialist. Comiserations & good luck to any other sufferers.................


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## xcguy (Apr 18, 2004)

yowza said:


> A week ago I had never heard of a shoulder seperation, now, & thanks to all the posters on this thread I am better informed & the wiser. I was on my road bike riding home from work at c30kmh & a girl on another bike appeared in fornt of me coming the wrong way out of a side street with no right of way. I T boned her back wheel & got catapaulted violently into the road (paved with concrete paving slabs), - 3 days in hospital, 4 broken ribs & a seperated shoulder, self assessment says grade 2 or 3, with 4 badly broken ribs its hard to know where pain from the ribs stops and pain from the shoulder starts. Initially horrified by what I read but then reassured from the collective wisdom of folk who have suffered the same deal. I am a very physical person and my physical life is my life so I need my body to work..............
> I am in a sling for 2 weeks then got an appointment with the specialist. Comiserations & good luck to any other sufferers.................


Yeah, you look like you're typing with one hand. We've all been there. Good luck!


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## herbn (Sep 17, 2005)

damn! as if cars wern't bad enough, now we have bike on bike accidents and this isn't even the standard group ride crossing wheels kind of thing.i wonder how does insurance work on this, respective car insurances?I'm sure this isn't the first one .


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## dynamicz (Sep 14, 2007)

6 weeks now. Back on the bike Tues, 4/3 and took it fairly easy, slow and worked on form. Today same trail, much faster. Stiff shoulders while descending but better after each ride. No pain, no issues with ROM. Only issue is really sleeping on the injured AC (left) side and waking up, it is stiff. I also have a sprained rotator cuff on the right side that I have to tend to as well.

I have to keep up with my stretches, exercises and icing to make sure my shoulder doesn't get tight and limited motion. I am so happy to be on the bike even if it is XC trails. My FR bike is being put together at the moment so even more motivation to heal up and get my strength in order.

Make sure not to get lazy on the PT. Try to heatup before exercises and ice up after. These 6 weeks taught me to be less stupid on the saddle and enjoy the ride while you can.


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## dirtdan (Jun 27, 2011)

JB800 said:


> I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The Doctors Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!


I've also had this injury and also didn't get surgery. Are you doing Physical Therapy? I still have some problems with the shoulder (separated it a few times actually) and I know they can go in and surgically repair it, but as someone else said, the surgery isn't all that effective long term so I'm holding out for as long as humanly possible.
Five weeks does seem like a long time for that to heal though. I don't remember it taking that long for me to get back to mostly normal activities. Do you struggle with 50 pounds because of pain or because of strength? You may be dealing with atrophy. You should be doing lower weights and high reps and build up to where you once were. I know my current shoulder status would prevent me from ever doing repeated high weights so you may be looking at adjusting your workout permanently.


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## Eric Z (Sep 28, 2008)

I joined the shoulder separation club today. I was riding with my wife and looked back to see where she was and then found myself in line with a tree. I lowered my shoulder and obviously the tree didn't move. 

The wind got knocked out of me but still had full rom. I rode the 2+ miles out- took it easy of course but there were climbs (as big as they get in the Chicagoland area) and didn't have issues. Rested at home and then it really stiffened up and the pain started. I went to the ortho and he said it was a grade I/II so not horrible. In a sling and will take it easy for a while. 

I appreciate the advice here. 
ez


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## dirtdan (Jun 27, 2011)

Eric Z said:


> I joined the shoulder separation club today. I was riding with my wife and looked back to see where she was and then found myself in line with a tree. I lowered my shoulder and obviously the tree didn't move.
> 
> The wind got knocked out of me but still had full rom. I rode the 2+ miles out- took it easy of course but there were climbs (as big as they get in the Chicagoland area) and didn't have issues. Rested at home and then it really stiffened up and the pain started. I went to the ortho and he said it was a grade I/II so not horrible. In a sling and will take it easy for a while.
> 
> ...


They do always seem to take a while to start hurting. I separated a couple ribs last Wednesday at the start of the ride and continued on doing another 15 miles before heading home... Once I sat down and relaxed, it was all downhill from there (and not the fun downhill).


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## Eric Z (Sep 28, 2008)

does anyone know when it's recommended to start pt on a ac sep? i had a grade I/II two days ago. it's feeling a lot better now and i kept it in a sling here and there to not make any sudden movements- especially when sleeping. it of course still hurts and won't try any big range of motion movements until it's been longer.

i have a follow-up appointment with the ortho in 3 weeks but just wanted to know what worked for you. i don't want to make it worse but also don't want my shoulder to become very weak from immobilization.

thanks!
ez


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## dirtdan (Jun 27, 2011)

Eric Z said:


> does anyone know when it's recommended to start pt on a ac sep? i had a grade I/II two days ago. it's feeling a lot better now and i kept it in a sling here and there to not make any sudden movements- especially when sleeping. it of course still hurts and won't try any big range of motion movements until it's been longer.
> 
> i have a follow-up appointment with the ortho in 3 weeks but just wanted to know what worked for you. i don't want to make it worse but also don't want my shoulder to become very weak from immobilization.
> 
> ...


Call ortho's office and ask them. Only they saw your x-rays and can give you the best advice.


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## Eric Z (Sep 28, 2008)

danhasdrums said:


> Call ortho's office and ask them. Only they saw your x-rays and can give you the best advice.


yeah, makes sense. i wouldn't want to do something stupid and take a step back. thanks!


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## TranceX (Dec 24, 2011)

Is this the club for guys that suck at jumping mountain bikes?

If so, I'm in! :thumbsup:

Level 3 AC separation on my right shoulder 4 days ago from OTB on a botched table jump at Graham Swamp. I plan to not do the surgery....for now. I'm an active 52 year old and need good range of motion for surfing, SUP, snowboarding, mountain biking, etc.... This thread has made me hopeful!


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## mission2 (Dec 3, 2011)

Hey guys tomorrow will mark 2 weeks in from a grade2/3 and im feeling really good almost full range of motion still some pain for sure but I never thought I would feel this good so soon. My advice for you all with a fresh injury is try to get out of your sling asap even if just for a little while. By no means am i a doctor so what worked for me may not apply for all of course. My ortho was pretty vague as to suggest exactly how much moving he wanted me to do but he did say to just use the sling for comfort. I was all over the internet looking for advice and most often I read that moving your arm/shoulder was good as long as you didn't feel any pain. Dont push too mush but just as important imo is don't keep still too much either. And of course ice is your best friend. this tread helped me a lot and hope it gives the rest of you here who are looking for advice some hope. The first 2/3 days are pretty painful but in my case, but each day afterwards would provide much improvement. I started PT today and therapist was suprised how much range I had already, strength is another thing but first you need to have range of motion before you can worry about building the mussel back up again. Good luck


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## Eric Z (Sep 28, 2008)

today is day 11 for me from my grade I/II separation. as others have said, the first few days were horrible- everything hurt. it took me 10+ minutes to change shirts!

i stopped wearing my sling around day 8. the movement and pain is so much better these past few days. i think the biggest improvement was the past couple days. i have a ton of range of motion but of course still pain here and there and it feels week.

just thought i'd provide an update. good luck, all- hang in there!


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## TranceX (Dec 24, 2011)

mission2 said:


> Hey guys tomorrow will mark 2 weeks in from a grade2/3 and im feeling really good almost full range of motion still some pain for sure but I never thought I would feel this good so soon. My advice for you all with a fresh injury is try to get out of your sling asap even if just for a little while. By no means am i a doctor so what worked for me may not apply for all of course. My ortho was pretty vague as to suggest exactly how much moving he wanted me to do but he did say to just use the sling for comfort. I was all over the internet looking for advice and most often I read that moving your arm/shoulder was good as long as you didn't feel any pain. Dont push too mush but just as important imo is don't keep still too much either. And of course ice is your best friend. this tread helped me a lot and hope it gives the rest of you here who are looking for advice some hope. The first 2/3 days are pretty painful but in my case, but each day afterwards would provide much improvement. I started PT today and therapist was suprised how much range I had already, strength is another thing but first you need to have range of motion before you can worry about building the mussel back up again. Good luck


Sounds like good advice.  Level 3 separation one week ago today. Been using the sling less and less each day. May go all day today without it. Walking down to the beach and back I notice it doesn't swing back and forth...lol....my arm that is.... :lol:


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## TranceX (Dec 24, 2011)

Eric Z said:


> today is day 11 for me from my grade I/II separation. as others have said, the first few days were horrible- everything hurt. it took me 10+ minutes to change shirts!
> 
> i stopped wearing my sling around day 8. the movement and pain is so much better these past few days. i think the biggest improvement was the past couple days. i have a ton of range of motion but of course still pain here and there and it feels week.
> 
> just thought i'd provide an update. good luck, all- hang in there!


Sounds good Eric. This waiting to heal up is teh suck. I'm looking forward to the PT but I know it's going to hurt .....


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## TranceX (Dec 24, 2011)

Obligatory X-ray of classic level 3 separation of the AC joint.


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## mission2 (Dec 3, 2011)

TranceX said:


> Sounds like good advice.  Level 3 separation one week ago today. Been using the sling less and less each day. May go all day today without it. Walking down to the beach and back I notice it doesn't swing back and forth...lol....my arm that is.... :lol:


I was completely out of sling by day 5 if it doesnt hurt to let the arm hang naturally go without, move as much as u can but do it slowly, and keep the ice handy. Good luck!


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## g00mba (Mar 9, 2011)

Just an update (pre and post op pics on page 15):

I had surgery 8 weeks ago and spent 4 weeks in a sling. It's a distant memory now.
I started PT 2 days after surgery "assisted stretching" meaning that I had to lift the bad arm with my good arm. After 4 weeks I was allowed to move the arm by itself, but it was pitifully weak, but the strength started coming back quickly.

Until 12 weeks I am restricted to lifting weights under 5kg, but have a physio regime with bands that is designed to build up coordination and strength. Its working well and every day I'm getting stronger.

I have a small bump left which is hardly noticeable and will be less prominent after I build the muscle back up on that shoulder, and a 3-4 inch scar.

At this point I am really glad I had the operation. I like waking up to a flat shoulder and I can already feel how much more stable it is (mine was a grade 5 separation).

Good luck with your recovery everyone.


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## TranceX (Dec 24, 2011)

g00mba said:


> Just an update (pre and post op pics on page 15):
> 
> I had surgery 8 weeks ago and spent 4 weeks in a sling. It's a distant memory now.
> I started PT 2 days after surgery "assisted stretching" meaning that I had to lift the bad arm with my good arm. After 4 weeks I was allowed to move the arm by itself, but it was pitifully weak, but the strength started coming back quickly.
> ...


Glad to hear it is going well.
Grade 5 I would have had the surgery too....I still get strange looks when I tell people I don't plan on getting surgery for mine, Grade 3.....


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## conrad (Jan 27, 2004)

*3.5 wks into a grade 3 separation*

lots of g8 advice here guys.......:thumbsup:
usual story.......hidden log down a hill.......bang over the bars onto my shoulder.....:madman: trip to a&e.......doc said grade 3......hve had grade 1's in there before from moto-x & road bike crashes...it all adds up in the end :nono:
have been biking fire roads etc after a week about to try my local single track trais today.....
used tape etc & a brace but my skin just couldn't stand the tape any longer..........
only plus it's my right shoulder and I'm left handed
and the bike not a mark on it from hitting that log.............


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## bloodpuddle (Jun 15, 2007)

*Hang in there*

Hey all

I'm 7 months out from a grade 3, and didn't have surgery.

Wanted to post an update because I had a significant milestone today: completed a 5km open ocean swimming race (Coogee-Bondi).

My shoulder didn't bother me at all during the swim - in fact I didn't notice it at all - and I could easily have kept going. My pace is probably on par with what it was pre-injury.

I'm super happy with the outcome I've had from this injury.

If you've just joined this club and are feeling sh!tty and miserable, then just know that with some time, good advice and therapy you'll get back to doing the stuff you want to do. :thumbsup:

Cheers
bp


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## BruceBrown (Jan 16, 2004)

Eric Z said:


> today is day 11 for me from my grade I/II separation. as others have said, the first few days were horrible- everything hurt. it took me 10+ minutes to change shirts!
> 
> i stopped wearing my sling around day 8. the movement and pain is so much better these past few days. i think the biggest improvement was the past couple days. i have a ton of range of motion but of course still pain here and there and it feels week.
> 
> just thought i'd provide an update. good luck, all- hang in there!


When do you plan on riding again from a grade 1/2 separation?

I banged mine on Saturday (OTB during a race), so I'm 80+ hours into the pain cave since the fall. I stopped the Ibuprofen Monday morning and have felt a bit better each day. The neck hurts a lot as well (head hit ground and whiplash/torn soft tissue in the neck results are not fun). I'm getting around fine, but getting out of bed is tough and of course, dressing is not easy. I seem to feel the best right after a hot shower.

BB


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## mission2 (Dec 3, 2011)

BruceBrown said:


> When do you plan on riding again from a grade 1/2 separation?
> 
> I banged mine on Saturday (OTB during a race), so I'm 80+ hours into the pain cave since the fall. I stopped the Ibuprofen Monday morning and have felt a bit better each day. The neck hurts a lot as well (head hit ground and whiplash/torn soft tissue in the neck results are not fun). I'm getting around fine, but getting out of bed is tough and of course, dressing is not easy. I seem to feel the best right after a hot shower.
> 
> BB


I'm almost 3 weeks in from a grade 2/3 I feel like I could ride ok (I've done a small fire road ride) but could I handle a crash??? Keep that in mind before you jump back in a saddle again, it will take a while to be able to put your arm out and "catch" yourself from eating dirt. Stay on top of therapy!


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## Eric Z (Sep 28, 2008)

BruceBrown said:


> When do you plan on riding again from a grade 1/2 separation?
> 
> I banged mine on Saturday (OTB during a race), so I'm 80+ hours into the pain cave since the fall. I stopped the Ibuprofen Monday morning and have felt a bit better each day. The neck hurts a lot as well (head hit ground and whiplash/torn soft tissue in the neck results are not fun). I'm getting around fine, but getting out of bed is tough and of course, dressing is not easy. I seem to feel the best right after a hot shower.
> 
> BB


i know what you mean about getting out of bed, dressing, etc. i couldn't reach the ignition to start my car until last week- luckily i can work from home whenever i want so i haven't been into the office since it happened. well, i did once and figured it wasn't worth the pain or the hassle. it should start feeling a ton better after about 3-4 more days.

not exactly sure when i'll ride again. it's 2.5 weeks now and it feels a lot better but still not full range of motion. i just tried moving my shoulder and i was able to move it more than i thought i could but there was more discomfort than i would like.

i'm going to play it safe and probably not get on a bike for another 2 weeks or so. i want to ensure this heals up nicely and i don't do anything stupid to take a step back. i probably won't do singletrack for at least 3 weeks.

good luck!
ez


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## TranceX (Dec 24, 2011)

AGGGGGHHHHHHH!!! IT'S BEEN A FREAKING WEEK AND A HALF! 

HEAL ALREADY!!! :madman:

Spending all my spare time reading the "lamest Injury" thread in here. Hilarious. That and figuring out what unneeded mountain bike modifications I should make to my bike..... :lol:


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## BruceBrown (Jan 16, 2004)

Eric Z said:


> i know what you mean about getting out of bed, dressing, etc. i couldn't reach the ignition to start my car until last week- luckily i can work from home whenever i want so i haven't been into the office since it happened. well, i did once and figured it wasn't worth the pain or the hassle. it should start feeling a ton better after about 3-4 more days.
> 
> not exactly sure when i'll ride again. it's 2.5 weeks now and it feels a lot better but still not full range of motion. i just tried moving my shoulder and i was able to move it more than i thought i could but there was more discomfort than i would like.
> 
> ...


Thanks, EZ. I've moved on with heat therapy (bought a nice Sunbeam pad that fits the neck and shoulders well). Mmmmmmm...it feels really good.

Today is 6 days after the crash and I have hope things have turned. Truly, the first 3-4 days were the worst. Yesterday, felt like a set back at first in the morning, but then I rallied for quite a comfortable evening compared to the prior evenings. Today began even better than where I left off yesterday. So day by day things are getting better. I'm still getting tired in the afternoon, but I think it is due to interrupted sleep and just dealing with the discomfort.

I might even try the stationary bike this weekend to get some blood pumping through my body more than I can get with casual walks (which I have been doing this week). I would hate to lose all of the training built up for the season, but did feel the need to take the past 6 days totally off. I figure if I can get some volume and intensity on the trainer, I might be able to salvage my season.

I guess from what everyone is saying, my body will tell me when it is ready to get back on the bike for singletrack. I will try neighborhood easy pavement riding first.

BB


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## TranceX (Dec 24, 2011)

Currently at 2 weeks since the injury (level 3). Stopped wearing the sling at 1 week. I think I'm around 10% at this point. I can use my arm but very limited range before pain starts. Trying to exercise....stationary bike, hikes, etc.


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## BruceBrown (Jan 16, 2004)

I couldn't take it (sitting around that is) so I went for a pavement ride yesterday.

Crazy as it sounds, 7 days after my OTB crash I wanted to get out and spin the legs to assess my physical damage. I had done a couple of short "around the block" rides with the dogs which hurt like a mo-fo earlier this week, but I am feeling a bit better now that a week has past. Again, my separation is in the grade I/II category - so I anticipate that my XC race season is not over (at least in my mind).

Yesterday, I suited up and headed off on the paved bike rail trail for a 90 minute zone 2/3 ride. Since I hadn't ridden in a week, it took a good 20 minutes to get warmed up and work my nerves out. The shoulder felt fine, but it was my neck and thigh that are not yet ready to be riding comfortably. I think if I flip my stem positive, I can get a bit more upright position (about 21mm higher and 8mm closer) to take some of the tension out of the neck muscles that are still sore and fighting to hold the head in position. This would allow me to work the lowers and get some good cardio on the paved trails without having to worry about fighting singletrack, bumps, and the danger of going down again.

And yes - thoughts went through my mind the entire ride of "what if I went down again here on the pavement?" I rode carefully and all was well at the end of 90 minutes. 

I realize I am probably weeks away from a return to racing, but with my trainer in the basement and some pavement riding on the rail trails - I think I can salvage my conditioning for a return when I am ready. I will start some upper body stretching/exercise to try and get the posture back and work on the neck.

BB


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## Eric Z (Sep 28, 2008)

BruceBrown said:


> I couldn't take it (sitting around that is) so I went for a pavement ride yesterday.
> 
> Crazy as it sounds, 7 days after my OTB crash I wanted to get out and spin the legs to assess my physical damage. I had done a couple of short "around the block" rides with the dogs which hurt like a mo-fo earlier this week, but I am feeling a bit better now that a week has past. Again, my separation is in the grade I/II category - so I anticipate that my XC race season is not over (at least in my mind).
> 
> ...


good to hear it wasn't bad to get on the bike a bit. i'm thinking about going on a couple rides around the neighborhood this week. i cut the grass today and that showed me i can do a lot with my shoulder. i'm just worried to take a step back in the healing process.

how's your range of motion and pain when moving? i have almost full range of motion but some ways hurt- not horrible pain but enough where i know it's not right yet.


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## BruceBrown (Jan 16, 2004)

Eric Z said:


> good to hear it wasn't bad to get on the bike a bit. i'm thinking about going on a couple rides around the neighborhood this week. i cut the grass today and that showed me i can do a lot with my shoulder. i'm just worried to take a step back in the healing process.
> 
> how's your range of motion and pain when moving? i have almost full range of motion but some ways hurt- not horrible pain but enough where i know it's not right yet.


Range of motion is improving. After a hot shower today, I was able for the first time to brush my teeth with my right hand and I could get the arm up over my head to comb the hair and blow dry it without wincing in pain or getting "sick to the stomach". I've had just about the same range of motion all week, but with pain which sort of tempered my motion as the pain was too much. Today was the first nearly pain free time to get the right arm up above the head to shampoo and groom. So I'll take it.

The most painful motion would be lifting a full/heavy glass with the right hand to drink and anything to do with going forward with it (starting the car, pushing the AC and radio buttons, leaning forward to shake somebody's hand, etc...). Ditto on trying to put a pullover shirt/sweatshirt on (which I have done the past 2 days, but it tickles). What kind of pain? Well, I'm not using any pain medication (Ibuprofen, etc...) so no edge is taken off. I feel it when I go too far. I used Ibuprofen the first 48 hours and it helped a lot. My problem is that I have to sing and Ibuprofen is a dangerous no-no for the singing voice outside of using it for a very short duration. So I have to deal with the discomfort full on until happy hour hits in the evening.

I've got twist shifters on some of my bikes and yesterday it was difficult to twist shift with the right hand. It hurts my neck muscles to swallow while lifting a glass to drink. I fear the neck is holding me back the most right now. Without the ability to get into the correct posture at the moment while standing, sitting and on the bike - the additional "weight" that incorrect posture puts on the head/neck muscles just adds to the neck tension/pain in my current condition....



Turning to the right and the left with my head on the bike allowed good enough vision yesterday to go for the ride, but not enough to be pain free and really let me look around like I should to be safe for vision while riding on city streets. I am hoping flipping my stem positive will get the bars up to a better Mary Poppins height so I have a bit more range of neck motion.

I get to see a PT this Thursday/Friday/Saturday/Sunday (my father-in-law will be in town), so I hope he can help me out with some therapy and a course of rebuilding. I'm not sure I am ready to use the push mower yet (let alone weed whacker), but will eventually have to try that by the end of the week. I wish I had a self-propelled mower for the hills in my yard....

I guess we will all heal up eventually, but 6 days off the bike was my limit and I am glad I went out yesterday to test myself as to what I could do. If I ride a bit later this afternoon, it will be with the more upright handlebar position and a shorter, recovery pace type of a ride.

BB


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## Eric Z (Sep 28, 2008)

bb, i know what you mean about difficulty brushing your teeth or starting the car. i was there about a week ago (maybe 1.5 weeks) and then it got waaaaaaaaaaay better the next couple days. it was amazing. i can for sure hop on my bike and ride, but just hesitant. i'm going to start some slow, long stretches tonight. i'm not looking forward to having a weak shoulder.

we'll be better in no time. 
ez


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## grant peeples (Apr 29, 2012)

JB800 said:


> I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The .Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!


I did mine last week in auto accident. A 3. I haven't hade much pain, really. Right now i can raise my hand above my head. I can't BELIEVE that I will be ever to use this arm like before thought. It looks SO fricked up. I have surgery scheduled for next Thurs. Now after reading all these posts...I don't know. I'm a musician and will have to cancel gigs. Really don't know what to do but i have to make a decision by tomorrow.


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## Eric Z (Sep 28, 2008)

grant peeples said:


> I did mine last week in auto accident. A 3. I haven't hade much pain, really. Right now i can raise my hand above my head. I can't BELIEVE that I will be ever to use this arm like before thought. It looks SO fricked up. I have surgery scheduled for next Thurs. Now after reading all these posts...I don't know. I'm a musician and will have to cancel gigs. Really don't know what to do but i have to make a decision by tomorrow.


i'm impressed you haven't had much pain and you're able to raise your hand above your head. with my I/II, i couldn't even lift my hand higher than my chest.

what's the surgery for? just for cosmetic reasons, or will it help it heal better in the long run. i would think there has to be reconnecting of the ligaments or something like that, right? obviously i'm not a doc 

regardless, good luck!


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## BruceBrown (Jan 16, 2004)

grant peeples said:


> I did mine last week in auto accident. A 3. I haven't hade much pain, really. Right now i can raise my hand above my head. I can't BELIEVE that I will be ever to use this arm like before thought. It looks SO fricked up. I have surgery scheduled for next Thurs. Now after reading all these posts...I don't know. I'm a musician and will have to cancel gigs. Really don't know what to do but i have to make a decision by tomorrow.


Which shoulder? Is it the dominant hand you use for playing whatever instrument (what do you play)? Is the surgery supposed to "speed up" the healing process, or is it - as EZ asks - more of a cosmetic alignment to get rid of the dip in the shoulder?

BB


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## Eric Z (Sep 28, 2008)

i'm 3.5 weeks into my grade I/II recovery and i noticed a huge improvement again these past few days. i have just about full range of motion with just a little tightness/pain here and there. i haven't started any PT yet- just been too lazy. i know, that's not very smart. feeling good though.


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## TranceX (Dec 24, 2011)

3 weeks out with a grade 3 AC separation.

I would grade myself at 15% of my original shoulder capablilty. I rode my beach cruiser to the beach....whooo hooo. I stopped wearing the sling at 1 week out. I have a follow up with my ortho tomorrow and expect to start PT very soon. 

I have an additional complication in that I was already having shoulder problems with this shoulder before the crash....in fact I was scheduled for an MRI on a Monday but crashed on the Saturday before. So the original shoulder problem has not been diagnosed yet....

Here are some observations of mine:

1) Friends still seem shocked that I'm not getting the surgery. They can see the lump through my shirt.

2) I wake up at least once every night in pain and have to move a bit to get somewhat comfortable.

3) I'm able to do things but have background low level pain still....doesn't really bother me much.

4) It hurts like hell when someone that doesn't know slaps me on the shoulder or shakes my hand vigorously....especially if they do that retarded dominance twist of the hand thing. I hate that crap.


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## BruceBrown (Jan 16, 2004)

Eric Z said:


> i'm 3.5 weeks into my grade I/II recovery and i noticed a huge improvement again these past few days. i have just about full range of motion with just a little tightness/pain here and there. i haven't started any PT yet- just been too lazy. i know, that's not very smart. feeling good though.


Start with the PT, it helps. I've been doing PT for 10 days now (hurt like a MOFO at the beginning), but my range of motion in the neck have vastly improved and the shoulder is coming along. I still feel very fortunate that mine was only a grade I/II and that I didn't break my neck!!!

Today marks 3 weeks out from the crash. I didn't want to lose fitness, so I got in 6 1/2 hours on the bike last week, and will hit 6 and change this week (which included back on singletrack for 2 days). It aggravates my shoulder and neck a bit, so I really ought to dump the HT for these training rides and stick to the full suspension to soften the bumps.

Short term goal if all goes well this week: Race next weekend.

If I feel my neck and shoulder are up to taking the demands of an XC race on singletrack, I will probably race. I shudder to think what another fall would do to me before I am fully recovered....

BB


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## Erockin (Jul 7, 2009)

I joined the pointy shoulder club on Sat. Took off weird on a jump and cased my front tire into the back of the landing and tomahawked over the bars. 3rd degree separation of my right shoulder and dislocated my left middle finger. Fortunately I was near the bottom of the trail and was able to call a friend to drive me to the hospital. Got the finger reduced in the emergency room but I have a small bone chip floating in the joint which may need surgery. I'll find out when I go see the hand specialist. Doesn't look like I'll need surgery for the shoulder. I have an appointment with the orthopod later this week so I can get going on PT.

In the meantime the worst pain is getting up from laying down. Hurts so bad, especially in the morning when the pain meds are worn off and all the muscles in my back are stiff and knotted up. Tore the ligaments attaching my clavicle to my sternum too...Anybody else experience this?

Another really big downer for me is I'm building up an Intense Tracer 2 right now. The rest of the parts will be in this week but I won't be able to ride it for who knows how long. Its been hard enough staring at the frame waiting on parts now I'll have everything but won't be able to build or ride it. Frustrating!!

I know, whine, whine, whine. Just gotta get over it and focus on healing...

Eric


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## TranceX (Dec 24, 2011)

BruceBrown said:


> I still feel very fortunate that ... I didn't break my neck!!!
> 
> BB


Same here..feel very fortunate.



Erockin said:


> I joined the pointy shoulder club on Sat. Took off weird on a jump and cased my front tire into the back of the landing and tomahawked over the bars. 3rd degree separation of my right shoulder.....


 Welcome to the club!! 

4 weeks out for me on a 3rd degree separation and I start PT today,,,,,


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## TranceX (Dec 24, 2011)

BruceBrown said:


> I still feel very fortunate that ... I didn't break my neck!!!
> 
> BB


Same here..feel very fortunate.



Erockin said:


> I joined the pointy shoulder club on Sat. Took off weird on a jump and cased my front tire into the back of the landing and tomahawked over the bars. 3rd degree separation of my right shoulder.....


 Welcome to the club!!  More specifically, welcome to the Right Shoulder 3rd Degree Separation Club!

4 weeks out for me on a 3rd degree separation and I start PT today,,,,,


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## Erockin (Jul 7, 2009)

TranceX said:


> 4 weeks out for me on a 3rd degree separation and I start PT today,,,,,


Thanks for the warm welcome! Wish I was more excited to be a member... 

Seems like a long time to wait to start PT. Is that normal?


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## TranceX (Dec 24, 2011)

Erockin said:


> Thanks for the warm welcome! Wish I was more excited to be a member...
> 
> Seems like a long time to wait to start PT. Is that normal?


I don't know....I guess start as early as you're doc says. I will say my doc has cleared me for all activity such as surfing and SUP'ing. I may even try some light mtb riding. However, I have another annoying issue with this shoulder beyond that of the AC separation.....it appears to be "frozen"...... :eekster:


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## BruceBrown (Jan 16, 2004)

Update: 4 weeks to the day yesterday and I made the decision to do an XC race. I tried singletrack on Wednesday aboard my Dos Niner. Hurt my neck too much, so on Thursday I tried a loop on a full suspenion 29"er. Felt much better and I decided to race yesterday using a full suspension bike and 4 Ibuprofen pills 2 hours before the start.

The suspension soaked up most of the race and only one nasty bump jarred my neck enough to make me wince. The shoulder felt fine during the race. Being gun shy at the moment, I rode conservatively and took a few corners slower than I would have normally done. My goal was not to fall and I managed to stay upright and in control for the duration. I was only 30.1 seconds out of first place and walked away with 2nd place in the master's. Had I pushed harder through the technical sections and on all corners, I would like to think that gap would have been pretty much closed - but no way was I going to fall and prolong the injury. 

I feel surprisingly good today after a peaceful night's sleep, but of course have the usual sore shoulder/neck pain that I've had for the four weeks. It is getting better, but I think everyone was on target that the first 6 weeks the nagging pains will be there. 2 more weeks to go to reach the 6 week point. I will continue my range of motion rehab, applying heat and working on core strength to bounce back. If I don't fall again, I may be able to salvage my season after taking the past 4 weeks off.:thumbsup:

BB


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## teckyb (Sep 13, 2011)

Well I am 8 months after my grade 2 AC Separation and all in all I am pretty much fully recovered, I would say about 95% as I can still feel it on odd things and just aware of it but perhaps that is psychological rather than anything structural.

I had 6months worth of pain, the PT (physio here in uk) thought I had torn my Labrum due to tests + symptoms so I went for a private MRI which confirmed the AC injury and cleared everything else (labrum/rotator cuff tears) which I wish I had done 4months sooner as the diagnosis for my pain was chronically inflamed due to advancing my PT work too soon. 4 weeks of dicloflenex and I was like a new man!

Strength is pretty much back to where I was a year ago if not stronger just keep a top up of massage to the shoulder/neck region to keep everything in tune and do shoulder exercises twice a week.

Thank you to this board is an amazing tool to have to help through the dark days of recovery I had - even for such a mild injury compared some people on here - as it gives hope when you hear of the recoveries and strategies people go through.


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## big terry (Apr 22, 2012)

I feel oddly soothed seeing so many people have experienced this. Just got my own 3rd degree today in my right shoulder.

I had an OTB taco-










that scored me my own beautiful lump on the shoulder.










Im only 5 hours out from the crash and the dilaudid shot I got at the hospital is still in effect... but I am sore.

I hiked the bike out with the tacoed wheel in my right hand, and 15 minutes later I was seriously contemplating going back out- I had acceptable range of motion, and it really didnt feel all that bad, all things considered. Smartly, I chose to go to the ER instead...


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## TranceX (Dec 24, 2011)

big terry said:


> I feel oddly soothed seeing so many people have experienced this. Just got my own 3rd degree today in my right shoulder.
> 
> ...


Welcome to the club!

5 weeks out for me witht the 3rd degree separation right shoulder. My recovery is awesome, however my issue is really a frozen shoulder now....it was freezing up before I crashed separating the AC joint.

Anyway, went stand up paddle boarding last weekend and it worked out OK....and if it wasn't for the frozen shoulder I'd be in great shape right now....I think. Really want to ride but the thought of falling on the frozen shoulder makes me think it could cause some major damage.


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## Old Ray (Sep 5, 2010)

JB800 said:


> I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The Doctors Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!


Sorry but I'm too lazy to have read this entire thread, so if I'm redundant, please understand. 
you stating that you were benching 340 made me instantly cue in on the likelihood that you have woefully overpowered your rotator cuff. 
I highly suggest a book, by the PT, Jim Johnson, entitled" "Treat your own Rotator Cuff. "
Jim has a gift for straightforward communications, and he backs his points up with evidence-based research data. Ge gives you a VERY good understanding of the shoulder joint and of the rotator cuff's significance to it, in specific detail.

Get the book, read it, (you'll find it fascinating) and use it to supplement your understanding of what the PT's you are working with are doing.

Best of luck,
/Ray.


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## BruceBrown (Jan 16, 2004)

TranceX said:


> 5 weeks out for me witht the 3rd degree separation right shoulder. My recovery is awesome, however my issue is really a frozen shoulder now....it was freezing up before I crashed separating the AC joint.
> 
> Really want to ride but the thought of falling on the frozen shoulder makes me think it could cause some major damage.


Or even minor damage. I tweaked my shoulder again 2 days ago. I didn't fall, but was fighting with the bike on some tight singletrack and just muscled the front end over a couple of roots. When I did that, I felt a pain in my right shoulder and wouldn't you know it, I have now set myself back a week or two in terms of recovery thanks to the jolt. Gone was the pain of getting in and out of a t-shirt, but now it's back. Ah.....my own bad for trying to rush it all.

At least I am able to fight every day with my posture and for the most part can stand tall and straight again.


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## big terry (Apr 22, 2012)

Man this sucks. I really dont want to go through the day in an opiate haze, so I am avoiding painkillers as best I can...but being uninsured and working a crappy job, I cant afford to take time off work. I still have a decent range of motion, but strength is nearly non-existent. I want to get on the bike and ride around the neighborhood, keeping it on the pavement, but I am afraid to even do that for the thought of an ill-approached curb and the jarring it would do to my shoulder.

Granted I am only 3 days in, but I am impatient as hell and really upset I will miss out on some great riding weather. I really dont see myself making it through june without being back on the trail, and that bothers me from having read so many recovery stories that have taken months and months. And I am not an excellent rider, either...i have a propensity for inelegant dismounts on a regular basis.


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## NJTransplant (Mar 30, 2012)

I'm two years out of a II/III separation. I chose not to have surgery and go with rehab etc. Mine happened during a downhill ski race.

I can say that even two years out my range of motion isn't 100% and if I hit it real hard on a fall it hurts more than it should. PT will be your best friend and don't push it too hard trying to get back out (even though we all want to).


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## big terry (Apr 22, 2012)

well for better or worse, i just spent 20 minutes riding in the condo complex, and in the soccer fields across the street. had to test my thresholds of pain and flexibility. 

negligible, at best.


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## Old Ray (Sep 5, 2010)

Once again, I strongly suggest that all you folks with shoulder injuries check out the book by Jim Johnson, PT, "How to Treat Your Own Rotator Cuff". It sheds light that even a medical professional in the orthopedic field, such as myself, can learn from. 

It's my opinion that educating oneself about the nature of the body structure injured, and not just robotically submitting to authorities RX for their condition, can actually aid in the recovery process. 

In the case of injuries, shoulder or otherwise, ignorance is NOT bliss. 


And no, I am not Jim Johnson, or even a shill for him. I just appreciate his work. It has helped me, and it can help you too.


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## BrendanR106 (May 30, 2012)

recently joined the ac separation group a few weeks ago with a grade 1/2 separation according to the doctors after hitting a tree, full range of movement with some pain in certain positions but ibuprofen takes care of that  i do now seem to have what i can only describe as a lump of muscle in my deltoid that seems to be out of place and there is a bigger gap between my trap and deltoid muscles on the affected side, has anybody else experienced this and does it eventually go away?


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## wsmac (Sep 5, 2010)

I have some of my old postings back in the teens... 11teen, 12teen, 13teen, and before that to Feb. of last year.

Just wanted to share my progress with my surgeries and shoulder stuff...

To quickly recap (something I rarely say or mean... quickly, that is ), I went OTB and blew 2 lig's in my right shoulder, opted for surgery... wound up having surgery twice.

Started rehab in my car driving to Texas, even rode a bit on dirt roads, and worked on the stretching continuing to today.

I have full range of motion.
I still find it uncomfortable to sleep on my right side for very long.
I have taken a few spills on that side mtb'ing, but luckily no hard hits and no problems because of them.

My surgeon cautioned me that if I impacted the clavicle again... it'd probably snap at one or both of the places where he drilled into it and wove the cadaver lig in, securing with plastic screws (the first time failed and 2 weeks later he worked it over again).

Basically, I'm VERY happy to have had the surgery! Of course... I have some pretty good insurance considering how little I have paid for it all and what the final price was 

I can wear backpacks with no issues (hauled around a 30-pound pack for 11 days in Mexico (the Yucatan) and Belize), and have no trouble with it other than sleeping too long on my right side as mentioned above.

For those who opt not to have surgery and do well... cool! :thumbsup:

My shoulder looks pretty normal... no super noticeable bump... just a very small one.

Now that this should has healed up, my ribs and left shoulder have healed up (from another bike accident last year), and the weather is treating us well here... I'm back to riding as much as possible!

I hit trails at Demo in Santa Cruz, and at Annadel in Santa Rosa, this week and even on the rocky techy trails... the bouncing and hammering my bike and I took had no effect on any of my previous injuries... Life IS Sweet! 

My best wishes for the newest members of the Pointy Shoulder Club! May you all heal as well!


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## BeanMan (Jul 6, 2006)

I'm 9 months past my grade III AC. No surgery. I am pain free and have a full range of motion. I haven't fallen on it yet though, I'm wondering how strong it is.


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## 62Tbirder (Jan 6, 2012)

Six weeks out from a big crash thanks to enthusiasm outweighing ability. Not sure what grade, but couldn't move right arm, doc said six weeks off work. 
Only took one week (self employed), pain was awful for first two weeks back at work. easier now, getting reasonable range of movement. Pain is now around a 3 on a scale of 10. Worse part is graunching and clunking from my inside shoulder when lifting my arm high.
No sharp bump on shoulder, but have this weird raised bump on my chest to the side of my sternum and the bone clicks. Anyone had this? Had lots of xrays, nothing broken but radiologist says its a rib moving inside a damaged socket on my sternum.
Had physio last three weeks, and exercises are helping. Still on anti inflammatories and pain killers. Got back on my bike last weekend, went okay, only pain was hitting bigger bumps. Felt good to be riding again.
Timeline seems to have been pain and no movement first two weeks, more movement and same pain week three, less pain and better movement weeks four to six.
Sure gets frustrating.
Strangely, big movements cause less discomfort than typing.


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## wsmac (Sep 5, 2010)

After a traumatic injury, those pops and clicks can sometimes be just a loose joint.
Same after surgery.
Once you rebuild the muscle supporting the joint, the looseness may disappear along with the popping and clicking.
Not 100% since it depends on what damage was done.

If it continues, and you feel discomfort or pain along with it... then it may be something that will need medical intervention.

When a joint starts popping oddly, sometimes you can move slowly through the ROM varying the angle of movement, the range, the speed, and find out if it only pops at certain times.
Could be useful to know.


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## big terry (Apr 22, 2012)

well, 2 weeks to the day after i earned a grade3, i went and did 15+ miles on two separate, yet easy, trails. i rode like a complete sissy out of fear, but after a good day of riding (only one jump-off dismount), I can say I came through unscathed, and not sore at all.

The swelling has really gone down, bruising is all but gone, and a solid regimen of ibuprofen has really made a big difference in comfort at the very least, and can very well be helping in keeping me in the saddle. Im quite terrified, i promise, of going otb again, because the shoulder is still quite weak in some respects, and still rather tender. but riding did not bother me at all, and neither did wearing a loaded camelbak mule for the last 8 miles or so.

very hopeful that recovery continues like this. only after i got onto a real trail again did i come to realize that i need to really be careful and not get myself into sketchy situations, because one wrong move could really put me out of business for the year. im glad i have some mellow trails to ride so i can retain some fitness without worrying too much if i am going to hurt myself badly.


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## pureliquidhw (Jun 6, 2012)

I took a digger snowboarding last year and got myself a Grade 3 AC separation. Went a month for rehab, hated the bump so I got cut. They did the Weaver/Dunn with the metal button and synthetic sutures. It ended up failing and the bump was back and I had an annoying metal button that hurt like hell with a backpack.

Went to another Dr, he jumped in there to see why it failed and to throw in a cadaver ligament. The first Dr didn't take off the end of the clavicle and that allowed enough leverage stretch everything out. All my second doc did was cut off the end of the clavicle and close me up. It looks way better.

If I did it all over again, I would just have the last 10-12mm of the clavicle sliced off and called it a day. It restores 70% of the appearance, and doesn't really interfere with rehab. If, or really when, I tear the rest of my "good" shoulder, that's what I'll do!

The reason I'm back in this thread is I took a digger this past weekend and stretched out the AC on my other shoulder. Probably only a Grade 1/2 but it came with some gnarly wounds on my leg. Not gonna pay for an X-ray that i don't need, but with no normal shoulder to compare, I can't be sure of the displacement. No more rigid single-speeds for at least a month. Oh well, ride on.

Thanks to everyone who shared their story before me. It got me through the initial snowboarding injury and got me onto the single-track!


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## TranceX (Dec 24, 2011)

Yup, love this thread! :thumbsup: Grade 3 right shoulder 7 weeks out. I've gone on a couple of mountain bike rides but have taken it easy. The AC joint doesn't bother me...the frozen shoulder does. PT on my own twice/day and twice/week with a therapist.



BruceBrown said:


> Or even minor damage. I tweaked my shoulder again 2 days ago. I didn't fall, but was fighting with the bike on some tight singletrack and just muscled the front end over a couple of roots. When I did that, I felt a pain in my right shoulder and wouldn't you know it, I have now set myself back a week or two in terms of recovery thanks to the jolt. Gone was the pain of getting in and out of a t-shirt, but now it's back. Ah.....my own bad for trying to rush it all.
> 
> .


 I think this my fear....falling on it again.... ugh.



wsmac said:


> I have some of my old postings back in the teens... 11teen, 12teen, 13teen, and before that to Feb. of last year.
> 
> Just wanted to share my progress with my surgeries and shoulder stuff...
> 
> ...


Good to hear that the surgery worked out for you. :thumbsup: I did not have surgery but my therapist says that he's heard there may be a move back toward surgery on these again.....interesting.


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## Erockin (Jul 7, 2009)

Tomorrow marks my 4 week anniversary of a grade 3 separation and finger dislocation. Finally got to see a hand specialist this morning and was told everything is good with my finger. Shoulder is feeling really good too so decided it was time to get back out on the bike this afternoon. Had a great ride made even better because it was the maiden voyage of a new to me Intense Tracer 2. Took it easy and did a climb up Uptown and rode Downtown for those of you familiar with Mammoth. Felt so good after that I jumped on the shuttle back up and did Big Ring. All super easy trails but just really nice to be back riding and gettting some exercise!


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## ThumperGary (Oct 3, 2010)

What a great thread - came on here to search for Shoulder Seperation and it was the first thread. :thumbsup:

I'm 2 weeks out from my Grade 3 I earned on Memorial Day. Looks like the 4 week mark is a milestone. Was actually thinking of riding a bike trail that is basically an old railway bed today. Pretty flat and boring but after reading alot of the other stories in these 17 pages might wait 2 more weeks. 

Really sucks for the summer. The week before Memorial Day I rode my first 50 mile endurance race. Hardest thing I've ever experienced but was getting ready for more endurance races this summer. Hopefully in a few weeks I can at least get out on some gravel rides.

I do have company though - my wife took a spill and ended up tearing a ligament in her thumb. She had surgery for that. So our recovery times pretty much coincide.


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## TranceX (Dec 24, 2011)

ThumperGary said:


> What a great thread - came on here to search for Shoulder Seperation and it was the first thread. :thumbsup:
> 
> I'm 2 weeks out from my Grade 3 I earned on Memorial Day.


Welcome to the club Gary.....your Memorial Day injury will be memorable....lol. How did you do it?


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## big terry (Apr 22, 2012)

I'm at 3 weeks and back to riding regularly, albeit easily. Getting to the point where I need to consciously be aware of my speed and level of aggression because the shoulder doesn't hurt at all. Only time I deal with pain is trying to get comfortable in bed, and a few ibuprofen tends to keep that in check.

Sent from my SCH-I510 using Tapatalk 2


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## 62Tbirder (Jan 6, 2012)

wsmac said:


> After a traumatic injury, those pops and clicks can sometimes be just a loose joint.
> Same after surgery.
> Once you rebuild the muscle supporting the joint, the looseness may disappear along with the popping and clicking.
> Not 100% since it depends on what damage was done.
> ...


Thanks wsmac, excellent advice and suggestions. You're right, it only graunches during certain movements. Took your comment re medical intervention on board and discussed progress with physio, he's set up an appointment with a specialist on June 21, starting with an MRI and going from there. Movement is getting better daily, but clunking on my chest/shoulder seems to be getting worse,


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## ThumperGary (Oct 3, 2010)

TranceX said:


> Welcome to the club Gary.....your Memorial Day injury will be memorable....lol. How did you do it?


As I mentioned I finished my first 50 mile endurance race the weekend before Memorial Day. I'm no spring chicken (50 this year ) and was pretty wiped out through the week from the race. We rode that next Saturday before Memorial Day and then planned a ride for Memorial day.

It was a place that we ride a lot but I was not feeling my best. Got about a half mile and a rooty drop off got me. Been over that spot a bunch but for some reason picked a strange and bad line. Up and OTB right onto a root. Man I knew it was bad when I hit. I still did the loop but pulling up on the bars was about impossible from the pain.

I'm just glad I didn't break anything. I had rotator cuff surgery on my right shoulder in Dec '10. It takes a long time to recover and get the strength back after surgery. Everyday I'm feeling better and I will be riding easy gravel by next weekend.


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## LittleBuddy (Nov 18, 2010)

Here's mine from last year.
The clavicle hook plate was wearing a hole through my scapula so I needed a second surgery to remove the hardware . Very painful for about a year and very expensive.


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## cabinfever (Feb 6, 2008)

*Looks like I joined the club*

7-3-12 I was having my best ride of the year. Coming down a slightly sketchy downhill, but under control. My carbon fiber handlebar snaps off just above the grip. OTB to a bad crash on the trail. Doing a mental check as i begin to untangle myself from the bike/trees/bushes. feet move, head moves...I seem to me mostly intact. Trying to pull my bike out of the bushes my shoulder feels odd. Thinking maybe a slight dislocation as it kind of pops and starts to move better. Hike out 1.5 miles and drive to the clinic. Long story short...Grade 3 AC separation. Crap. So I have been reading and getting encouragement from all the other posts. Go see the ortho guy next week. At least now I have a good idea of what to expect. x ray looked just like most of yours. So far not much pain and fairly good ROM. So I am hopeful for a quicker type recovery that some have had. Fingers crossed! My question is what to do for the next week. Clinic Dr gave me a sling with no real instructions. I ran a 3 day course of ice and ibuprofen. Any thoughts as to if I keep it in a sling for a week...or start to work on ROM more? Hate to waste a week of healing by doing it wrong. I usually don't go to chat boards for medical advice, but there is a lot of good first hand info on here. Thanks CF


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## TranceX (Dec 24, 2011)

cabinfever said:


> 7-3-12 I was having my best ride of the year. Coming down a slightly sketchy downhill, but under control. My carbon fiber handlebar snaps off just above the grip. OTB to a bad crash on the trail. Doing a mental check as i begin to untangle myself from the bike/trees/bushes. feet move, head moves...I seem to me mostly intact. Trying to pull my bike out of the bushes my shoulder feels odd. Thinking maybe a slight dislocation as it kind of pops and starts to move better. Hike out 1.5 miles and drive to the clinic. Long story short...Grade 3 AC separation. Crap. So I have been reading and getting encouragement from all the other posts. Go see the ortho guy next week. At least now I have a good idea of what to expect. x ray looked just like most of yours. So far not much pain and fairly good ROM. So I am hopeful for a quicker type recovery that some have had. Fingers crossed! My question is what to do for the next week. Clinic Dr gave me a sling with no real instructions. I ran a 3 day course of ice and ibuprofen. Any thoughts as to if I keep it in a sling for a week...or start to work on ROM more? Hate to waste a week of healing by doing it wrong. I usually don't go to chat boards for medical advice, but there is a lot of good first hand info on here. Thanks CF


Welcome to the club CF! 

OK, my doc said wear the sling only as needed for comfort. I completely stopped wearing the sling 7 days out. I would not leave it in the sling all the time. Take it out, move it around. Here's the deal....with a grade 3 you've done all the damage to it already.....lol. You ripped out all the ligaments and the end of your collar bone is pushing up freestyle! So you're not really going to hurt anything by moving your arm around. But if you don't move it around it could start locking up. So move it a bit more each day and wear the sling for comfort....ditch it completely in 7 days if you can.

I am 3 months out at this time and I mountain bike and standup paddle just fine. I'm still doing PT, but it's for a frozen shoulder, not the AC separation.


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## dozer5 (Sep 5, 2007)

I would highly recommend keeping it in the sling as the doctors said. I was on a solo night ride 1 month ago and went over the bars and dislocated my shoulder. Had to walk out about 4 miles and a friend met me at the closest road. Went to a specialist and it was determined that the socket was shattered. (my second time) After a few days I everything felt great and I took off the sling so I could get a good night sleep. About 3 am I woke up to my arm being up over the top of my head and the shoulder was dislocated again. I had to wait until the morning to get into the orthopedic center, Needless to say there was no more sleep that night. I spent the entire next day at the orthopedic center trying to get the shoulder to pop back in. As a result, I incurred more damage to the shoulder. I had surgery almost 4 weeks ago and go back on tuesday to see if the socket is healing at all. If not I will require more surgery and bone graftng, I am off the bike for at least 6 months and even after that I was told that I " can not crash on that shoulder again or I may need an entire joint replacement!" Needless to say I learned a very painful and expensive lesson about not listening to the doctors orders. Just my 2 cents....


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## TranceX (Dec 24, 2011)

dozer5 said:


> I would highly recommend keeping it in the sling as the doctors said. I was on a solo night ride 1 month ago and went over the bars and dislocated my shoulder. Had to walk out about 4 miles and a friend met me at the closest road. Went to a specialist and it was determined that the socket was shattered. (my second time) After a few days I everything felt great and I took off the sling so I could get a good night sleep. About 3 am I woke up to my arm being up over the top of my head and the shoulder was dislocated again. I had to wait until the morning to get into the orthopedic center, Needless to say there was no more sleep that night. I spent the entire next day at the orthopedic center trying to get the shoulder to pop back in. As a result, I incurred more damage to the shoulder. I had surgery almost 4 weeks ago and go back on tuesday to see if the socket is healing at all. If not I will require more surgery and bone graftng, I am off the bike for at least 6 months and even after that I was told that I " can not crash on that shoulder again or I may need an entire joint replacement!" Needless to say I learned a very painful and expensive lesson about not listening to the doctors orders. Just my 2 cents....


That is completely different than a grade 3 AC Joint Separation. An AC Joint Separation is not a dislocated shoulder.


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## cabinfever (Feb 6, 2008)

*Making good progress*

Well, here I am at day 8. Went for a short one mile road ride last night. Felt really good. There seems to be a few lucky ones that bounce back from this quicker. I have almost full ROM and only slight pain on occasion. Just a big lump. Tomorrow is my first Ortho appointment, so hoping he sees it as favorably as I do. Lack of pain in my shoulder sure makes me notice the pain in my ribs. Getting comfortable to sleep is the biggest challenge at this point. Going to put a new bar on the bike tonight and throw it in the truck. Depending on what the Dr says...may go for an easy spin on the trail tomorrow. Good luck to everyone in their recovery, and for you that will be reading this in the future.


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## Old Ray (Sep 5, 2010)

I have a couple rather obvious points to contribute to this discussion.

As of this coming Sunday, the 16th, I will officially be at the 6 week mark since incurring my Grade 1 A/C separation. It was on the previously reconstructed shoulder,(2008) so I was somewhat concerned, and I booked an appt. w/ the Ortho Doc who had done my repair then. He tested me for ROM, strength, etc. and told me it was a mere Grade 1, that it would heal in 6 weeks, and that I should be "very careful" about doing any strength training aside from the rotator cuff exercises that I do to maintain the repairs and grafts that he installed in '08. All of my "retained hardware" (wonderful term, no?) was intact, in place, where it was supposed to be. 
So, of course, on week 4, to the day, I could not resist trying a few easy, elevated pushups....minimal pain, no significant clicking/grinding noise, good to go. So, I did a few body-weight rows, at about 45 degree angle. I did these while riding a few laps in the UCSD woods, where as you may know there is an entire circuit training setup, and also a very fun, mildly tech, perimeter trail, perfect for the rehabbing mtb people. Again, no problem. Then, a few days later, I tried a few sets of high-rep overhead presses with cables. First visit to the gym since my OTB event. Some shrugs. All at pitifully feeble weights, by my standards. But, no pain, and no impediment.

So, I think that following doctors' orders is a good idea, but they always tend to err on the side of caution. No big surprise for most of us, I know. 

The other point I wish to make is a bit of an epiphany to me, which more than likely gives the reader an idea of just how bright I am (not). 
And this point is very simple, and for me it is very true, and I intend to follow it. 
On days when I do upper-body resistance workouts, I will NOT ride the trail afterwards. After working the major and minor upper body musculature to near the point of failure, what I find is that I lose a good deal of fine motor control in the upper body for the remainder of that day. Couple this with a relatively fast decent on a technical trail, even one that I know "like the back of my hand", and the results can be problematic. This was EXACTLY what I did on that Sunday just about 6 weeks ago. The result was a 17mph OTB into the rocks, a hamburgered face, and the A/C separation. 

I feel that a road ride is a much safer bet on upper-body days. After all, just look at the pitiful, stick-arms those roadies, even the best in the world, have! Pitiful! But the point is, for road, you don't NEED the guns. In fact, they are an impediment to the really fast guys. 

So there you have it, my observations, to take or to leave. 

Best luck to all of you, and may your recoveries be hitch-free. and as painless as possible! :thumbsup:


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## dardas99 (Jul 18, 2012)

Glad to find this forum! Nice to konw I'm not alone. 

I just joined the "shoulder bump" club last week. I was cycling very cautiously across a flat, wooden boardwalk over a wooded trail. Just creeping along because I knew the wood was still partially damp from a recent rain, and my son had crashed there recently. What I didn't realize is that turning, but didn't realize was that since the rain, some kind of mold or slime had grown over the wood making it Vasoline slippery. So, after successfully crossing it, when I tried to accelerate at the very end, the rear wheel spun then "Bam!" Sudden, very painful landing, as the shoulder ligaments tore.

So now I'm at day 6 of what is almost certainly either a Type 2 or 3 separation, with the usual "bump" on rt. shoulder and a lot of blood the seeped under the skin, covering half my chest, (aka ecchymosis -- looks like a giant ugly purple/yellow bruise, but no tenderness).

Oddly, I have only very mild pain and surprisingly good range of motion, except if I reach across my chest to my left shoulder (yow!). Sleeping's a problem, and I wake up more sore than when I laid down. The worst chronic pain is actually not at injury site, but in upper back where the right shoulder blade impinges near the spine.

Since I was experiencing little pain, I didn't go to a doc -- seemed like it might just heal. But then after the swelling went down, the bump appeared so I googled "shoulder injuries" and -- yup, its a classic shoulder separation. 

On day 2, I left on a 450 mile driving trip, no problems really except sleeping. Yesterday, I biked on paved/gravel 5 miles yesterday, and 15 today with no problem -- i.e. no more sore at end than beginning, so long as I stand up on the pedals over bumps, to absorb the shock -- however I've become a bit paranoid about falling, which is no doubt prudent til it heals.

I'm puzzled whether this is type 2 or 3. I ahve "the bump" and lots of blood under the skin (has seeped down to cover 1/2 my chest!). How can one tell? Any clues on this?

Tomorrow I'm off to see a brilliant physiatrist (Sports Med MD) who has "saved" me and friends many times in the past. She's a great diagnostician and prescriber of very precise, conservative therapy, so I'll report back here on what I learn.


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## Mr.X (May 23, 2012)

I'm in the quick healing club. I was back on the bike 18 days out (Today actually). I probably could have cut it shorter, but I wanted to make sure that I could do most things with the bad arm in the case something catastrophic happened. I almost felt fortunate that I got a grade 3 instead of the 1 or 2 because I didn't have to worry about babying my ligaments. If you're a grade 3 it's a pain thing, the damage is done. I still have pain doing pushups, but I'm 260, if I were 180 I'm sure it would hurt a little less. I'm not sure about the other fast healers, but as a grade 3 with nothing to lose I was out of the sling the second day. Quit the pain meds after the first. I used ibuprofen for the first week for the swelling and didn't ice like I should have. I firmly believe that getting out of the sling and increasing my range of motion ASAP within the limits of pain had me with almost full range of motion after a week, mostly pain free after 10 days. I would say I'm at about 70% at this point overall, but closer to 85% within the less challenging ranges of motion. I felt a little more nervous descending than I thought I would be, so the mental aspect may be the bigger challenge.


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## rodwilsonsr (Aug 6, 2012)

*Grade 5*

Hey All, 
Nice to see everyone dealing with the same crap. I do mtn biking and road riding, this happened on my road ride.

I was doing a 100 mile fundraiser ride in place of a 4-5 hour training ride I had on the schedule. The ride was fairly flat, maybe 3k of climbing over 100 miles. Even though this was just a "ride", I of course did not play it as smart as I should and I slowly creeped my way up with the front of the group.
I have not done many fast group rides with the front of the pack, and I dont think I have done any with the front of the pack where I dont know anyone. Hindsight tells me that I should not ride with the fast group when I dont know anyone's handling skills. It was turning out to be one of those rides where everyone starts acting like they are riding like a pro and have something to prove...along with me...crap.

Anyhow, there was a rest stop at mile 50 and when I left the rest stop, it was just me and one other older guy. We figured the rest of the pack would catch up anyways. I had some good conversation with this guy and we had both agreed that neither of us have much experience riding in a group and the most of our riding time is solo. After a few miles the pack caught up and I pulled for 5 or 6 miles. I then dropped back and settled in about mid way...I think there was a total of about 25 people. Settling mid pack, I decided to get behind the older guy that I left the rest stop with. He seemed experienced and I felt like I could trust his skills.

Right around mile 60, we were cruising along at 25mph, according to my Garmin, right along a nice flat fairly newly paved road...and the KAAAAABAAAAAMMMM!!!!!
My front wheel eats a storm drain that is 4 inches below the pavement. I go over the handle bars, land on my head and shoulder, crack my helmet, hell even the back wheel flew off the bike. I could tell that my shoulder was a mess as I immediately could not move it.
Ironically, I had crashed 2 months ago at my first road race and landed on the same shoulder, but the previous time, I didnt tear or break anything.
Of course, I forgot to mention that NO ONE in this pack was pointing out road hazards and I really thought this older gentleman in front of me would have some riding wisdom...but nope, no warning at all.

The group stopped for me, called 911 and I got carted off to the hospital. Shot up with pain killers and then X-rays, they confirmed I had a separated shoulder. Now I have no idea what this means other than my shoulder looks and feels like a mess.
I was sent home and followed up with my ortho.

During the upcoming week, i managed to see 5 ortho's and get thorough opinions on what my options are. And I also talked to my Coach as he has suffered the same injuries. Looking at the X-rays and what my shoulder looks like, I felt like I had no choice but to go through surgery. All 5 doctors called this a grade 5 separation, but 1 out of the 5 said surgery could go either way.

Apparently, from what I have read and learned...shoulder separation treatment is really split down the middle on what people end up doing. It seems that full use, functionality and strength can be restored without surgery but your just left with a bit of a deformity in the shoulder. People that get the surgery and have successful surgery are also restored to full functionality and cosmetically are put back pretty close to normal.

The way I am about stuff, I need to have symmetrical looking shoulders and I would be bothered continually by the uneven-ness of my shoulders and I just want to know everything is back in place... So I elected to have surgery.
I ended up using Mazzacca from Uconn in Farmington CT. He is a shoulder and elbow specialist...even he was a little bit on the fence with doing surgery, but his deciding factor was the amount of space between my collar bone and the bones below the collar bone. There was a huge distance of space.

So I had surgery almost 2 weeks ago. They use a cadaver tendon to tie the bones together and then suture the ligaments together. I am in a ridiculous brace to hold my left arm immobile for 7 weeks. 24x7, I live in this brace. The purpose being to ensure the ligaments heal back together, hence no movement of my arm.
Once I am out of the brace, PT will start and I will imagine I can speed up PT as long as Im willing to put in the work...which obviously I am. 
I think in total, I will be 4-5 months before I can be back in full force...and to think I felt like I was just coming into the peak of my season and feeling so strong.

So call my stupid or whatever but yesterday I decided to go for a long walk, I ended up mixing some running in with my walking all the while wearing the brace. I actually felt pretty good.
Today I went and got a gym membership and rode the recumbent stationary for a while. I will be visiting there quite often to do this.
I'm really hoping after 6 weeks, I get this brace off, start PT and start excelling the process of recovery and getting back out there full force!
Here are some pics of the process including the storm drain I hit.


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## giantfox (Aug 13, 2012)

*ouch*

Very interesting forum of like-shouldered riders!!

Grade 3 separation - Day plus 12.

Massive OTB and a long drop on a steep slope (didn't make the switchback - done it many times before - this time too fast, too confident and weight too high, plus a new front fork with extra 40mm and a brand new brake. Looking back, this was a recipe for disaster)

Luckily missed the 50 foot cliff with the rocks and landed a long way down in the bushes. Heard the shoulder go, managed to drag my bike back up and walk out.

Day 1 just felt sorry for myself, didn't believe the doctor's advice (conservative approach - no surgery), so came back to see the same surgeon who did my ACL replacement 8 years ago, because I trust him

Started doing movement on day 2, pain dropped off noticably after 7 days and now have an almost normal range of movement, but little strength in certain directions.

Started in the pool on day 9, just with resistance movements and swam 20 metres last night (it was sore, but could do it)

Recommendation from my surgeon (yesterday) is no surgery. He thinks given my progress so far I will have an almost normal use of the joint in the future and considers that there is a bigger risk of ongoing pain from the operation. I have to go back to re-discuss with him in 4 weeks.

The main thing now is to build up the strength gradually. I yanked it on a handrail yesterday after shedding the sling and boy did it throb for the rest of the day and night.

Could easily ride a bike on the flat, but won't until it has healed a bit (in case I come off)

Aiming to go SUP on 1st September. Need to be good for the ski season end of December, and looking forward to some serious mountain biking next summer (going to get some armour)

the most painful thing was the quote from the surgeon yesterday.

" if we were looking at a younger, athletic patient, we would probably go for surgery"

I'm 47.


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## rodwilsonsr (Aug 6, 2012)

i would punch the doc in the face for that one. hope your recovery continues to go well. I have 28 days left in this brace, then I can start PT if I dont screw things up before then.

This injury is SO on the fence when it comes to deciding surgery or not.

Personally, I think at any age, if your fit and want to continue doing this stuff, if the injury is bad enough, surgery should be considered and I'm 41.



giantfox said:


> Very interesting forum of like-shouldered riders!!
> 
> " if we were looking at a younger, athletic patient, we would probably go for surgery"
> 
> I'm 47.


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## giantfox (Aug 13, 2012)

rodwilsonsr said:


> i would punch the doc in the face for that one. hope your recovery continues to go well. I have 28 days left in this brace, then I can start PT if I dont screw things up before then.
> 
> This injury is SO on the fence when it comes to deciding surgery or not.
> 
> Personally, I think at any age, if your fit and want to continue doing this stuff, if the injury is bad enough, surgery should be considered and I'm 41.


The reason I went back to the surgeon who did my knee is because I need to hear from a guy that I trust.

with Type 3 separation there is no consensus within the medical community on surgery or conservative approach.

My main concern is that I will not be in this health insurance policy for much longer, and I'm sure this injury will be excluded from the next one, so if I ever do need surgery, now would be the time.

But the explanation the surgeon gave me is that with the conservative approach he would expect me to have a pain-free joint - how useful it is is just down to me to train it. If I take a big fall again there is no reason that a surgically repaired joint wouldn't break anyway.

If I go for surgery, the main issues are:
a) pulling the bone back down into position through the soft tissue 
b) the remains of the ligaments causing problems through movement (maybe they can be trimmed off like the knee meniscus??)
c) bone against bone issues in the future (without the natural ligaments)

In short, he thinks the risk is that I would end up with a joint which has its use limited by pain, and he won't guarantee that it will be better (compared with the knee surgery, for instance)

No doubt these pros and cons will be debated further. At first I wished I had broken the collar bone instead, to be honest, I'm glad I didn't end up as a red blob on the rocks, so we live and learn.


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## rodwilsonsr (Aug 6, 2012)

I totally get it...just to offer some other support on making a decision on this stuff.

I have been working with a coach for the past few years...he has had 2 grade 5's and elected no surgery. He is a HUGE advocate for no surgery when it comes to anything that has the slightest chance of getting better by putting the work into PT and other related strength focused stuff.
He has 100 percent mobility, strength and functionality of his shoulder...it's just that his shoulder looks deformed. I went back and forth over getting the surgery based on his experience and discussions. I just couldn't stand to look at uneven shoulders everyday, and I just like the thought of things being put back together.

Anyhow, no guarantees for sure...one wrong fall and it can all be blown apart! 

Rod



giantfox said:


> The reason I went back to the surgeon who did my knee is because I need to hear from a guy that I trust.
> 
> with Type 3 separation there is no consensus within the medical community on surgery or conservative approach.
> 
> ...


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## cabinfever (Feb 6, 2008)

In the FWIW catagory...I have been 5 weeks post wreck grade 3, riding regularly as ever. Yesterday I did a 4 hour ride as long and difficult as anything I rode all of last year. It was a little sore at times specially at the end of a long 1.5 mile decent. But overall it was not an issue. My legs were toast but shoulder felt good. I started lifting weights (lightly) a little bit to early and was getting sore and backed off. Now I feel like I just need to get some strength built up. Pleased with the recovery so far, I'm further along than expected (I'm 47). Full ROM and pain free, as long as I don't sleep on it. Not liking the deformed shoulder look, but was not interested in surgery after reading everything I could find about it. Biggest thing was the extended recovery time. I also got the " If you were a younger athlete" speech. Uggh! Best recovery to you guys!


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## giantfox (Aug 13, 2012)

End of day 12:
15 minutes exercise in the pool followed by a 40 metre breastroke. Could have done more, but didn't want to push it. 
can now touch fingers of opposite hands behind back (one over the shoulder, the other behind the back - don't know what you call that stretch)

tempted to get on the bike tomorrow, know I shouldn't..............

anyone tried any of these neoprene shoulder supports? any comments/ advice?

it's great to comminucate with other who are sharing the same "pain"


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## giantfox (Aug 13, 2012)

100 metres breastroke - becoming pain free at a leisurely pace


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## chrnol (Mar 29, 2011)

Got my first collar bone injury and first broken bone tuesday night. Now have a Level 3 AC seperation and a distal radius fracture both one the right side. Cant wait to get back to riding, just got my new tubless set up in the day after my fall. I havent seen an ortho doc yet but the ER says 6-8 weeks recovery


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## giantfox (Aug 13, 2012)

Nice separation,
you are probably going through the surgery/ no surgery thing.

I'm now day 18 of my separation, was on my bike today (on the street), Pain is dropping off daily, 95% range of movement, good strength in certain directions, others very little.

Now tending towards no surgery, which is the advice I was given by two different doctors.

get well soon!


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## giantfox (Aug 13, 2012)

*posting photos*

sorry if I appear thick, but how do you attach photos??


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## giantfox (Aug 13, 2012)

just an update for those to follow.

Day 23, swam in the sea today, took it easy but no real issues. then spent 10 mins doing SUP paddle moves, with the paddle but without the board. Again no real issues, probably ready to take the board out but a bit nervous of getting into trouble on open water. Maybe next week.

Tonight I can feel all the soft tissue around the bone. it is kind of "buzzing" rather than painful.

Next Tuesday night is bike night. 'bout time I got back on my hoss.


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## giantfox (Aug 13, 2012)

day 27, 16km of easy riding round the track.
No problems at all.

No doubts about next season now


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## rockafella (Nov 17, 2009)

Interesting to see everyone's experience. Hope I can add some collective wisdom.

I have a Grade 5 AC tear and getting ready for surgery next week. Pitched over the bars at ~23mph according to the GPS going down a trail I had been down a bunch of times before in a place I ride almost every weekend. Too confident + too fast = bad news. I am an XC/single speed guy so this was not some crazy technical trail with big drops and jumps.

Landed on my side, cracked the helmet and actually had the CamelBak straps rip through my jersey and tear through skin. Tried to get up and felt like I had been punched all over. Probably bruised a few ribs, not sure. Took about a long time before I could get up and look for my bike. Couple of riders passing offered to call an ambulance. That was nice, but I declined. No broken bones as far as I could tell and had all my teeth so I didn't consider things that bad. 

However, I was more worried about my body over the bike. You know it's bad when that happens.

Rode out, cleaned up and tried to pretend life would return to normal. Thought I'd be riding in two weeks. Had a hard time breathing and knew the shoulder had taken a hard hit but thought it would heal. Took almost 2 weeks to get to the doctors (wife saw the bump after the swelling subsided and freaked out).

Anyway, going with the buttons + suture + ligament. Apparently that is the hot ticket these days. Goals are to reduce or eliminate the bump, return the shoulder to normal range and strength. I'm in week 3 going on 4 after the accident. Shoulder aches but no sharp pain. Went off the advil after the first week.

Hope to be on the single speed again soon. Good health to all!


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## martinizer (May 2, 2011)

I'm on day 8 of a grade 3 (although the original ER doc was calling it a 5), caused by a classic endo on a trail I've ridden 100 times. I'm still amazed at how much this thing hurts! I'm spending more time today out of the sling, but mornings have been brutal and I've had to take 600mg of ibu upon waking. 

The ortho recommended rehab over surgery. I had my left elbow surgically rebuilt (tommy john) years ago and don't relish the thought of going back under the knife, so rehab it is for now. But right now I'm really bumming out that I still have so little mobility and so much pain.

Somebody tell me this is going to get better. I can't bike, can't surf, can't even hug the kids.


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## xcguy (Apr 18, 2004)

martinizer said:


> I'm on day 8 of a grade 3 (although the original ER doc was calling it a 5), caused by a classic endo on a trail I've ridden 100 times. I'm still amazed at how much this thing hurts! I'm spending more time today out of the sling, but mornings have been brutal and I've had to take 600mg of ibu upon waking.
> 
> The ortho recommended rehab over surgery. I had my left elbow surgically rebuilt (tommy john) years ago and don't relish the thought of going back under the knife, so rehab it is for now. But right now I'm really bumming out that I still have so little mobility and so much pain.
> 
> Somebody tell me this is going to get better. I can't bike, can't surf, can't even hug the kids.


Maybe going under the knife is the best course of action. Don't rule it out. Your kids need hugs. Can't surf? Neither can I, but I live in Colorado!


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## giantfox (Aug 13, 2012)

martinizer said:


> I'm on day 8 of a grade 3 (although the original ER doc was calling it a 5), caused by a classic endo on a trail I've ridden 100 times. I'm still amazed at how much this thing hurts! I'm spending more time today out of the sling, but mornings have been brutal and I've had to take 600mg of ibu upon waking.
> 
> The ortho recommended rehab over surgery. I had my left elbow surgically rebuilt (tommy john) years ago and don't relish the thought of going back under the knife, so rehab it is for now. But right now I'm really bumming out that I still have so little mobility and so much pain.
> 
> Somebody tell me this is going to get better. I can't bike, can't surf, can't even hug the kids.


keep it moving - after 2 weeks i had virually full range of motion, also pain dropped off dramatically.
cycled during the week, going sailing this afternoon and maybe some SUP. (Day 30)

I have also been advised against surgery, and I still can't make up my mind if it is the right thing.

give it a few more days and you should see some rapid improvement.


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## giantfox (Aug 13, 2012)

setback....


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## wsmac (Sep 5, 2010)

giantfox said:


> the most painful thing was the quote from the surgeon yesterday.
> 
> " if we were looking at a younger, athletic patient, we would probably go for surgery"
> 
> I'm 47.


I did mine last year (many pages back now) and I was 51! 
My surgeon never questioned me getting surgery... but then, he's a mountain biker too, and he heard plenty of how hard it is to keep me still for very long! LOL

This is a cool thread! Not cool that folks are getting hurt, but it just seems like the bin that everyone who mtb's/ski-snowboard/skateboards/etc eventually winds up in... a place to belong!

It's interesting the options available depending on your doc, and the directions people head in their treatment/rehab.

I'm... 1 1/2 years or so out now and with my surgery, I feel normal... in the shoulder, that is! 

We have a trail we get to on fire roads and we cross a couple of gates. Lifting my bike up and over the gates is no problem. I never have a reminder of my shoulder injury through physical pain or deficit. I can do pull-ups, hanging stretches, yoga all with no issues concerning my repair or injury.

I ride and do just fine. I have learned to stop worrying about my shoulder when I do ride [fast].
Yesterday I went balls-out down a nice singletrack we have locally, having a really great ride, and I don't recall once thinking about my shoulder... or my ribs... or my little pneumo last year, or my head, neck, hip.......... good or bad, I was just having fun :ihih:

I wish all the new members to this thread an equally great recovery! :thumbsup:


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## martinizer (May 2, 2011)

wsmac--how long after your AC separation did you have the surgery done?


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## giantfox (Aug 13, 2012)

It is a great thread to review opinions based on real experiences!

My setback is based on the weekend's activities, (swimming, sailing) 

Everything was going fine until saturday night, which was at best "uncomfortable"

It feels as though the bone has moved again - I can really feel the end of it poking around the soft tissue. Not exactly painful, just weird. 

the only thing i did that I think could have caused this was lifting up the rudder, which is probably a 30kg lift. No issue at the time, but I'm wondering if that has shifted the bone?

It would be good to hear from some long term "no surgery" guys, to know how this thing is going to behave once all the soft tissue damage has healed..

THinking again about surgery.....


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## wsmac (Sep 5, 2010)

martinizer said:


> wsmac--how long after your AC separation did you have the surgery done?


Waited 6 weeks after injury to see the healing process, and to wait for the new Ortho Surgeon coming to town.

I was his first case up here... which was soon after the 6 weeks... but now I can't recall.
Must be buried back in this thread somewhere. Injury in Feb '11, surgery in April I think?

Ligament stretched 2 weeks after surgery, opened back up and replaced with new ligament (I was told they were manually stretching the thing to make sure it wouldn't slacken after they closed me back up  ).

I was put into a rigid brace for 6 weeks instead of the soft sling/foam block thing I had been in the first time.

Started physical therapy, although I did plenty on my own.

Been back to normal activities since then.
When I posted last, I forgot that it is uncomfortable for me to sleep long on that shoulder... not impossible, just uncomfortable.
Otherwise, I feel great! Went boogieboarding yesterday, loads of fun even when I wiped out


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## KCX (Sep 5, 2012)

Grade 5 AC separation snowboarding. Took the surgery route without a second thought. 
About 3 1/2 weeks now since surgery. Biggest problem so far is the tightness in my neck and back
As well difficulty getting comfortable especially when trying to sleep. 

Other than that just looking forward to loosing the sling and getting into PT. 
Lost quite a bit of muscle especially in my left arm.


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## mission2 (Dec 3, 2011)

KCX said:


> Grade 5 AC separation snowboarding. Took the surgery route without a second thought.
> About 3 1/2 weeks now since surgery. Biggest problem so far is the tightness in my neck and back
> As well difficulty getting comfortable especially when trying to sleep.
> 
> ...


get out of sling asap I believe it helped me tons even if its just to let your arm hang naturally as long as it does't hurt stay out of sling and start making small movements with your shoulder


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## rockafella (Nov 17, 2009)

*Post Surgery Here*

This is the day after surgery for me. Not too much pain and the x-rays show a completely closed ac joint. I waited a few weeks after the injury to get the procedure and that created a lot of scar tissue the surgeon needed to remove.

Hope it all heals up closed and quick. Speedy recovery to all!


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## KCX (Sep 5, 2012)

mission2 said:


> get out of sling asap I believe it helped me tons even if its just to let your arm hang naturally as long as it does't hurt stay out of sling and start making small movements with your shoulder


Thanks, ya I've been letting it out and moving around. Nothing realy hurts to much. 
Only way I can describe my shoulder is a feeling of needing to pop. 
What'd you have done and how long ago? 
I had a tight rope done ten days after injury, there was some other damage going on in there that he either cleaned up or left alone.


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## wsmac (Sep 5, 2010)

KCX said:


> Thanks, ya I've been letting it out and moving around. Nothing realy hurts to much.
> Only way I can describe my shoulder is a feeling of needing to pop.
> What'd you have done and how long ago?
> I had a tight rope done ten days after injury, there was some other damage going on in there that he either cleaned up or left alone.


Best check with the doc who fixed your shoulder, about unslinging.

The sling helps take weight off your repair while it sets up and heals. You go putting too much weight on it too soon and you risk undoing what was done.
Seriously.
I'm all for getting on that PT as soon as possible... but don't let people who's medical expertise comes only from their personal injury influence you too much... even me and my personal experience.
Sure... use our experiences, but definitely rely more on the advice from the person you trusted to actually cut into your body! Would you allow anyone here to open you up and sew buttons and shoelaces into your body? If the answer is YES... be sure to provide pics! After all... it ain't SH\T without pics! :thumbsup:

With shoulder injuries (and other similar joint injuries), if you have stretched the connective tissue holding the joint 'together', you will have a loose joint.
Even with a repair to a shoulder injury, you may have a loose joint until all your connective tissue(s) (tendons, ligaments, fascia) heal.
Things will likely pop until the healing is done, but then again... you may always have some degree of slack that will allow the joint to pop. It's not that actual bone ends are popping off each other, but more likely the stretched connective tissue slipping over bone ends and bony prominence.

Then again... I'm not a real doctor... I just pretend to be one with my GF!


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## bloodpuddle (Jun 15, 2007)

giantfox said:


> It would be good to hear from some long term "no surgery" guys, to know how this thing is going to behave once all the soft tissue damage has healed..
> 
> THinking again about surgery.....


I'm not sure if I qualify as "long term" yet, but next week it'll be 1 year since the Grade 3 on my right shoulder. I'm right-handed.

At the recommendation of two orthos I didn't have surgery, and have not regretted that decision at all so far.

One year out and I have full range of motion and strength as before. I can now sleep on that side, but probably only in the last 2 months has that started being comfortable again.

I'm riding just as well as before (or just as badly, you could say) and have crashed on that shoulder several times now since the injury without any additional problem.

It took me a while to get my confidence on technical stuff back - about 6 months I think before I was back to where I'd been: but that has nothing to do with surgery vs no surgery.

I do alot of open water swimming, and did my longest race yet (5km) when I was about 7 months out from the injury, but I'd been back in the water from about month 2 (doing breaststroke) and then freestyle from month 3. I've saved going back to butterfly for my one year anniversary next week! Best of all, I haven't lost any pace or endurance.

I'm a little hazy on the timelines now, but I think from about month 4 onwards I was pretty much back to doing everything as before the injury, with the exception that my free-riding career has been placed on indefinite hiatus (it was botching a jump that gave me the injury to begin with).

I had weekly PT for about 2-3 months, but haven't been back since.

So as I said above, 1 year out I'm pleased with the course of treatment I took. I don't think surgery could have given me a better outcome at this stage. What it'll be like in 10 years, 20 years etc, who knows?

Anyway, speak to lots of Drs and other experts. Don't take too much advice from strangers on internet forums  and good luck!


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## giantfox (Aug 13, 2012)

thanks bloodpuddle for that info.

i'm now 5 1/2 weeks..went sailing yesterday and today, been cycling round the track (tarmac), swimming is OK. Went SUP on thursday and today and that was too much. Not really painful, but i got the feeling that it wasn't doing me any good.
Can't get used to the feeling of having the bone floating around in amongst the muscle. Still feels strange.

My doc told me that all the soft tissue damage would be repaired after 3 months and after that it will be as good as it is going to get. so I'm almost half way there.

long term , just need to be patient!


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## G-reg (Jan 12, 2004)

I'm exactly 3yrs out from mine. I've got a few posts in this thread if you want details. But the cliffs notes are: No surgery, have a goofy bump, only pain is from sleeping on that side or physical activity like a wide grip pull up or mil press.


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## giantfox (Aug 13, 2012)

tnks for that!


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## TranceX (Dec 24, 2011)

5 months out from Grade 3 AC Separation plus the dreaded frozen shoulder...I'm 52. I've been mountain biking the last 3 months or so but taking it easy. I finally rode on the trail I injured myself on this month...rode slow, dragged my brakes everywhere, avoided jumps....except for bunny hopping over stuff....I'm definitely gun shy and don't want to get hurt! Injuries suck!! Anyway, I'm hoping my confidence will build up over the next several months....

I did get to surf 5 days straight last week thanks to Tropical Storm/Hurricane Leslie! :thumbsup: I ended up with ice on my shoulder after those long paddling sessions....


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## aedubber (Apr 17, 2011)

Had my spill July 14th , separated right AC and 3 fractures to my scapula .. 1- on the spline and 2 across the glenoid . My ortho and PT asked me how in the world did i fracture my glenoid lol . Well my fractures have healed up and i started my PT last week but now my right collar bone looks like its going to come out of my skin lol but my ortho said its fine and wont come up anymore .

Most the pain is gone , but i still get tensed up in a few spots . Im working on getting full range/motion now so no weights for me . My PT should be around 6 weeks give or take . I was in a sling for 4 weeks , so it feels great to move my arm around now but man my body took a toll , lost a lot of muscle and been eating like crap but im changing up my diet and hitting cardio now and leg workouts .


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## dieonthishill (Dec 15, 2011)

I am 5 weeks out of a grade 5 AC and CC separation surgery. They installed a TightRope in my collarbone and shaved the end of the bone down because it was displaced and could not fit back down to where it was supposed to be.

This is my third time in a sling and the thing was driving me [email protected]#@ing crazing. Took the sling off after 3 weeks but made sure to rest my shoulder on things as much as I could to prevent it from hanging. I did get back on my road bike after I took the sling off but made sure not to hold the bars too hard at all. As of today, I am feeling great and the doctor say I should be able to start using it lightly next week.

***** of an injury and should be able to mountain bike in 6 more weeks, maybe a little less...


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## amartin (Sep 20, 2012)

I have (according to the first ortho) a 3rd degree separation. Its been 7 years since the damage and at the advice of the ortho, I didn't do the surgery. It was 3 months before I could do any real PT, and it bothered me daily for over a year. It always aches after use, and I suspect I have some amount of arthritis. I would say I'm 80% where I once was, but get weird pain in my upper back often and struggle with posture. In my case it is my dominant side which is annoying for most other sports and I cannot to this day sleep on my right side. I still feel an overall lack of stability and no longer buy the story that "it'll heal fine and you'll just have a bump". In the gym I can work through the pain, but choose not to since I can feel and hear the pops/crackling sounds of heavy lifting. Even after a 10k jog, I have pain in my shoulder. I'm wondering now if I did other damage as well, but it was missed. 

I'm getting a second opinion today at 4:30, although I'm not holding out much hope. If I could do it all over again, I would have requested surgery at the time of the accident. To anyone with a bad fresh injury, whether you opt for surgery or not, get on a stationary bike asap. I didn't, and after a year of very little activity had a long road back to fitness...


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## giantfox (Aug 13, 2012)

now day 52. each week is spent recovering from the weekend's activities. every 7 days I feel the end of the bone working its way a little closer to the skin. Bump gets steadily bigger. last sunday went for a 10 minute run on the beach and I'm still feeling the effects, 5 days later.

problem is, I still have another 40 days before all the soft tissue damage is supposed to be repaired (according to the doc) so I still don't know what to expect from the permanent situation. 

dear amartin: your experience has been an awakening: however, whether one has surgery or not, the only way to know the difference is to try a full non-surgery recovery and then compare it to an operation later......

thanks for posting your story.


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## TahoeBC (Apr 11, 2006)

I'm a year out from my grade 3 separation. Doc told me I'd be trading a lump on my shoulder for a scar with the same end results, so I went the no surgery route. Although my nude modeling days are over I have not regretted not going under the knife. Besides a lump it causes me no issues what so ever.


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## giantfox (Aug 13, 2012)

TahoeBC said:


> I'm a year out from my grade 3 separation. Doc told me I'd be trading a lump on my shoulder for a scar with the same end results, so I went the no surgery route. Although my nude modeling days are over I have not regretted not going under the knife. Besides a lump it causes me no issues what so ever.


good to know!!


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## vic.j (Sep 25, 2012)

*ac seperation grade 3*

Ok, I've joined the club and went over the bars on the 6th September which resulted in a Grade 3 separation. The NHS referred me to a shoulder specialist which would have taken 4-5 weeks before I would have seen him.

As I knew time was of the essence in regards to surgery being effective, I sought the opinions of two specialists privately. I went with the second opinion of 'tightrope' surgery which was carried out yesterday - 24 September (to the tune of £4600.00).

Apparantly this is only successful if carried out within 4 weeks of the accident, otherwise the scaring of ligaments prevents healing.

To be honest the pain had subsided and I had full range of movement before the operation. But I could not live with the bump and noticable 'droopy' shoulder. I also lift weights three times a week and was worried that I might not be able to train with full intensity if left without surgery.

I will post 4 weeks from now when I am out of the sling to let you know how I am getting on.

Vic


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## giantfox (Aug 13, 2012)

hey vic,
yours is an interesting comparison. we are 5 weeks apart in injury, you with your surgery and me without.

I'm very keen to see how we compare.

I'm not very happy with my shoulder, but have another 4 or 5 weeks until all the soft tissue damage is supposed to have repaired itself and i will get to feel how it will be permanently.
One thing for sure is that over the last 2 weeks the bone has moved upwards - even to the point that the skin was itchy over the bump - same feeling you get when your skin is swollen due to an infection underneath.

I'm still avoiding using full strength, but doing most things to a lesser extent.

hope you get a quick recovery from the op.


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## Staurm (Aug 27, 2012)

Hi,

I went OTB in a MTB race in NY August 5th - leading to a third degree separation of my left (non-dominant) shoulder.

I went to the orthopedist the next week, he took X-Rays and recommended no surgery - he said I could go either way but I should regain almost full mobility and strength without it.

For Reference, I'm 45 yrs old - active mountain biker.

The first couple weeks sucked. Sleeping didn't work well. I began PT the second week - that has really helped. I stayed off the bike for the first 4 weeks - I decided to be cautious.

Followup with the Ortho at week 5 (Now in Week 7) - he said everything looked good.

I have a really gnarly bump and droopy shoulder, but I have almost full range of motion (with some 'gutteral' pain at times if I go the wrong way). I'm still letting it heal.

I've been road biking a few times since and have ramped up this week - it is sore afterwards but not unbearable. I've also been running. I notice my neck stiffens up after running - the PT says this is b/c I am overcompensating with muscles for the ligament that is ripped. 

I am going for a second opinion tomorrow with a sports Ortho that does a lot of athletes - I still believe I do not need surgery, but the wife and PT said it can't hurt to have another opinion. Will see what he says.

Ortho said about 12 weeks before most of the pain would go away. I've done a couple of slow MTB rides with my kids, nothing that fast yet, maybe this weekend.

All things considered - I am fairly amazed that it has recovered this well so far. I may be lucky in my range of motion. I've broken bones - they hurt for longer. The pain still hurts. but hoping that it gets better. 

And I have a scary looking shoulder to scare the kids with .

This thread has been very informative for me. Nothing else like it on the internet. Thanks to all for their stories / experiences.


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## giantfox (Aug 13, 2012)

don't know if anyone else has tried it.

But I wouldn't recommend golf at 10 weeks...


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## gman_beef (Oct 6, 2012)

*AC separation Rockwood III - notes on recovery (tightrope surgery)*

Hi All

Here's my story:

AC separation Rockwood III - Injury sustained 23.06.2012 Operated on 04.07.2012 (acute, double arthrex tightrope, no clavicle resection)

Sustained a Rockwood III AC Separation while single-trailing in Switzerland.

I decided surgery was for me, because I consider myself to be a part of the "overhead athlete" category. I searched out specialists in shoulders, who also had plenty of experience doing the OP (obviously).

Goal is to be surfing in Australia in December. I am an Australian living in Switzerland, lifelong surfer.

Here's a brief listing of things I noticed, hope it helps.

* Physio first 2 months - ROM
* Minimal pain after 1 week post OP, very rarely woken at night, especially after sleeping on good side and then the bad side rolls forward - this caused a deep throbbing pain in the shoulder (presumably the CC ligaments)
* Work up to getting hands behind head
* Everything is super tight from wearing a sling for 4 weeks (in Bed and during the day, only taken off during exercises or when arm is supported)
* After 3 months, can use weights to build up muscle
* At this stage I had pretty much full ROM (got a bit cramped with the arms straight up in the air), but still really weak
* Rotator cuff exercises - with weight
* Continuation of Theraband exercises (rows etc.)
* Heavier weight behind the head, on the bench
* Door jamb stretch does wonders for stretching out the last of the stiffness from the sling
-- Arm stretched at right angle up against door, push slightly forward

Current exercise plan
* Core exercises - 3 * 20 alternating leg drops on mat
* Triceps using rope system (safe for shoulders)
* Deltoids using rope system (adduction)
* Rotator cuff
* Hand bike to warm up (10 minutes) on an increasing setting (resistance)

Plan for 06.10.2012 - 20.12.2012 (75 days - roughly 10 weeks)
* Core exercises - 3 * 20 leg drops on mat
* Build up shoulders - rotator cuff, delts, lats, pecs (in order of priority)
* I intend on thrashing the Hand-bike - machine to simulate paddling
* First breaststroke, then freestyle (also one of the final pieces to the puzzle)
* Push-ups (the final piece in the puzzle) to help with standing up while surfing

Overall the recovery is long (longer than I thought) and filled with disappoinments but more importantly successes. At certain stages I was worried about the droopiness of the shoulder (the gleno-humeral seemed to droop forwards - is now centralised again), the pull of the arm when I came out of the sling, the time it took to get my hands behind my head, the list goes on. The point is you have to stay positive, and keep doing your exercises. It accelerates everything. There is also no point in being obsessed with your shoulder and looking at it the entire day.

Right now I feel very strong and I am rapidly getting back to normal with all the gym and physio exercises. I've been more on the conservative side with everything - the sling, exercises (quitting when I feel a "bad" pain (deep or sharp) as opposed to good pain (stretching, small amount of burning on the rotator cuff)). I think it pays to be conservative - although there could be an argument to giving up the sling earlier.

Cheers

Greg

PS Would love to hear from any surfers who have had an AC separation surgery.


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## wreckingrob (Aug 24, 2007)

*New member of the club...*

Stage 3 separation. At least the prognoses is good. Sucks right now, but at least I'm sleeping, and its not my dominant shoulder.










Also, it was caught on camera...

Rob's Crash - YouTube


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## TranceX (Dec 24, 2011)

wreckingrob said:


> Stage 3 separation. At least the prognoses is good. Sucks right now, but at least I'm sleeping, and its not my dominant shoulder.
> 
> 
> 
> ...


Nice video.  I normally run the GoPro but didn't the day I got my Grade 3 Separation.

Update: 6 and 1/2 months out. I SUP in the ocean a few times every week. No shoulder issues. Yesterday I went on a 25 mile offroad/road ride. No shoulder issues. I'm lifting light weights to increase strength and I'm glad I didn't do the surgery at this point. Plus the lump is really sexy. :thumbsup:

As far as riding goes I will now be much more hesitant to launch off of jumps or go flying full blast down a hill. Injuries suck. :nono:


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## TranceX (Dec 24, 2011)

Rob, what happened to cause you to crash? Why were you so far off to the right side of the trail? Just curious, I know things happen fast...


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## TranceX (Dec 24, 2011)

For those of you considering surgery for a Grade 3 separation for cosmetic reasons here's what it looks like without the surgery.

Here I am less than an hour after the "incident".










This is 6 and a half months later. Notice the difference? Not much. 










Cracks me up when friends come up and say, "hey it's looking better!" I'm like "really? You do realize that's the end of my collar bone sticking up there right? It doesn't get better....lol."


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## wreckingrob (Aug 24, 2007)

*Good Question...*

Hey TranceX,

Good question. As you can tell from the video, it was just a water bar on a moderate slope of downhill. I was doing a little left to right weave as I came down the trail. I remember thinking, "I'm to far right for this water bar, but no problem. I'll just hit it and deal with the branches.", without taking the crown of the water bar into consideration. The middle of the bar was much better suited to jumping than the right or left. It was to abrupt out on the edges. My rebound threw the back end up and I endo'd. Oops.

It was a dumb mistake, and right at the top of one of the best down hill trails in NC. The worst part of this was having to walk down the rest of the trail - seeing all the great lines and technical features by foot was more painful than the fall itself, and that hurt like a *****.


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## mattedhead (Jan 24, 2012)

Grade V separation here.

Surgery:
Double Arthrex Tightwire
Hamstring Graft
Clavicle resection

Played golf 8 weeks after surgery, My shoulder is now 100% and have had no ill effects. It was the worst recovery I have ever had to deal with though. I have broken nearly 30 bones, had 6-8 surgeries to mend bones/soft tissues, even cut a finger off...and NOTHING sucked as bad as the recovery from the shoulder injury!!! It was absolutely worth it. Keep up with the PT as that makes all the difference in the world.


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## TranceX (Dec 24, 2011)

wreckingrob said:


> Hey TranceX,
> 
> Good question. As you can tell from the video, it was just a water bar on a moderate slope of downhill. I was doing a little left to right weave as I came down the trail. I remember thinking, "I'm to far right for this water bar, but no problem. I'll just hit it and deal with the branches.", without taking the crown of the water bar into consideration. The middle of the bar was much better suited to jumping than the right or left. It was to abrupt out on the edges. My rebound threw the back end up and I endo'd. Oops.
> 
> It was a dumb mistake, and right at the top of one of the best down hill trails in NC. The worst part of this was having to walk down the rest of the trail - seeing all the great lines and technical features by foot was more painful than the fall itself, and that hurt like a *****.


Ah, that explains it. Damn.

After I fell I actually grabbed some advil I had in my camelbak and popped two before I even got off the ground. My buddies helped me walk out and I drove myself to the ER .... less than 1/2 hour away and they shot me up with pain killer ASAP. Mine never really hurt that much....I'd say maybe a 4 out 10.


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## xcguy (Apr 18, 2004)

mattedhead said:


> Grade V separation here.
> 
> Surgery:
> Double Arthrex Tightwire
> ...


That's great you're back but "worst recovery ever" doesn't really go with "played golf 8 weeks after surgery". What exactly is it you're saying about your recovery?


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## bloodpuddle (Jun 15, 2007)

wreckingrob said:


> The worst part of this was having to walk down the rest of the trail - seeing all the great lines and technical features by foot was more painful than the fall itself, and that hurt like a *****.


:thumbsup: Spoken like a true mountain-biker!


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## giantfox (Aug 13, 2012)

good to see people on here with "many years of experience" behind them. Can still show those young 'uns a thing or two! 
I have an update - during a drunken running challenge (against a girl) I managed to trip and fall at full pelt on my shoulder. 
Funny things: 
1 it didn't hurt
2. it "feels" better (better movement, less strange)
3. the bump is about twice the size it was.

Not sure if there was still a bit of ligament attached and now its free??

I'm getting towards the end of my 3 months "soft tissue repair" period, and the bone still feels weird and I'm thinking I won't be happy if this is as good as it gets..


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## vic.j (Sep 25, 2012)

*Update*

Thought I would post a little update, Its now 15 days from my key hole tight rope surgery on my grade 3 and I am now out of the sling. Doc says I must not lift my arm above shoulder height for another 4 weeks but i am now moving freely below this, all be it with extreme care.
At this point in time i'm so pleased i went for the surgery, I have normal looking shoulder again and the muscles in the area no longer ache from trying to compensate 

For those of you that went the non surgery route my hat goes off to you, I guess im just too much of a tart to live with the bump and i did not want to take a risk on complications later on in life.

I cannot beleave the NHS did not give me a choice on what i wanted done. The attitude of wait and see then if you have trouble we can then do a bigger operation instead of the keyhole does not make sense to me. (Probably makes perfect sense to the NHS Budjet:madman: ) If you are like me and the NHS will not sort it and you want the OP, I strongly recommend going private while the injury is fresh and the tightrope is a viable solution.

I will update again in a few weeks

Vic


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## gkendallw (Oct 19, 2012)

Hi, first post, new member of this not-so exclusive club. Joined 10 days ago. Typical story, fast downhill endo on a trail I had used at least 100 times. Major initial pain, badly bruised ribs, ER says Grade 3, first Ortho on Cape Cod says Grade 3-4 and possible surgery.

So 2 days ago I went to a prominent sports/ortho guy near Boston who has done some major repair on my son (snowcross career). Xrays look like many others here. But he added the element of ultrasound to make sure the tendon (across the shoulder) was not damaged as that would influence his surgery decision. Tendon showed no damage so we discussed the options.

He says surgery is probably only going to be needed for the bump. At 57, my swimsuit modeling days are behind me. He also says I should do the surgery within 30 days of the injury. 45 max. He uses the button method, but would need "something more involved" if I decide later to go ahead.

The most telling comment for me was that he said "I love doing surgery and have done many of these, but if it were my shoulder, I wouldn't do it". He is late 30s and very active.

Best news is that there has been a remarkable change in the last 3-4 days. I am out of the sling, eating, writing and typing with my left (dominant) hand. Going to try the pool today for some ROM stuff.

I guess I am opting for golf, snowmobiling, winter MTB and swimming over the 6 month sentence that the surgery would entail. The bump (while initially shocking) seems like a fair trade. Surgery is never a picnic, even when all works out.

Thanks for this amazing thread!

GW


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## wreckingrob (Aug 24, 2007)

So I'm 2 weeks out to the day from my stage 3 separation. No surgery planned. I rode fire roads the following Wednesday, and man did that feel good. No pain at all. I started riding trails again 9 days after the initial injury. Again, it felt really good. Obviously jumps and big log overs are a no-no, but no issues on moderate downhill and bumpy terrain. 

I think half of my recovery is dealing with the impact the rest of my body took. I basically stacked all my body weight on the should in question, so there is a great deal of bruising and soreness there. However, it seems to be dissipating quickly. I find I'm able to do more and more each day, especially after riding. I'm doing an "active recovery", and the more I do the better it feels.

Even the guys in the group I ride with, half of whom have stage 3 separation from riding and or years of rugby, are surprised by my recovery. So, my message to those who have recently busted their ass and are wondering WTF they are going to do now, is to stay active. I believe if you keep the legs and lungs strong, the shoulder will follow.


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## giantfox (Aug 13, 2012)

i have developed a major bump on my belly over the last 11 weeks.

i think it might be connected


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## TranceX (Dec 24, 2011)

giantfox said:


> i have developed a major bump on my belly over the last 11 weeks.
> 
> i think it might be connected


 Ha ha!


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## Andy17 (Sep 18, 2011)

I have joined this club too.. With a level 3 separation I am going to go for the sugery too. I have not found a good reason not to have this fixed from the start. Yes I know the rehab is longer but the outcome is better I hope. Does anyone have good advice. 

Andy


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## TranceX (Dec 24, 2011)

Andy17 said:


> I have joined this club too.. With a level 3 separation I am going to go for the sugery too. I have not found a good reason not to have this fixed from the start. Yes I know the rehab is longer but the outcome is better I hope. Does anyone have good advice.
> 
> Andy


Other than the bump I'm not sure the outcome is much different. Good luck with the surgery and be sure to do the PT as required! 6 months out and I surfed hurricane Sandy last week and have been mountain biking a lot....getting stronger all the time!


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## giantfox (Aug 13, 2012)

13 and 1/2 weeks since the fall.

It still feels wierd but I can do everything I want so far, but it hasn't really been tested. 
For instance I have not hung my full weight on the arm and tried to pull up (yet)

Cycling isn't an issue, have rode some bumps but no real test. Golf was terrible.
Can SUP without too much drama, but is mildly painful swapping the paddle from one side to the other.
last week had to put the winter tyres on which was a different test - carrying 8 wheels up and down to the basement and swapping them over. No real issues at the time but it ached that evening and I could feel it for a few days.
It feels to me like evereytime you do something strenuous, the end of the bone is rubbing against all that soft tissue and must be damaging it slightly - then it takes a few days to heal.

If you take some time to read the posts and do some research you won't find anything conclusive that leads towards surgery or no surgery. Which is quite frustrating.


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## Andy17 (Sep 18, 2011)

I have some friends with AC separation that wasnt repaired and ALL 3 of them said to have it repaired period. They have been living with it for as many as 20 years and have limits to what they can do and pain that comes and goes with heavy use or over head use. All three of them have clicking which is painful at times. I would bet guys with surgery have some issues too but really havent heard them.
My doc says the shoulder will be 100% and I can go back to anything I want to after a 6-9 month rehab.
It's been a week after the crash and the shoulder is much better as far as pain but I am really amazed at how much closer my arm is to my body. The shoulder has rotated down so far there is a very noticeable difference. The top of the collar bone is still very tender where the bone fragments were torn from. 
Other than the rehab taking much longer I think the rebuilt shoulder will be better and trouble long term should be better. I have read most of this thread and haven't seen too many long term results. The one I have seen was only about a year out. Your right just not much conclusive results or posts. Like one guy said each person is different and so is the injury, level of rehab, actitivity level and results linked to them. This makes conclusive leads difficult. It would be nice to hear from both sides 2-10 years out but I dought we will.


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## giantfox (Aug 13, 2012)

an interesting tale.

went sailing today and there was a guy with a bumpy shoulder same as mine....(but younger)

he did it 3 years ago, no surgery and is doing all sports normally including MTB and wake boarding. 

No issues whatsoever...according to him


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## Andy17 (Sep 18, 2011)

How bad was his separation? Glad you enjoyed it, not the story I wanted to be telling for sure.
Just looking for info from non and cut guys. Thank you for yours.


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## TranceX (Dec 24, 2011)

Andy17 said:


> It would be nice to hear from both sides 2-10 years out but I dought we will.


I promise to post up 3 years out on this! I'm only 6 months now. I went on a 9 mile easy mountain bike ride this morning and SUP'd in the ocean for an hour this afternoon. No pain...but it is a little tender. I know it is there. Here is where I'm currently weak.....prone paddling on a surfboard. I can surf but when it is overhead and offshore I had trouble getting my 5'6" fish into the waves (duh, wrong board choice). Nonetheless, I'm positive with some strength exercises I'll be pulling that off next hurricane season. :thumbsup:

I'll have to admit I may be different than others.....I'm 52 and not getting any younger but my mind keeps telling me to push and learn new things on my bike and on my boards. I have an office job and feel unsatisfied if I don't get a good workout at least on the weekends.

What I don't know is if I would be better off 2 or 3 years out with the surgery than without.....

Stay tuned.


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## Andy17 (Sep 18, 2011)

I will do the same here with surgery. I don't have a date yet but expect it will be before the end of the month. All 3 of my buddies do most anything they want just maybe not as well or long. 2 of them bike with no problem.


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## giantfox (Aug 13, 2012)

Andy17 said:


> How bad was his separation? Glad you enjoyed it, not the story I wanted to be telling for sure.
> Just looking for info from non and cut guys. Thank you for yours.


separation was identical to mine except mine is left (non-dominant) and his right.

Thing that impressed me was wakeboarding, which is about as full-on use of the shoulder as you can get.

Mind you, maybe it is the less strenuous but more difficult movements that cause problems eg- overarm paddling motion.

My bone aches this morning and I wasn't doing anything particularly sporty yesterday, just pulling on a few ropes and getting in and out of the boat.


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## giantfox (Aug 13, 2012)

TranceX said:


> What I don't know is if I would be better off 2 or 3 years out with the surgery than without.....
> 
> Stay tuned.


this is the great question.....no way of knowing


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## Andy17 (Sep 18, 2011)

TahoeBC said:


> I'm a year out from my grade 3 separation. Doc told me I'd be trading a lump on my shoulder for a scar with the same end results, so I went the no surgery route. Although my nude modeling days are over I have not regretted not going under the knife. Besides a lump it causes me no issues what so ever.


My doc said the opposite, surgery will move shoulder back into normal position and you will be 100%. As strong as before, corrects posture and no bone interference (clicking or bone on bone issues). But will have scar and longer harder recovery time. I asked if it would be as durable as natural shoulder and he said as durable as before after the long rehab. He did give the option of no surgery and said a lot of guys do just fine without surgery. 
I'm only a week into this and don't want to have 2 recoveries. Most pain is gone but I a have no strength. The shoulder feels very unstable and much closer to the rib cage! I was thinking of long term shoulder issues including as one guy here had talked about frozen shoulder, limited mobility, posture issues and back problems as it would not be as balanced.


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## giantfox (Aug 13, 2012)

Andy17 said:


> My doc said the opposite, surgery will move shoulder back into normal position and you will be 100%. .


this is the great dilema.

the medical fraternity is still not decided and it very much depends on which doctor you ask.

like my surgeon, who would have been quite happy to take the money but recommended against the surgery


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## vic.j (Sep 25, 2012)

Andy17 said:


> I will do the same here with surgery. I don't have a date yet but expect it will be before the end of the month. All 3 of my buddies do most anything they want just maybe not as well or long. 2 of them bike with no problem.


Hi Andy,

Can your doc not do the tightrope procedure? It can be done with key hole surgery and you are left with 4 tiny scars if you can call them that. It must be done asap though after the injury. I dont think i would be waiting till the end of the month if i was you.(2 -3 weeks is optimal apparantley.)

I am 6 weeks out from my tightrope op and i am so pleased i went this route. Every week my shoulder is improving and i think i would go as far as to say the last few days feels like its back to normal. It isnt of course as ive yet to stress it, i go back for a checkup this week where i can then start overhead stuff with my arm, but im hoping this will go smoothly so i can then concentrate on range of movement.

Good luck with your injury


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## Andy17 (Sep 18, 2011)

Yes he is doing the tightrope. That sounds great!! I am glad to hear your doing so good so quick. My doc says since my ligaments are completly torn really doesn't matter when the sugery is done.
I had read here people saying the sugery had to be done very quick but he said didn't matter the ligaments (AC and CC) are not reused. He is going in with a 2-3 inch cut to take end of bone off and bone frags too. I would rather had key hole but he didn't say and I didn't ask why cut really. I am hoping end of this week or at least before thanksgiving. 
How soon did they get you moving the arm? Can you feel the button or screw? Did the surgery put you down for a while? Could you sleep in a bed or chair? sorry for the questions


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## Andy17 (Sep 18, 2011)

giantfox said:


> this is the great dilema.
> 
> the medical fraternity is still not decided and it very much depends on which doctor you ask.
> 
> like my surgeon, who would have been quite happy to take the money but recommended against the surgery


Excatlly what doc said and he did recommend trying with out surgery. But also said the surgery would put shoulder back in normal position and be "100%" . I have (for now) good insurance this year and the cost is very minimal, around $500. for everything. Next year cost goes up to $5500. Thanks Obama care. :madman:
That is why I am not waiting along with having to recover two times. If it had happend two months later I would have had to go no surgery route also....


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## vic.j (Sep 25, 2012)

Im guessing your injury maybe slightly different to mine then as i had nothing taken off of the end of my collarbone. I had a grade 3 too so my ligaments were totally torn but from my understanding if the collar bone is put in place before 4 weeks have passed the ligaments will heal together. Although i think its more scar tissue and not a true ligament as it once was.

I could take my arm out of the sling to wash but that was it for the 1st 2 weeks, i was sleeping on my back only at this time.

After 2 weeks the doc advised taking my arm out of the sling when at home but on no account lift my arm above my shoulder.

At four weeks i did not use the sling at all but my shoulder felt very odd and weak.

Now at 6 weeks it feels normal to use with with light duties

I cannot feel the button at all which is a relief.


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## Andy17 (Sep 18, 2011)

He said taking off the end of the bone would stop interference or bone to bone contact. Yes he said the scar tissue that would form at the old ligaments would not hold and possibility of isssues with the scar tissue over time. 
Great information thank you! Sounds like yours is going great, I wish you the best also!


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## Teh Smith (Jun 28, 2011)

*No PT?*

I'm 47. Went OTB 9 days ago and received a level 3. Ortho Doc recommended non-surgery, but when I asked him about PT, he said not to worry about it, just let it heal naturally.

My question: How many of you were given similar advice regarding PT? Did you follow that advice, and did you heal up just fine?


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## DreamingDog (Mar 13, 2012)

Teh Smith said:


> I'm 47. Went OTB 9 days ago and received a level 3. Ortho Doc recommended non-surgery, but when I asked him about PT, he said not to worry about it, just let it heal naturally.
> 
> My question: How many of you were given similar advice regarding PT? Did you follow that advice, and did you heal up just fine?


I had a grade 2 separation at the beginning of March. The first doc I saw just referred me elsewhere. The sports medicine guy I saw gave me a little pamphlet of stretches and exercises to do. If I'm honest, I didn't really do most of the stuff in the pamphlet. I'm all healed up now but it did take a few months before I stopped feeling twinges of pain while doing simple stuff.

The biggest thing I can recommend is don't try to go too fast with recovery. After about three months, I was feeling 'good' and tried to do some light pressing movements in the gym and practically re-injured the shoulder. Now, 8 months later, I'm back to full strength and bench pressing heavy. With that said, I do still feel some slight discomfort in the shoulder when pressing heavy but I'm fine while riding.

At 9 days out, you may want to start some small movements. Raise your arm up to the side, in front, try to cross it over your chest, etc. The crossing over the chest part was the most painful for me. Maybe do some arm circles. I didn't really follow any certain PT program. I just tried to move it around as much as I could without causing too much pain. A bit of pain with any movement will be normal for a few weeks/months.

Sorry about your injury. Take it easy so you can get back out there.


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## wreckingrob (Aug 24, 2007)

Teh Smith said:


> I'm 47. Went OTB 9 days ago and received a level 3. Ortho Doc recommended non-surgery, but when I asked him about PT, he said not to worry about it, just let it heal naturally.
> 
> My question: How many of you were given similar advice regarding PT? Did you follow that advice, and did you heal up just fine?


4 weeks ago I separated my shoulder, and yesterday I completed SWANK 65 in the Pisgah of NC. The shoulder was a total non-issue. I can't quite get over big log overs like I used to, but suspect that'll be over in a couple weeks.

I didn't do any PT. I just rode. After two weeks I started doing those shoulder muscle exercises with the bungie cords, and 3 started shoulder presses and shruggs. Active recovery works.


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## kmacon (Nov 15, 2006)

I shrugged off PT at first after my grade III and kept having dull pain that just kept getting worse to the point that I was totally obsessed with it. Went back to the orthopedic surgeon thinking I was going to have to go through surgery to stop the pain. He suggested first to do a round of PT and talk about surgery afterward. The result was after one and I mean only one visit to PT my constant pain went away. I did PT for like six weeks and it was the best treatment I could ask for without the surgery. Probably should do more on my own but well, after 4 years who has the time or desire.


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## giantfox (Aug 13, 2012)

Teh Smith said:


> I'm 47. Went OTB 9 days ago and received a level 3. Ortho Doc recommended non-surgery, but when I asked him about PT, he said not to worry about it, just let it heal naturally.
> 
> My question: How many of you were given similar advice regarding PT? Did you follow that advice, and did you heal up just fine?


Interesting flurry of posts which illustrates the vast differences of medical opinion and patients' own experience.

I am now 15.5 weeks since I did mine. Can SUP as strong as before, push ups, riding bike no problem (not yet MTB as I'm currently in the flatlands), however turning the steering wheel is painful and changing the car tyres was painful and left me with pain for a few days (minor)

I'm going back to see my surgeon (who advised against surgery) on Monday as a follow up to see what he has to say.

I'm wondering if I have some bone fragments attached to the loose ends of the ligaments that irritate the soft tissue when I move in a certain direction (arm out elbow down).

Although people have done some fairly major exercise (and riding) within a few weeks, in my case this was not possible. Everytime I pushed it I was rewarded with a few days of pain, which receded and it has take 3 months to be able to get to where I am now. However, keep it moving from as early as possible so it doesn't stiffen up. I could touch my hands behind my back across opposite shoulders (don't know what the correct name for that stretch is) after 12 days - in fact first time I tried it.
Above all my advice would be to stay positive and do what you can do. you will probably be surprised. Also, it is worth taking a few hours to read this thread, because everything you can think of has been posted at one time or another.


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## ascbeerman (Jul 11, 2009)

Hi All,

First time post here but I owed it to this forum (and especially this thread) to contribute. I did a type 3 on May 30th of this year. I'm 46 and have crashed my bike many times in my lifetime but never like this. I saw a Ortho the next day and decided to have surgery. My Ortho is also an avid cyclist and had the same injury. He initially decided against surgery but changed his mind after six months and had the surgery. After 2 or 3 days had passed my pain level subsided considerably and I was having second thoughts. My research began in earnest. I learned that my pain was gone because all of my connective tissue was gone as well. There was nothing left to hurt any more aside from general soreness from the impact. After reading this thread and many other opinions, I decided to persevere. I had surgery on June 4th. I'm not gonna lie. Surgery and the rehab was a *****. The worst part was getting the sling off even though it was what I looked forward to the most. After 3 months, it starts getting steadily better though. I am now over five months and I feel so normal. I am still healing but at this point I really believe I made the right decision. Biking is a non issue. Strength and flexibility are about 95% and I am sure that 100% is right around the corner. Hope this helps. Good luck to all.


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## Ricisan (Aug 30, 2006)

*The Weakest Link!*

After a lifetime of adventure and the consequences of that, I have learned this.
When you push your body to the limit, the weakest link will let go first.
The shoulder has 17 muscles and tendons crossing the joint.
If any one othe them is weak or injued, it will be the first to go.
For those that have been able to avoid the most painful movements,
you can hide from them forever! LOL

I agree w/rest and ice first. After that, you can't avoid the weak/damaged
muscles that will get tested when you least expect it!

I'm back to doing my circuit training, less overhear presses.
If it hurts to do something, there is probably a reason.
You can't protect your injury 24/7.

JMHO

R


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## giantfox (Aug 13, 2012)

hi guys. this could be a very long post but i will try to keep it short.

16 weeks today since went OTB and over the drop...... started having flashbacks but that is another story...

i have been following a conservative approach (no surgery) as advised by 3 different doctors/surgeons.

went back to see my surgeon 2 days ago. I lost confidence in him... won't bore you with the details.

Had a thorough going over and the conclusion was that I have a full range of movement and good power transfer, but I have lost some strength due to under use (because I neglected the physio and was doing my own thing)

Just back from the physio with a whole set of very specific exercises to get going with.

Still have the pain at the end of the bone feeling and the surgeon asked me if i can live with it.... I said yes.

So for the moment I'm sticking without the surgery and working on my muscles


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## Andy17 (Sep 18, 2011)

Had surgery yesterday. Not too bad yet good drugs help. Dr said everything went good.


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## giantfox (Aug 13, 2012)

more physio


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## Andy17 (Sep 18, 2011)

It's been about a week since surgery and I'm off all pain meds and have no pain. First 3-4 days were the worst not much pain but the drugs suck. I can't believe people want to take that stuff. Going to the doctor tomorrow the get stiches out and find out when I can start PT. As far as the shoulder goes it feels like it is hanging normal again but it's hard to tell with the sling. It's swollen but bump isn't noticeable. I just hope it heals up good and strong and I can get back to riding soon.


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## dwnhlldav (Feb 2, 2006)

TranceX said:


> For those of you considering surgery for a Grade 3 separation for cosmetic reasons here's what it looks like without the surgery.
> 
> Here I am less than an hour after the "incident".
> 
> ...


Not everyone looks like that with a grade 3. When I was just standing with my shoulders in a neutral position my clavicle sat in it's natural position and swimming kept my shoulders strong enough to support the weight of my arm. I had very little deformity or difference in height between my shoulders.


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## dwnhlldav (Feb 2, 2006)

I posted awhile back in this thread, but I can't remember what I said and I don't feel like looking through 22 pages to find out.

So, here's my short back story. I did a grade 3 separation of my left shoulder 5 years ago, September of 2007. I ended up not having surgery and did pretty well. In 2010 I went to an orthopedic surgeon who specializes in shoulders and knees of athletes. I was having some issues. He kept me from doing surgery, we made some changes to my physical therapy and resolved the issue.

In June of this year I went down on my shoulder. It was a really minor fall. But in the weeks after I started having issues. The most bothersome was subluxation of the joint. Basically at random times, my clavicle would slip up and over my scapula and then pop back into place. If you've dislocated a joint, you know it's not comfortable. This was happening 2-3 times a day. There was no clear pattern so I couldn't just stop doing the movement that caused. it. It was most problematic when it would happen while riding. I'd lose all the strength in my arm and almost crashed a couple times because of it.

I went back to my surgeon, who by now knows me really well, he took care of a bone spur and torn ligament in my ankle in 20120. Also, in addition to being his patient, I take care of his bikes. After an extensive assessment he determined that I tore much of the muscle fascia in my stabilizing muscles. My surgeon suggested surgery. 

I've been researching AC reconstruction since my original injury. 5 years ago the prevailing thought was that those who under went surgery and those who used only physical therapy would end up at about the same level after a year. In the last couple years there have been some subsequent studies looking at long term results. New data suggests that even if you opt for the conservative route after a grade 3 separation, you will eventually end up going under the knife because you will develop arthritis in the joint much more quickly then those with an intact joint. This, combined with my now grade 5 separation made the decision to have surgery easy.

So, I went under the knife just over 5 weeks ago. I was released from my immobilizer sling on Wednesday and started therapy on Thursday. Right now it's just stretching to restore range of motion lost from being immobilized for 5 weeks. I'm still in a decent amount of pain. Still popping percocet two or three nights a week. I'm limited to no lifting over 5 pounds for another 5 weeks, but I can already tell that all the popping and clicking is gone. Each day I feel much better. I'm optimistic that I'll be better off than prior to surgery. I think that having attempted the conservative approach with good results until I made things worse by crashing again puts me in a unique position to be able to assess the outcome of the surgical route vs physical therapy. I'll let you all know how things progress.


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## giantfox (Aug 13, 2012)

that is an interesting post.

in my last update following the 3 month visit to the surgeon, I said that I had lost confidence..

following his insistence that conservative approach is right for me, and it seems to be going well, he rounded it off by saying that I "shouldn't have any trouble at all" doing my job (I more or less work from a desk)

Right from the beginning I told him that what was important to me was to be able to do the active things that I like doing....

Due to a change in job i am also changing health insurance cover next friday. The new cover is supposed to cover existing conditions, but I will be moving country which means a new doctor.

I'm tempted to find the best doctor I can in the new town and get a completely fresh opinion.


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## dwnhlldav (Feb 2, 2006)

I did just fine without surgery for 5 years and would have gone many more had I not made things works. 

Really, my only limitations were holding a heavy weight in my arm for a sustained time. I'm not a lifter, but I could lift anything I wanted to, I just couldn't hold things for an extended time (think, carry a kid around a store).

I could swim (I had a mental lapse a few years ago and got into triathlon). I actually think swimming was very good for strengthening the stabilizer muscles. But, I had to limit how much I swam or my shoulder would get irritated. I found that I had to keep it below 6000 yards a week and was better closer to 4000 yards a week.

Riding was fine. 

I didn't do any paddle sports post separation, but I imagine I'd have had the same limitations as swimming.

That being said, after reading the more recent studies, it seems that if you are an active person with a grade 3 separation, you will eventually end up having surgery even if not doing it initially. You might not get reconstruction but you will have to deal with arthritis in the joint. I'll try and find a link to the studies.

Look for a a surgeon who specializes in athletes. My surgeon specializes in the shoulders of athletes. He also knows that being able to ride, ski and play with my kids are much higher up my list of priorities than work. I couldn't have found a more qualified doctor.


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## NJMTB (Aug 1, 2010)

*One Year Later, I'm 95%*

Those of you that just had it - there is hope! It's not over! Mine turned out pretty good. :thumbsup:

I posted on here a year ago - Grade 3 right shoulder after hitting a jump wrong at Whistler. :madman: Bruised or sprained the left too (apparently while I was doing a rag doll unconscious down the road). Broke a rib, finger, etc.

I'm 39. Didn't get surgery. So glad I didn't. I was back on the bike in three weeks, probably six months before I felt really normal, but now I'd say I'm 95%. Like I said, I'm 39, half the joints on my body are at 95% so I figure that's pretty good!

I can lift, ride, sleep on that side (for a few hours at least). Just got back in the thai kickboxing gym a month ago, straight right and right hook to the body are as hard as ever. Life is good.


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## G-reg (Jan 12, 2004)

dwnhlldav said:


> That being said, after reading the more recent studies, it seems that if you are an active person with a grade 3 separation, you will eventually end up having surgery even if not doing it initially. You might not get reconstruction but you will have to deal with arthritis in the joint. I'll try and find a link to the studies.


Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.

Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.

Interesting that the opinions on how to treat a AC tear are so polarized.


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## dwnhlldav (Feb 2, 2006)

G-reg said:


> Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.
> 
> Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.
> 
> Interesting that the opinions on how to treat a AC tear are so polarized.


I've been searching, I'll continue... The study didn't say that surgery would prevent arthritis. It said that those who did not get surgery in the beginning would develop arthritis that could/would be bad enough to require surgery in the future. It also said that those who had surgery immediately after the injury would also develop arthritis (supporting your doctors opinion). The short version of the conclusion was that surgery or not following the initial injury, people with grade 3 separations are very likely to require a surgery years down the line. Keep in mind that the study looked at the Weaver-Dunn procedure as the initial repair. The study I remember most clearly was published in the last year or two.

As far as the difference of opinions, it seems to me that it's the difference between general orthopedic surgeons and shoulder/athletic specialists. Keep in mind, my sample size is limited and I am in no way criticizing your surgeon or putting down his abilities or knowledge.

I've been to 3 different orthopedic surgeons for this injury. Initially I self diagnosed this injury because the ER doctor missed it. My clavicle was not displaced when my shoulders were in a neutral position so it was an easy mistake to make. Due to outside circumstances, I didn't get in to see an orthopod until 12 weeks post injury. In that time I did a lot of research. The first two doctors I went to shared your doctors opinions about this injury. They also had no idea what I was talking about when I brought up the newer procedures. The third doctor is an orthopedic surgeon who specializes in shoulders of athletes. Though he was aware of the most recent techniques, and helped develop one as a surgeon for the Navy, he kept me from doing surgery. At the time I first went to him it was a year post injury, or 4 years ago. I was back to all my normal activities. He suggested that since I wasn't having more than occasional discomfort I should continue therapy. He also said the if I did surgery then or years down the road, the surgery would be the same. So I didn't get surgery. I went back to him a couple years ago because I was having some issues. Again, we did not do surgery. I made some changes to my therapy and resolved my issue. It wasn't until I fell in June and upgraded from a grade 3 to a grade 5 separation that he thought surgery was the best route.

Some of this you may know, but hopefully it helps others understand what's going on with this injury.

AC joint separation involves two major ligaments. One goes out from the end of the clavicle, horizontally and attaches to the acromion. This ligament is rarely rebuilt. The second major ligament is vertically oriented and goes from the clavicle down to the coracoid process. When both of these ligaments are torn, you have a grade 3 separation. There are a couple different approaches, but from my discussions with my doctor and the studies I've read, the latest technique is to remove 1cm from the end of the clavicle, and then use a hamstring tendon to rebuilt the ligament from the clavicle to the coracoid process. The tendon can either be from a cadaver, or your own. It's the same tendon used in ACL reconstruction. This seems to be the most current technique and has produced better results that the Weaver-Dunn procedure. It's also what I had done. The method your doctor described will alleviate interference between the clavicle and acromion, but does not help to stabilize the joint and will certainly lead to arthritis down the road. The weaver-dunn is widely known and is still the defacto repair for surgeons not specializing in shoulder repair. The Weaver-Dunn was a decent fix for problematic grade 3 separations and for more severe separations, but it did not produce a joint as strong as the original and that is why it's not indicated for grade 3 separations that respond well to therapy.

Here's an abstract to a study of the most recent technique. You have to have a subscription to see the full article. My doctor's PA printed it out for me. Clinical Outcomes of Coracoclavicular Ligament Reconstructions Using Tendon Grafts

Studies have shown that there is little benefit in rebuilding the ligament from the clavicle to the acromion. They also show that using either a cadaver hamstring tendon or an autogenous (from you) hamstring tendon to rebuilt the Coracoclavicular Ligament resulted in a joint that was at least 95% as strong as the original joint. Sometimes stronger. Using your own tendon is less likely to have complications. Using a cadaver tendon puts you at risk for rejecting it.

The testing is quite interesting. The way they tested these repairs was to rebuilt the joint on one side of a cadaver and then fail test both shoulders and compare the results of the rebuilt side to the uninjured other side. (I'm totally donating my body to science when I die)

I can say that all of the clicking an popping I had prior to surgery, and for the last 5 years, is gone. I'm almost 6 weeks post surgery. My biggest issue is loss of range of motion do mostly to being in the immobilizer sling for 5 weeks. It's coming back quickly. I'll be very happy with the results if things continue to progress as that have.

Disclaimer: I'm not a medical professional. This is a synopsis of my own personal research into AC joint reconstruction. I'd like to link all of my sources, but I replaced my computer since doing the research and lost many of the links. Should have switched to google chrome earlier...


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## wsmac (Sep 5, 2010)

dwnhlldav said:


> ... the latest technique is to remove 1cm from the end of the clavicle, and then use a hamstring tendon to rebuilt the ligament from the clavicle to the coracoid process. The tendon can either be from a cadaver, or your own. It's the same tendon used in ACL reconstruction....


This is the technique I had done April 2011.
I have fallen with my bike, as well as gone straight up over the bars, since then.
I can say honestly that as I travel up and over, my thoughts do center around my shoulder and trying not to land on it.

So far, I've been doing pretty good with that! 

I continue to stretch my upper body and shoulders frequently just to keep up my ROM, as well as other exercising when I make myself do it.

I have been doing pullups for quite a while now with no issues concerning my shoulder.

Basically, I am glad I had the surgery done (approx. 8 weeks after the injury).
There is nothing so unusual about my shoulder that reminds me of my injury... either feeling anything different, or seeing anything different.

I had cadaver ligament two times.
As mentioned many pages ago here, the first time around the ligament stretched and my clavicle returned to the post-injury state.

Two weeks later the surgeon went back in and put a new ligament in and this is the one I've been living with ever since.

Thanks for all the up-to-date info... I enjoy reading this thread as more people add on!:thumbsup:


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## G-reg (Jan 12, 2004)

Good info!


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## giantfox (Aug 13, 2012)

G-reg said:


> Please share the links if you find them. It sound like you are implying that a shoulder repaired via surgery will not have any arthritis problems.
> 
> Which is 180 from my ortho's explanation of the injury. His opinion was that you'd have less arthritis problems with a AC sep that was not "repaired." If it is a problem they surgically zip off the last 1/4 of the clavicle and that's it. The joint itself is rarely repaired, the clavicle is just brought down....where it's more likely to bang into the process of your scapula where it used to be bonded.
> 
> Interesting that the opinions on how to treat a AC tear are so polarized.


this was my surgeon's main argument against surgery.- that the risk of athritis was greater following the surgery than left alone


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## giantfox (Aug 13, 2012)

i'm still no further forward in forming a definitive opinion..

lifted up my son yesterday straight in fornt of me (about 30kg) That hurt a bit.


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## mapdash (Oct 18, 2012)

I am 4 weeks out from a grade 2 AC. Day 1-3 were hell. Progress from there was fast and encouraging. I wore a sling for 3 days then ditched it. didnt take pain pills, just advil. Have been to the gym every week since week 2 at least twice. First time i was useless. Great improvement since then at about 25% of usual weight. I even did shrugs this weekend which was impossible previously. 

Just had follow up with dr. yesterday and he said gym is fine with high rep count. 25+. 

I rode at 3 weeks....gingerly with pain. Rode this weekend with almost no pain at about 80%. 

I am 37 btw. 

Good luck and speedy recovery to everybody.


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## mapdash (Oct 18, 2012)

Oh and btw: My dr said that the ligament will indeed "fuse" back together on a grade 2. He didnt like the term regrow. 

On a grade 3 or above they generally do not he said. I mention this because i read conflicting info on here about ligaments healing/regrowing. 

I asked about reinjury from another fall and he said at 2 months it should be as strong as pre injury (ligament wise).


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## jhhall (Nov 14, 2005)

I joined the club about 2.5 weeks ago. Grade 3 AC Separation. Honestly the pain wasn't ridiculous at first but the discomfort since that has been bothersome. I initially opted for the non-surgical route but after reading more about it here and other places I think I'm going to get the surgery. 

I can't stand the thought of not being active on a bike for at least 3-4 months, but I think that in a years' time I'll be happy I went this route. I've never had surgery before and I really hope I'm doing the right thing here.

Here's a pic from the ER.


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## Andy17 (Sep 18, 2011)

Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level. 
Anyone want to chime in on rehab and time frame that have had surgery?


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## Old Ray (Sep 5, 2010)

Andy17 said:


> Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level.
> Anyone want to chime in on rehab and time frame that have had surgery?


For me, rehab time was pretty lengthy, but my injury was complex, and I had the surgery at age 55. In a sense, I'm more or less stuck with a a process of ongoing re-hab for life.

All of which points out that there are so many variables that come into the equation of how long one can expect to rehab. Degree of separation, other damage done, age and health of the patient are some of the biggies. Some of them. There's lots more.


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## wsmac (Sep 5, 2010)

jhhall said:


> I can't stand the thought of not being active on a bike for at least 3-4 months, but I think that in a years' time I'll be happy I went this route. I've never had surgery before and I really hope I'm doing the right thing here.


It's a long read but this whole thread is full of info on rehab and such.
I started my story on page 12.
I did very little rehab with a PT, instead I worked on it at home, while driving in my car...
The important thing for me was to be a COMPLIANT patient... which is damn near impossible for me.
Take yesterday and today, for example. I am 4 weeks out from hernia surgery and not supposed to be lifting more than 10 lbs, but I rode up into the hills yesterday to clear some trail. A bit of sawing with a handsaw, mostly cutting branches, briars...
Today I removed the bumper from my GF's p/u to hammer out a couple of dents she put in them. I took it all slow and easy, but still... I'm sure my surgeon would have given me the evil eye!:nono: :eekster:

Back to the topic at hand...
I wore a soft sling with pillow block after my first surgery and the repair failed.
After my second shoulder surgery in 2 weeks, I was put into a more rigid brace than the sling with foam block.
I made sure I followed doctor's orders MUCH better that time and it paid off.



Andy17 said:


> Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up. I would like to get the sling off, at this point I dont feel I need it but I know its here for another 3 weeks. My shoulder is feeling really good but loosing muscle from being in the sling 24/7 and I have another 3 weeks in it. I am wondering how long it will take to rebuild and get back on the bike. I see 2-3 months rehab to get it back to a useable level or hard mountian biking level.
> Anyone want to chime in on rehab and time frame that have had surgery?


After 6 weeks waiting for surgery, then 2 weeks with a failed attempt at surgery, I spent another 6 weeks recovering from the second. The brace, a change in my attitude, and time spent moving my arm (as allowed per doctor's orders from initial rehab and after brace removal) through as much normal range-of-motion planes as possible, helped me get back pretty much everything in movement.

I have recovered my strength as well. I can climb at the indoor rock gym with no issues, do pull-ups, lift weights, and most importantly... MOUNTAINBIKE!... as good as I could before.

I did the wall crawls, stretches on every plane I could think of and could take, and created a pulley device to help.

The device I made was similar to something I saw at the PT office.
I used a bit of webbing and a slider, figure-8 descender, some rope, and two hand-width sized pieces of 3/4" pvc.

I fashioned the webbing to have the slider on one side of a door, with the webbing passing through the jamb to the side I was on.
With the door closed, it became my anchor.
The other side of the webbing(loop) went through the figure-8.
I ran rope through the other end of the figure-8 such that it was a length that would hang down to my sides.

I slipped each piece of pvc onto the rope, then tied the rope back to itself to fashion handles.

Holding onto the pvc handles, I could use my good arm to pull my recovering arm up from various positions.
I could stand with my back to the door and pull my arm straight up in front of me.
I could stand with my recovering side to the door and pull my arm up sideways.
I could stand away from the door and pull my arm up behind me.
I even took this on the road with me.

You can get imaginative and do plenty of PT on your own as long as you understand the mechanics of what's happened to your shoulder, what's happened since the surgery, and what you are trying to accomplish with your PT.
It really is simple mechanics, if that helps you think it through that way... it did for me.

When driving, I would slowly raise my arm up to the steering wheel repeatedly as exercise until it was fairly easy, then I started walking my arm up over my head on the headliner of the car. After that, it was lifting my arm over to the passenger side, eventually getting my arm far enough back to get behind the headrest.
The opposite of that was reaching across my chest to grab my seatbelt(not as great an extension as the other direction, but it was better than nothing).

I just spoke to a friend of mine who had a ligament repair to his shoulder along with other work to the joint.
He was given a unit that was basically a portable cold pack device.
He had to pay for it (or hopefully his insurance will), but using that often after surgery has really helped him out, he said.
I offered to buy it from him, figuring I'll probably have a need for it down the line if I keep up with my style of mountain biking! LOL


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## jhhall (Nov 14, 2005)

Andy17 said:


> Looks like mine.. Sorry your here. I'm 3 week since surgery now going to doctor tomorrow for 3 week check up.


Thanks Andy! Let us know how the appointment goes/went.


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## jhhall (Nov 14, 2005)

wsmac said:


> It's a long read but this whole thread is full of info on rehab and such.
> I started my story on page 12.
> 
> Back to the topic at hand...
> ...


Thanks WSMAC - I went back and followed your story - good read. I'm glad to hear that it's all paying off for you.


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## Andy17 (Sep 18, 2011)

Everything going great, it's in perfect position. 3 more weeks in the sling.:thumbsup:
I cant wait to get back on the bike.


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## dwnhlldav (Feb 2, 2006)

I got the go-ahead to start riding on the trainer. My doctor doesn't want me to risk falling for another few weeks so nothing outside.

Now, I just need to find my trainer. I think I may have loaned it to someone...


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## Andy17 (Sep 18, 2011)

Wow thats great Dave. Your about 6 weeks post surgery and are making great progress!! How long until you could ride woods do you think? How is the rom and strength at about 1 week post sling? My shouder is drying up and getting stiff. I'm just wondering how long to get it back up to speed. I am thinking about 2 months post sling to regain enough strenght and allow the repair enough time to get strong enough before we can get back at it. I think another couple months after that before we can go fast. I am hoping maybe 4 weeks and maybe I can get to dirt roads? I will do what ever the doc says but from reading, a lot here, ( good info) this may be about what we are in for..


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## dwnhlldav (Feb 2, 2006)

My first day out of the sling was rough. I didn't know what to do with my arm.

I saw my PT the day after and ROM was pretty limited. But it's coming back very fast. Within a week it had improved to 75% of ideal in my worst movement, 95% in my best movement. I missed my 1.5 week appoint due to work. I'll go back tomorrow and it will be two weeks out of the sling.

As far as woods riding goes, I don't know. My doctor says he'll release me to ride outside after my next appointment on January 2nd which will be 3 months post operation. But, we won't have any trails open at that point. I could go to Ray's in Milwaukee, but I've never ridden there without falling and I don't think it would be fun to go and not push myself. My plan is to get back to commuting to work 2-3 weeks and then hit the single track when it opens here in the spring. Maybe a late winter trip to Rays...


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## dwnhlldav (Feb 2, 2006)

Saw my doctor last week. His words were "You can ride your bike, but you can't fall." So I'm sticking to the trainer for now.

His explanation was that the old thinking was that by 8-10 weeks the tendon and bone junction would be fairly well healed. But newer studies are pushing that out closer to 16 weeks. So, he eased up my restrictions, but said the longer I can be conservative the better. 

ROM is back to normal in all directions except the one most limited when I was in the sling. That's external rotation with my elbow at my side and bent 90 degrees (like it was in the sling). But I'm up to 90% on that movement. Started light strengthening and was okayed to do easy swimming (breast stroke only) for 20 minutes, 2x/week.


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## jhhall (Nov 14, 2005)

dwnhlldav said:


> Saw my doctor last week. His words were "You can ride your bike, but you can't fall." So I'm sticking to the trainer for now.
> ek.


Sounds like a good decision on your part. This recovery is something I don't want to ever have to do again so I'd opt for the conservative route too!

Andy - how are you doing?

I'm just over 3 weeks post op. on meds for 2 weeks and now just OTC if needed. Still a decent amount of pain but the past week I've seen pretty good improvements. I have a 4 week post op appt next week. My guess is another 2-3 weeks with sling and then start PT.


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## Andy17 (Sep 18, 2011)

I went to dr on 31st and took sling off. My first appointment for PT was Thursday and it went pretty good pain wasn't too bad but it did hurt. I'm doing all the home work and like Dave I'm going conservative. I can't put more than 5lbs pressure for 6 full weeks which will take me to the 3 month stage also. To me Dave and I have the same treatment routine. Getting out of the sling is not fun it is a lot of work to get ROM back. I think it will come back fairly quick as you guys have said. 
I have no hump at all bones are lined up perfectly right now. It's a long road but I feel it was the best for me.


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## dwnhlldav (Feb 2, 2006)

jhhall said:


> Sounds like a good decision on your part. This recovery is something I don't want to ever have to do again so I'd opt for the conservative route too!
> 
> Andy - how are you doing?
> 
> I'm just over 3 weeks post op. on meds for 2 weeks and now just OTC if needed. Still a decent amount of pain but the past week I've seen pretty good improvements. I have a 4 week post op appt next week. My guess is another 2-3 weeks with sling and then start PT.


Glad you're improving. I went off the hardcore pain meds after about a week, but found that I wasn't sleeping well. I kept rolling in my sleep and waking myself up with the pain. Started back on the percocet at night and it helped a lot so I think I ended up taking a half dose every night for a total of 4 weeks. When I finally ran out, I switched to simply sleep for another couple weeks. I'm off all pain meds and sleep aids at this point. I'm a side sleeper and tend to switch sides during the night. This is still my biggest issue. My doctor said it's okay at this point to lay on my side, but it's uncomfortable so I'm still waking up multiple times during the night from pain. I guess if this is the only discomfort I'm experiencing then I'm doing pretty good.


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## dwnhlldav (Feb 2, 2006)

Andy17 said:


> I went to dr on 31st and took sling off. My first appointment for PT was Thursday and it went pretty good pain wasn't too bad but it did hurt. I'm doing all the home work and like Dave I'm going conservative. I can't put more than 5lbs pressure for 6 full weeks which will take me to the 3 month stage also. To me Dave and I have the same treatment routine. Getting out of the sling is not fun it is a lot of work to get ROM back. I think it will come back fairly quick as you guys have said.
> I have no hump at all bones are lined up perfectly right now. It's a long road but I feel it was the best for me.


It comes back quick. Keep working at it and you will start feeling better quickly.


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## Andy17 (Sep 18, 2011)

Yes then there is sleep or the lack there of. I went off pain meds after 3 days and use Advil at night but it really doesn't help get a good night sleep. I also sleep on my side and sleeping on just one side is hard. I can't sleep on the bad shoulder at all yet. I can lay on it but for just a few mins. 
I'm working on the stretching and strength exercise program and can see results already. Good to hear you guys have good results quick. Thanks guys!


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## giantfox (Aug 13, 2012)

about a month since i last posted, quite an improvement.

been back on the trails, nothing too difficult, but there were no issues at all with my shoulder (although i did have very heavy legs)

1 week on skis - absolutely no issues (including a fairly impressive wipeout)
can SUP no problem, running no issues (was painful early on when running)
swimming no issues

this week i had the gym, bit of a mid-life crisis due to other issues.
absolutely no issues in strength, but just the occasional twinge.

can sleep on it..

so 5 months after the injury, no surgery, I would rate my shoulder at 98 to 99%.
it just took its own time to get there.

still looks awful, but hey!


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## dwnhlldav (Feb 2, 2006)

I'm back on skis now. That was another "You can ski, but you can't fall" conversation from my doctor. I joined the National Ski Patrol this year so I'm working on getting certified with the toboggan. Had my first day in the handles. My shoulder did fine with the weight of the sled, but we won't have passengers for another few weeks.


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## TranceX (Dec 24, 2011)

When I asked my doc about mountain biking and falling again he just laughed and said, "you've already ripped it apart so you don't have to worry about that...." His attitude was no surgery for grade 3 as the data 1 year out doesn't suggest it is needed, and not to worry about it... That being said I just completed my first 50 mile mtn bike ride yesterday at the Tour de Felasco 9 months out from my injury.


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## dwnhlldav (Feb 2, 2006)

TranceX said:


> When I asked my doc about mountain biking and falling again he just laughed and said, "you've already ripped it apart so you don't have to worry about that...." His attitude was no surgery for grade 3 as the data 1 year out doesn't suggest it is needed, and not to worry about it... That being said I just completed my first 50 mile mtn bike ride yesterday at the Tour de Felasco 9 months out from my injury.


I was back on my bike, and falling a week after I did the grade 3 separation. You're doc is right, it doesn't need to heal. Just stop hurting.

I didn't go for surgery until I fell and made it a grade 5.

But with surgery, falling would be a major setback.


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## Andy17 (Sep 18, 2011)

I went to doctor a week ago and got the ok to ride dirt roads at 12 weeks but "don't fall". My range of motion is coming back but has been a little slow. Seems I am sone of those people who get really tight. I have around 85% ROM or better now. The bones are still lined up great. I am going on a 28 mile ride saturday and looking forward to it. The recovery is long and hard but I have no regrets with the surgery. The doctor says I can get back in the woods when I get strong enoough but go easy until the 6 month mark. He said the new parts will reach max strength around 6-9 months and be as strong or stronger than the original. Thats my 12 week post op up date.


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## jhhall (Nov 14, 2005)

Congrats Andy! That's incredible progress. I can't imagine being allowed or ready to ride in 4 more weeks. Enjoy the ride on Saturday!!

I am 8 weeks post-op and was out of the sling at 4 weeks due to frozen shoulder. I was nowhere near ready to be out and the first few days were tough. I immediately started PT and have seen pretty good progress. I'm probably at 40% ROM now and can ride the trainer as of 2 weeks ago. I rest my arm on the bar but can't put any weight on it. I'm being super diligent on the home exercises. I have my 8 week appointment with my surgeon on Monday.


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## Andy17 (Sep 18, 2011)

Progress is speeding up for sure. At 8 weeks I couldn't have rode either. The last two weeks I have made a lot of progress. There is no way I could ride in the woods right now I have not got enough strength to begin to even think of it. Dirt roads only and they have to be smooth, he didn't even want me to cross the smallest ditch log or rut in the road. Oh and do not fall. 
My shoulder was frozen up pretty bad too but he wouldn't let me out of sling until 6 weeks. I had very little ROM and have still not regained it all yet. 
Looking forward to the ride!!!!


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## dwnhlldav (Feb 2, 2006)

Went in for my most recent appointment at 15 weeks. Up till this, my PT has been doing only ROM and very light strengthening with me. She asked me to see if we could get going with heavier stuff. Doc's words were "You can go to town." I love that guy. 

I really haven't gotten back on the bike that much. Went to Ray's in Milwaukee and made it about 30 minutes of mild riding before the shoulder was telling me it was time to stop. I was given the okay to do easy swimming at 12 weeks. I'm up to 750 yards at an easy pace, planning on doing 1000 yards a couple times this week and seeing how much I can push the pace since given the all clear. I have a standing invitation from one my customers/local tri coach to go swim with his group on Wednesday evenings, but need to get a bit more fit before I show up there.

ROM is at 100% for all motions except external rotation which is 85%. Though I notice a big difference when I'm in the pool. Good swimming form takes a lot of shoulder flexibility and even though I'm being measured at "100%" I'm very unequal so we are still working on ROM in PT.

In closing, I'm finally feeling like I'm better than before surgery. Progress has been substantial in the last month so I'm fairly confident saying I made the right call in going under the knife.


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## Ricisan (Aug 30, 2006)

*Over reaching?*

My injury was about as bad as can be fixed. I'm almost 8 months in and making progress. Here are a few thgings that have worked for me, and a few that have NOT!

The plyo ball allows me to work my back and core, as well as both shoulders so as to keep the strong one strong and flexible.
I started doing the rab exercises every day, no good.
I now do the exercises every third day followed by circuit training.
That has been my best move yet, I improve every workout!

I went on to doing compound exercises "weight lifting" on my basic
lifts. Found out my lack of tendon strength was holding me back.
So I am back to working on my tendon strength first in the morning,
then circuit training later that day if I feel up to it.

I noticed that I was neglecting a few exercises that were very difficult.
I had to go back and be honest w/myself about what exactly is the weak link in my chain, and follow up on refocusing on those.

Leave the ego behind, do what you can when you can. 

I make my rehab the most important thing in my day, other than work!

Don't forget the Ice machines to keep things chill.

R


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## AC Straighter (Feb 17, 2013)

Im curious to know if anyone has had a surgery for a grade 3 separation years after the initial injury. I separated my dominant shoulder almost 12 years ago and it has always bothered me, but I've had complete ROM and noticed very little reduction in strength. Of course I have the huge bump but the appearance never really bothered me. It has always been sore/painful, and made lots of crepitus/clicking, crunching, popping sounds, but I was told on initial eval to not have surgery. I have always wondered if I should have. Almost 2 yrs I had gone thru 1st yr medical residency and didn't have much time to work out. When I did get back into it last year I began to have pain with that shoulder with push ups and pullups etc. so went to see Ortho. Long story short, we never found out exactly what the new injury was and although I can do push ups and pull ups again, I get much more sore afterwards and I now have a painful click when I draw down on my opposite site (a motion as if I'm drawing down with a gun on someone standing at my opposite side) as well as a "jump" when I rotate my dominant right arm internally when standing upright arms at my side. My ortho said he could do an arthroscopy but still doesnt think I should get the AC reconstructed. My fear is that the separation caused a shoulder dysfunction which will predispose to degeneration of the joint from altered mechanics. Sorry this is long but has anyone ever had a tight rope procedure years after the injury?


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## Ricisan (Aug 30, 2006)

I'm glad I'm not the only one that puts nicknames on the rehab exercises. lol
I do the gunfigher crossdraw, the comes across my chest into an overhead hitch-hiker
thumb out move. 
This is my most difficult move. I could only do 6-8 w/#1 weight.
Yesterday I did 14 good ones! 

I also lie on side and do a 45* side raise for superspinatus.
Went from 5 reps to 15 w/#1 weight.

The final is lying on my back, shoulder at 90*.
Like I am throwing something overhand.
I just went from #3 to #5, very happy.
Feel like celebrating.

My injury was getting worse.
My sergon told me mine was second oldest/worst seen.
Last guy let his go 12 yrs, it was too much to fix properly.
Mine had fatty deposits and bursa that had to be removed.

I just turned 59, so yrmv!

R


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## AC Straighter (Feb 17, 2013)

Glad to know you're doing better. What procedure did you have done and how long after you're initial injury was it done? Why did you decide to get cut?


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## dwnhlldav (Feb 2, 2006)

AC Straighter said:


> Im curious to know if anyone has had a surgery for a grade 3 separation years after the initial injury. I separated my dominant shoulder almost 12 years ago and it has always bothered me,


I waited 5 years after the initial injury. I was forced into surgery by another fall that made the grade 3 into a grade 5. In some ways, I wish I had done it immediately after the initial injury. But in the end, I'm glad I waited because I found a doctor who was doing more advance repairs than what I was told about initially.

Don't go for the weaver-dunn or any of it's modified versions. It's outdated. But because it's been widely used for 3 decades, it is still performed. Studies indicate that it only produces a joint that has 10-30% of the strength of the original joint. (source) http://isakos.omnibooksonline.com/2011/data/papers/icl/ICL_10.pdf

The most recent technique, that has better results, doesn't have a short name yet. The long version is Anatomic Coracoclavicular Reconstruction using Semitendinosus tendon, either allograft using a cadavor tendon or autograft using your own tendon.

The newer procedure has been shown to reliably produce a joint that has 85-95% of the strength of the original joint, with outliers above 100%. (Unfortunately I can't find the source, this is from memory, though I have a very good memory for statistics like this, I'll keep trying to track down the source)

I went with my own tendon because of the higher risk of rejection with a cadaver tendon.

The procedure described, starting on page 10 of this paper is the one that most closely describes what my Doctor performed, though mine was done as an open surgery with a 5cm incision.
http://isakos.omnibooksonline.com/2011/data/papers/icl/ICL_10.pdf

This one made me glad I waited, as the first two surgeons I talked to recommended the modified weaver-dunn (though one of them didn't know that was it's name...). Hopefully you can access it, my doctor printed it for me when I was doing pre-decision research on surgery.
Semitendinosus tendon graft versus a modifie... [Am J Sports Med. 2009] - PubMed - NCBI

Another one that sold me on the newer technique.
http://depts.washington.edu/shoulde...vicular-Reconstruction-Surgical-Technique.pdf

If you can access it, this is a good article as well. My doctor also printed this one.
Sign In


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## Ricisan (Aug 30, 2006)

Ive had 5 shoulder injuries over the years. The last was an OTH and I landed on my arm. I asked for an MRI, twice! I was turned down twice.
When I couldn't raise my arm over my head any more, that did it!
I got my own MRI, then they couldn't pretend that I did not need the surgery.
If I learmed one thing through all this: BE YOUR OWN ADVOCATE!
Be informed and know your options.

My Superior rotator cuff was retracted beyond the glenoid.

If a year of rest and rehab has not made real change, get an MRI.

R


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## shredjunkie (May 16, 2012)

Looks like I've joined AC separation club. Dodging around the outside of a waterbar, I cutback too quick catching my tire on the edge of the log, locking up the front wheel, and was sent flying over the bars and straight into the base of tree. The crash was intense: helmet and shoulder took the impact, stars and little birdies encircled my head, sunglasses blasted from my head landing six feet away. My Tallboy LTc sat in a crumpled heap 10 feet behind me, undamaged save the slightly misaligned bars.

The least of my worries is the tree bark temporarily imprinted into my shoulder in the strangest bruising pattern I've seen. Although my shoulders look to still be level, I've got sore bumps both on the shoulder in the typical AC injury location as well as on my collar bone just off center in the front far away from the impact location. Sore muscles and slight swelling extend across my my entire upper back. Two days in and I feel like I was run over by a truck.

Has anyone else experienced such a wide range of impacted area without the usual evidence of actual separation besides a small bump on my shoulder? Seems the entire right side of my upper body was compressed by the impact resulting in strain on the entire shoulder/neck/back structure rather than just the AC. My sports doc is open again for business tomorrow, so hope to find out more then. In the mean time its ice, advil, and rest for me. At nearly 44, I might be getting a bit old for this.

Below my new tree bark temporary tatoo. If you know your trees, you'll recognize it as an oak.


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## Ricisan (Aug 30, 2006)

If you have any doubts, get an MRI.
Mine was $550, Kaiser refused to reimburse me. lmfao
I had no visible damage, other than a dent where
my rc was torn.
If they find enough damage, it becomes a
Medical Necessity and they have to do the surgery!

R


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## shredjunkie (May 16, 2012)

shredjunkie said:


> Looks like I've joined AC separation club. Dodging around the outside of a waterbar


Just a quick update. I was very fortunate. X-rays showed no AC ligament damage or bone fractures. The pain on the front of my chest was simply from the strain put on the clavicle, and looking at the model of the shoulder in the docs office it was clear how the force would travel from the AC joint down the clavicle and strain that connection.

To those less fortunate in their injuries, I feel for you. Best wishes a
and a rapid recovery to all.


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## WillTheGreat (Aug 26, 2010)

Well yesterday I endo'd pretty hard, the front wheel was completely pinned so it happened very fast. I was going about 15 mph at the time, and didn't even realise I crashed until I was on my back. Apparently I landed squarely on my right shoulder (glad I'm a lefty).

Anyway after I rode home and very painfully removed my shirt(s!), I noticed my shoulder was hanging low, and my collarbone was sticking out, so obviously my shoulder was separated. Since it was Saturday, I went to the Urgent Care. They x-rayed me and referred me to an orthopedic surgeon. The doctor thought it was a grade 4 separation and would definitely require surgery, but obviously I will need the ortho's diagnosis and recommendation. I will schedule an appointment with an ortho ASAP on Monday morning.

I am 31 and want to regain as much of my shoulder function if possible. Really bummed about missing spring/summer activities. Also, my mtb race schedule is totally thrown out. I just hope I'll be able to race Iceman on Nov 2. Also was hoping to do the Lumberjack 100 again, but that is now totally out of question.

I have attached the x-rays I got at urgent care. They are not terribly clear, but if anyone has any comments on them please provide. Thanks to everyone else for providing their experiences, I'll be reading through them. I'll update my progress for the benefit of others who experience this common injury.


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## dwnhlldav (Feb 2, 2006)

WillTheGreat said:


> Well yesterday I endo'd pretty hard, the front wheel was completely pinned so it happened very fast. I was going about 15 mph at the time, and didn't even realise I crashed until I was on my back. Apparently I landed squarely on my right shoulder (glad I'm a lefty).
> 
> Anyway after I rode home and very painfully removed my shirt(s!), I noticed my shoulder was hanging low, and my collarbone was sticking out, so obviously my shoulder was separated. Since it was Saturday, I went to the Urgent Care. They x-rayed me and referred me to an orthopedic surgeon. The doctor thought it was a grade 4 separation and would definitely require surgery, but obviously I will need the ortho's diagnosis and recommendation. I will schedule an appointment with an ortho ASAP on Monday morning.
> 
> ...


Sorry to read about your injury. If the Orthopedic Surgeon suggests a Weaver-Dunn or any version of the procedure, walk out and find a different doctor who is more up to date on the current fixes for AC separation. Refer back to my most recent post (prior to this one). What you want is a Anatomic Coracoclavicular Reconstruction using Semitendinosus tendon using either an allograft or autograft. The modified Weaver-Dunn is a success if it produces a joint that is 30% as strong as the original joint. The newer procedure, using a hamstring tendon to rebuilt the Coracoclavicular Ligament has been shown to reliably produce a joint with 85% to 95% of the strength of the original joint.

I've had a lot of injuries. I hate to say it, but recovering from this surgery has been one of my longest recoveries to date. I had surgery on October 25th of 2012 and it's just in the last month that I feel I'm better than before surgery. So, 3.5 to 4 months. It is very important to be conservative for as long as the doctor recommends. There has also been a shift to a longer, conservative period. Previous thinking was that the rebuilt joint would be mostly healed in the 10-12 week post surgery period. More recent studies as pushing that out to the 14-16 week time frame. As the newer surgery uses a tendon to replace a ligament, it actually undergoes changes on the molecular level. Even though you will be feeling much better, the new ligament will be weakest in the 12-14 week period. It is a well understood phenomena as this is the same tendon used to rebuild injured ACLs.

It's been a tough recovery, but I'm confident enough to say I'm glad I went under the knife. If you read my previous post, I lived with a grade 3 separation for 5 years, but a subsequent fall made it a grade 5 and there really wasn't much question that I needed surgery. Having gone through it, I would like to have had surgery much earlier, but if I'd done it after the initial grade 3, I would have had the less successful, older procedure, the Weaver-Dunn.

PM me if you have any questions, or ask them here.


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## Old Ray (Sep 5, 2010)

As I've mentioned here before, if a full-thickness tear of a connective tissue component is not the case, few surgeons these days would recommend surgery prior to a period where non=invasive therapy is tried. You'll find out soon enough what category your shoulder is in. Until then don't do anything to aggravate it. A sling might be in order, but you will find out son enough. 
I agree with downhlldav.........shoulder surgery is a serious thing to rehab from. You have age on your side, so you gopt that going for you. Best of luck with whatever you decide to go with. 

And I'd add that you should not be shy about seeking a 2nd, or even 3rd completely independent opinion, from another Ortho Doc, or from a Physical Medicine Doc, as well. So many cases. in our rather "unique" for-profit health care system, are driven by financial incentive and/or what that patient's health care coverage will pay out for, and not necessarily by what evidence-based case studies might indicate.

Keep a positive attitude, and an open mind.


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## dwnhlldav (Feb 2, 2006)

Good points from Ray. The doctor who did my surgery was the third surgeon I had seen, fourth doctor if I count the ER doctor I saw right after the injury. He was recommended to me by my physical therapist when I started having issues a few years after the grade 3 separation. He convinced me to keep doing physical therapy instead of surgery the first time I saw him, and even the second time when I was in for a different injury so I trusted him when he said surgery was the best, only real solution when I injured myself further last summer. 

Surgery is generally indicated for grade 4 or above. The prevailing consensus is to pursue non-surgical treatment for acute grade 3. Only when grade 3 becomes chronic is surgery indicated by consensus. 

There was recently a study published (I'm still trying to track it down again) that looked at long term results of the modified Weaver-Dunn procedure performed shortly after initial injury versus non-surgical treatment. It concluded that for both types of treatment, in the long term, you are very likely to develop osteoarthritis that will eventually require at least arthroscopic debridement. This is one of the reasons for the controversy about surgery vs. non-surgery. I would very much like for this type of comparison to be made between the newer repair and non-surgery.

Unfortunately the long term results of the newer procedure that I had performed have not been compared to non-surgical treatment in this way (as far as I've been able to find at least), though it's been shown to produce results that far surpass the modified Weaver-Dunn in joint stability and strength. From this, I've inferred that it should at least take longer to develop osteoarthritis compared to the non-surgical treatment of a grade 3 separation. 

Surgery was not a decision I came to lightly. I'd been researching it since very shortly after I injured my self initially, over 5 years, and discussing it with a doctor I trusted for over 2 years. Prior to injuring it worse last year I was getting close to seeking out a surgical solution as I was beginning to have minor, though constant discomfort, was treating with ice at least once per day and resorting to pain killers more than 3 times a week. Sleep was also becoming difficult due to pain.

Good luck with whatever you decide.


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## G-reg (Jan 12, 2004)

Here's a dissenting opinion disguised as an update on my shoulder. In short 4 years ago I got 4 opinions from or those, all gave different opinions. My full story is in here somewhere, but I didn't have surgery. 

Things like wide grip pull ups hurt a bit and sleeping on that side will leave it sore when I wake up. I've fell on the shoulder hard enough I'm pretty sure that I'd have broken my clavicle or blown up any of the AC surgeries, had my AC joint still been healthy or "repaired." 

That impact hurt, but not too much more than when I sleep on that side. The real danger is if you hit hard enough or just right a healed cat 3 could become a 5.


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## Ricisan (Aug 30, 2006)

I fought surgery for years. While you can strengthen the other 17 muscles and tendons that cross the shoulder, you can not do much for a full thickness hole or tear.
I agree w/person: 30% surgon vs. 70% rehab!

No improvement over a year is a condition for surgery.

R


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## WillTheGreat (Aug 26, 2010)

I appreciate everybody's advice and shared experiences. I had follow-up x-rays performed yesterday, and they showed that the end of my collarbone is also broken off. The doctors said that I will definitely need surgery.

There is a chance that some of my ligaments are still in tact and attached to the broken-off piece of collarbone. It is possible that I may have less ligament damage than I originally thought. At this point, though, it is uncertain.

I live in a university town, and went to the university hospital. It is a top ranked medical school, and I have an appointment with the orthopaedic surgeon for the football, hockey, etc teams. He is also a professor. I have to assume that he will be able to provide good advice based on modern procedures. I think it is a plus that he is used to working with athletes as well. I will also seek alternate opinions, of course. I don't want to name the institution in this space, but it is obvious based on where I live.

It's been 3 days now since the injury, and my shoulder is feeling better. I was able to put on a button down shirt today for work, so that is progress!  I have been wearing a sling since the injury, applying ice, and taking Ibuprofen for pain/inflammation. I have been sleeping well, but only on my back of course. I sleep in my sling because sometime I jump or move suddenly in my sleep. I've been trying to maintain my normal schedule and life because I know that things will get much harder after the surgery.

Here are the newer better x-rays:


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## wschruba (Apr 13, 2012)

Grade 3 AC checking in here. Clean separation of the shoulder, with no breaks or fractures, and 2 days out, already hitting about 50% of my range of motion. The doc recommended a wait-and-see. Said about 4 weeks from the pictures.

All told, I'm pretty happy, considering I came down from 6 feet on top of it.


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## gman_beef (Oct 6, 2012)

Hi All

Here's an 8-month follow-up report to my grade 3 - operated with the double tightrope procedure acutely.

In my first post I was saying I wanted to be get back to surfing - mission accomplished. No worries. Super weak on the injured side to start off with, but that disappears within a week or so of hard paddling (I have to say that I spent a session or two in the local pool for about 8 weeks before I started surfing again). 

As for daily things - carrying around bags can be a bit annoying when the straps go right on top of the tightrope button that sits on top of the clavicle. My AC also clicks occasionally now - when reaching across the body or putting arm far up behind the back. But in comparison to what I hear from guys who haven't had the OP - there's no "crunching", just a bit of what they call "crepitis". Doc said I will/might have arthiritis in 10 - 15 years time. I don't think that's a problem as long as it's just the AC - they usually just do the clavicle resection OP.

There's still a little lump, but I think I'm the only one who notices it...According to the literature the tightropes give a little over time and the gap increases.

Here's some exercises that I found to be good (on advice from Physio):
* Y's, T's and I's
* Lateral raises with small weights and big reps

Cheers

Greg


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## Canuckistani (Jan 31, 2010)

Hey all, I've been reading these forums since I did my own grade three separation at the end of July '12 (almost 8 months ago) and found them helpful so I figured I'd add my two bits.

Separated my right (dominant) shoulder bailing on a way too steep BMX jump at a jump park. I had just finished a ride with a friend and was feeling good on my trail bike with clipless pedals. What was I thinking?

Anyway was diagnosed with a separation by emergency room doc. Made an appointment with my own doctor about 10 days later who confirmed a grade three. Told me to live with it and that I'd still make my planned trip to Moab two months after the injury.

My wife is a nurse and she told me that I should avoid the surgery if it wasn't required because of all the things that can go wrong when they cut you open and start messing around.

First while after the injury was brutal. Had to sleep on my back. I was in a sling for about 2.5 weeks. My shoulder fatigued from just having my shoulder out of the sling. 

Saw a physio who gave me some really basic exercises that I did with a two-pound sack of coins (tied into an old sock). Five pound weights were too much. One thing that helped was leaning forward and using a table for support and then gently letting my injured arm hang down and very gently swinging it like a pendulum in circles and back and forth, side to side. You can find pics/vids on the web I'm sure.

So I really took it easy the rest of the summer. I did physio daily but sat on my duff most of the time. Slowly the strength returned and the pain subsided.

By the time the Moab trip came around I was a bit nervous of getting out on the bike. I went for a few timid rides near my place and figured I was good enough. Gotta get back into it.

I went down with a handful of guys for the Outerbike show in the fall. I'm glad I went, I rode 8 days hard riding. It was the first real riding I'd done since the injury and actually I have to say that my saddle was more in agony than my shoulder. Although by the end of day eight, going from zero riding to eight days straight my shoulder felt like it was going to fall off. This went away with rest though.

I keep generally active and over the winter I did about a month of the P90X workout program. That helped with strength and I didn't have any shoulder discomfort at all during this time as the increased strength helped. I have since fallen off the 1.5 hrs a day six days a week wagon. 

I had to modify some of the exercises a little but overall I was fine. The only exercise that gave me problems was a side raise where I'd lie on my side, tuck my left arm/hand up on my right shoulder and lift myself up with my right (injured) arm/shoulder. My clavicle would move around in there and even make some "shloop, shloop" kinda sounds. hearing those made me a bit queasy and I stopped doing that exercise.

Fast forward and a couple of weeks ago I was doing a pushup -- I'm lucky pushups haven't been too much of a problem for me, same for sleeping on my side. I heard a tearing sound and my shoulder popped a little bit. It was really weird, I was tender and a little sore, but my shoulder (especially my clavicle) felt much more solidly attached.

I told my wife the good news and she told me to call it a "readjustment" instead of a tear followed by a pop.

Has anyone else experienced anything like that?

Overall shoulder is definitely getting more solid. I have some discomfort in my right trapezius, associated with weakness I think -- I really should get back on the workout program but it's nice out now and I want to ride.

Riding has been fine. I can ride anything I used to bunnying and pulling up on the bars is no problem.

I do have a lump on my right side. It's not so bad, I tell myself. And only one person has pointed it out to me so really nobody's looking at it but me (which I seem to do a lot).

I'm hopeful that the weakness/discomfort goes away. I think that going no surgery was better for me. Got me healed more quickly for sure. Good luck to anyone out there with this injury.


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## Andy17 (Sep 18, 2011)

Update time.. I went to the doctor monday and got good news.... I don't have to go back! 18 weeks post op and I was released from care. I can finailly get into the wood again although he said slow and easy for another 6 weeks and careful after that. He wants the allograph to fully strengthen and says 6 months it should be there. I feel great ROM is almost 100% in every test. Strenght is getting better every week. At this point I feel great and I'm really glad I had the surgery. 
As someone has stated here already everyone is different and every injury is too. There for take my posts as you will for what every its worth to you.

I'm ready to put the new Tallboy LTc in the woods for sure! I will tell you it won't be hard to take it easy as I really dont want to travel this road again!!!


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## nevadanelly (Mar 28, 2013)

New to the forum  and guess what AC SEP stage 4. due to my occupation surgery was a must. cant ride, cant golf, cant do anything. having Surgery April 8th and was wondering what i should exspect and if there are any MUST HAVES prior to the cutting. ie recliner, plenty of pain meds 

any help would be great. 

happy trails


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## ccrecon (Mar 29, 2013)

Separated shoulder at about 13 never x-rayed it, just toughed it out. 4 months ago hit some rocks on motorcycle, had x-rays, a good grade III sep. Oh by the way I'm 55 now. Just had Anatomic Coracoclavicular Reconstruction 11mar2013. Hoping for the best, being very careful to use sling.


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## Andy17 (Sep 18, 2011)

A recliner is great for the first few days. I only spent 3-4 nights in it then sofa and then the bed. Get an extra sling to take shower in the first 2 weeks I had to wear te sling 24/7! After that I could take off the shower and dress and thats was it!! 6 weeks is a really long time! Your should (orat least mine) will freeze up and grow to be very weak. Don't push it, if you read this thread completely there has been a couple of guys that have and had to go back under the knife for a re-repair. I'm not going there if at all possible! As far as pain meds I took them for about 3 days and stopped all together, I really hate the way they make me feel and the pain was not too bad. Don't get me wrong I was sore. I have had a good result with the surgery. My ROM was very slow and strength is still not 100% but I feel very close to normal now. Good luck guys its a long road but not too bad other wise. 

Andy


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## wschruba (Apr 13, 2012)

Almost at 4 weeks after injuring the shoulder, and I have, generously, 95% of my RoM back. My strength isn't where I would like it, but I started riding on the road last week, and it has helped in that area tremendously. I still have a little bit of a pulling sensation when I reach down to the left, but most of the pain subsided around the same time that I gashed my fingertip with a rotor! After the tetanus shot that I got just about two weeks ago, my other shoulder has been giving me the majority of my pain. It would appear, as they say, that I cannot win.


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## ccrecon (Mar 29, 2013)

Andy

Thanks for the reply, you may have said previously but did you have anatomic reconstruction with tendon grafts or another procedure.
Thanks again


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## nevadanelly (Mar 28, 2013)

Andy thanks for the heads up. i hate painkillers as well. how long did you go from injury to surgery? and what kind of surgery


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## Andy17 (Sep 18, 2011)

When I first went to the doctor he checked me out and told me to come back in 2 weeks so surgery was about 3 weeks after injury. I was injured on sept. 24 and had surgery on nov. 20. I did have teh anatomic repair with a allograph (donor tendon). Pain wasn't too bad really, I was sore and your not going to move it period. I froze up really bad in the shoulder after being in a sling for 6 weeks. The last 2 weeks are tough you are not sore from surgery and want to move it and get the show on the road so to speak. 
ccrecon your half way thru the sling and well on your way. You guys be careful and wear the sling! 
My new tendon hasn't streched at all, I have no bump and I am getting to where I can sleep on that shoulder again with my arm over my head it has taken a while for that.


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## ccrecon (Mar 29, 2013)

*Ac sep*

Andy

Thanks


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## chief muckymuck (Apr 2, 2013)

I fell a year ago - level 2/3 seperation. I couldnt lift my arm for a month and it was three before it was pain free & stronger. Broke a lot of things....but this was the worst. Went to PT and did the exercises on my own since then. Lots of light weights and reps 2x a week. It felt as good as new after 4-5 months - until I fell on the same shoulder last month!

No pain this time - worked OK vs. 1st time - but now its closer to a four...ripped evertying off - a big bump and very lose. I can move the collarbone about a half inch back and forth - shoulder too. Going to rehab myself it again. 

I wouldn't reccomend surgery to anyone - I think it hurts more / takes a lot longer.....(unless your a pitcher). Check with a sports ortho guy - get a few oppinions. Remember they only get paid when they do surgery.


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## nevadanelly (Mar 28, 2013)

seem to be a touchy subject Surgery vs Non surgery. after 4 consultations with 4 different surgeons, i feel that in my case surgery is a no-brainier. after reading this entire blog it seems to me that people with a grade 3 or higher that chose not to have surgery noticed a drop in there range of motion, and for some mild discomfort longer down the road. as a PGA golf professional i cant take that risk. Surgery bound and cant wait. 

i think you (chief muckymuck) should possible talk to a orthopedist to see if your injury could be recurring due to NOT having surgery. Either way this Forum is a really good testimonial for anyone having to weigh the options for surgical/non surgical treatment. im really happy its here for people. 

i hope your Shoulder Heals up soon. 

see yah on the trails
NV-Nelly


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## chief muckymuck (Apr 2, 2013)

Ok - no surgery unless your a pitcher... or a PGA golf professional. A little lose....not quite as strong for awhile. A little lose & sloppy is your problem...not relevant to 99.98% of the population.

Recurring because I flipped over the handlbars and flew 10 ft. and landed directly on my bad shoulder on a big jump / downhill....nothing to do with not having surgery. As a matter of fact it would have been worse if I hadn't built up all the muscles for the last year - thats why it wasn't as bad this time even though the injury was much worse.

Good luck you you -and given your profession it is a no brainer...but most of the other people i've read about on this site DONT need surgery...just time and the correct exercises. I'd suggest everyone else who doesnt need 100% accuracy try the no surgery option for at least a year. If it doesn't work you can always do it later.... I've had no loss of range of motion either time - Make it move and it does.(12 yrs. of Yoga...welcome to CA) Sloppy is different. Busted AC's are a bit sloppy...esp. 3+


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## dwnhlldav (Feb 2, 2006)

chief muckymuck said:


> Ok - no surgery unless your a pitcher... or a PGA golf professional. A little lose....not quite as strong for awhile. A little lose & sloppy is your problem...not relevant to 99.98% of the population.
> 
> Recurring because I flipped over the handlbars and flew 10 ft. and landed directly on my bad shoulder on a big jump / downhill....nothing to do with not having surgery. As a matter of fact it would have been worse if I hadn't built up all the muscles for the last year - thats why it wasn't as bad this time even though the injury was much worse.
> 
> Good luck you you -and given your profession it is a no brainer...but most of the other people i've read about on this site DONT need surgery...just time and the correct exercises. I'd suggest everyone else who doesnt need 100% accuracy try the no surgery option for at least a year. If it doesn't work you can always do it later.... I've had no loss of range of motion either time - Make it move and it does.(12 yrs. of Yoga...welcome to CA) Sloppy is different. Busted AC's are a bit sloppy...esp. 3+


There is little debate about grade 1/2, no surgery. Grade 4 and above indicate surgery. Again, almost all parties involved agree with that. The only time it's debated is for grade 3. Speaking in absolutes is not helpful. Every person is different, every injury affects people differently. For some people, surgery is the better option. Others live the rest of their lives without surgery or problems. I do agree that it's best to try rehab for a year before getting surgery on a grade 3.

I tried no surgery for 5 years. I went 6 months after making it a grade 5 before surgery. I wish I hadn't waited so long to get it done. I'm much better off than before surgery, better than before making my grade 3 into a grade 5. It's been so long, I don't remember what 100% (pre-injury) feels like, but I'd say I'm there.

Also, not all surgeons suggest surgery just to make money. Mine kept me from doing surgery for several years. It wasn't until I made things worse by falling again that he said surgery was the better option.

My other shoulder (not the one I had surgery on) has a grade 2 separation. It's been 6 years since that injury. The only time I notice it is doing push ups. I wouldn't even consider surgery for that.


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## dwnhlldav (Feb 2, 2006)

Andy made some great points. I bought a second, cheap sling for wearing in the shower. Sling was on 24/7. If I was sitting in a recliner with my elbow supported to keep weight off my shoulder, I was allowed to take my arm out of the sling and move at the elbow. My shoulder didn't freeze up completely, but it did take a a few months after getting out of the sling to get my ROM back to normal. I swim in addition to riding. I'm now back in the pool, and I notice that my repaired shoulder is still much tighter than my injury free shoulder. Swimming takes a lot of shoulder flexibility so even thought the doctor and pt say my ROM is back to 100% against their standards, I don't think I'm back to my 100%, but it's coming.

I took pain meds for 3-4 days then stopped. I started taking them again a few days later, but only at night so I could sleep.

It's been almost 6 months since surgery. I still can't lay on my repaired side for more than 20 minutes before it gets irritated, but I couldn't lay on it at all before surgery.


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## wschruba (Apr 13, 2012)

I picked up an EVS SB03 (shoulder brace) today. I'll have a review in a week, after using it for a while, but my first impressions are quite nice. After about 20 minutes of getting used to how it feels (and apart from it being made of neoprene, ie: breathable as a rubber suit) it has my shoulder bump fairly smoothed out, but still obvious.

More to come as it gets used more.


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## TranceX (Dec 24, 2011)

One year out from my over the bars on a table jump that led to my grade 3 separation. No surgery and 53 years old (this month). Mountain biking has been fine....I can ride all day no problem.....took me a long time to work up the courage to ride where I hurt myself (Graham Swamp) but I've ridden it half a dozen times since the crash. 

Standup Paddling (SUP) also no problem. Prone paddling on a surfboard was weak last year and I hope to see improvement this year. ROM with the shoulder is good and I'm doing pushups everyday. I will admit that I can still feel it....low grade ache comes and goes. It is barely noticeable and seems to ache less when I continue to do my home PT exercises.


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## nevadanelly (Mar 28, 2013)

just got home from the hospital. surgery went really well, but damn this pain is incredible. had a hard time breathing after anesthesia, so they kept me overnight. anyone have the same prob breathing after surgery?


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## ibrahim (Apr 10, 2013)

what's the current update on your recovery? Thanks!


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## nevadanelly (Mar 28, 2013)

having a really hard time sleeping pain is there but not as bad as it was yesterday. i absolutely hate these drugs they make your mouth sooo dry, your skin itch, and you pee every ten min. any thoughts on sleeping???


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## ccrecon (Mar 29, 2013)

nevadanelly said:


> having a really hard time sleeping pain is there but not as bad as it was yesterday. i absolutely hate these drugs they make your mouth sooo dry, your skin itch, and you pee every ten min. any thoughts on sleeping???


Hey, I'm 5 1/2 weeks from my surgery, if you have a recliner thats the best.


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## nevadanelly (Mar 28, 2013)

how are you doing in general 5 weeks out. pain all gone? sleeping in a bed yet? showering comfortably?


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## Andy17 (Sep 18, 2011)

I got off pain meds on the third day I just couldn't stand the way they made me feel. Sleep in a recliner for a couple days then move to sofa for a couple an finally to the bed. It really took time to get good sleep though. I am about 5 months out and can sleep on the repaired side now but still not all night. I have always gone from side to side at night anyway. 
Good luck be really careful and do what the doctor says. I am very happy with my repair! I have been back in the woods a couple of times now but dialed way back and trying to get back in shape. There is no pain or discomfort at all. 
I hope you guys do great.


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## ccrecon (Mar 29, 2013)

nevadanelly said:


> how are you doing in general 5 weeks out. pain all gone? sleeping in a bed yet? showering comfortably?


pain is gone, was using oxycodone worked well but the sooner you can get of that **** the better, made me depressed. I have a recliner and stayed there for about 3+ weeks, some folks went straight to the bed after 3 days. After 2 weeks doc said I could shower, thank god.


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## Andy17 (Sep 18, 2011)

I showered after the 3rd day. Get some press and seal kitchen wrap and put over the shoulder good and it will be water tight. I did use a hand shower and didn't spray right on the wrap. I was surprised at how good it worked. My bandages were dry every time.


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## nevadanelly (Mar 28, 2013)

Thanks for all the good advise Andy and ccrecon. Can't wait to ride and play golf again, at least my shoulder is now in the correct position and iv started the healing process. Thanks again nelly

Ps I haven't **** in 3 days  so lame lol


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## ccrecon (Mar 29, 2013)

nevadanelly said:


> Thanks for all the good advise Andy and ccrecon. Can't wait to ride and play golf again, at least my shoulder is now in the correct position and iv started the healing process. Thanks again nelly
> 
> Ps I haven't **** in 3 days  so lame lol


the side effect of drugs, I was four days I think, did some fiber and slammed lots of water. And made a concerted effort tring to be careful of sutures


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## nevadanelly (Mar 28, 2013)

1 week post surgery no pain meds in 4 days. my shoulder feel really good, its amazing how much better it feels now that it is in the correct location. i think after some good PT i will be well on my way to recovery. sleeping is tough but every night is better than the last. 

thanks to all the peps who answered some many question i had!!

see yah on the trails soon
NVnelly


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## Andy17 (Sep 18, 2011)

It will be about 4 months before you hit the trail again.. sorry.. Yes it is better right off the bat after surgery! It really feels good about 8 weeks out you will feel normal but have no strength in it. About 14 weeks flexiablity will be coming back good and strenght. You will feel better weeky after the sling comes off. I am 22 weeks and have no regrets. 

Glad your doing well! For 5 more weeks don't even think of moving it and leave it in the sling 24/7!!!! Good luck!


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## nevadanelly (Mar 28, 2013)

did you wear your sling when you slept? how often did you do PT and when does that typically start? 

thanks


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## dwnhlldav (Feb 2, 2006)

I wore my sling night and day for six weeks. Sleep was tough for me, I'm a stomach or side sleeper. I didn't sleep well so ended up sleeping in 2-3 hour blocks through out the night and day for a couple weeks. I went of the Oxycodone after 3 or 4 days, but went back on after a few more days only taking it at night. It was the only way I got a semi decent sleep.

We have an "L" shaped couch. I stuffed an aero bed in the L. I slept right against the side of the couch and built a wall of pillows on my other side. This mostly kept me from rolling in my sleep. After I was able to lay on my non-surgery side, I would prop my surgery arm up on the couch. I tried sleeping in bed with my wife probably once a week, but to be honest, it was 6 months before I was as comfortable in bed as I was on the aerobed with my arm propped up on the couch. I wasn't in pain the last few months, just not comfortable and it impacted the quality of my sleep.

I didn't start PT until I was out of the sling, so six weeks after surgery. I went 3 times a week for a month, then twice a week for a month, then once a week for 2 months.

I was released from PT 5 months after surgery with a plan for home workouts to be done 2-3x a week indefinitely. I saw my Doctor last week. I'm a little over 6 months out and he released me for good. Though, I'll be back to him at some point. I chipped my elbow at some point in the last few years and have developed a bone spur that is getting more and more irritating.


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## Andy17 (Sep 18, 2011)

24/7 yes at night too. I got to take it off to shower after 2-3 weeks and that was it! I slept ok but not great after a week in the bed on my good side only! I still sleep mostly on the good side but roll to the repaired side a few times a night with no problems. I only had pt for 12 weeks 2 times a week but also will keep it up at home indefiniely. 
Glad your doing good Dave, have you been riding much yet?


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## NJTransplant (Mar 30, 2012)

Not sure on grade yet getting an mri later this week. Really bad swelling and bruising. Took a header over the bars dropping a little for footer onto a solid slab of rock... Thought I cracked my helmet to luckily no concussion. Dr thinks something else is going on because of all the selling and bruising. 



Sent from my SCH-I605 using Tapatalk 2


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## aedubber (Apr 17, 2011)

Sleep? What sleep ? LOL man that **** was terrible .. I would stay off the meds man , i only used them for 1 day but try and bare the pain . Those meds really mess you up . I would just pop some ibuprofen . I was like a zombie the first couple weeks , sleeping in spurts of like 2-3 hours . What helped me was using a pillow to kind of not let me roll over onto my right arm .


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## Ricisan (Aug 30, 2006)

Spending time in a recline w/arm tucked in properly is important. keeping the sling tight is also very important. Leting the joint knit w/o gravity pulling things apart is a constant struggle. Thrashing around while sleeping is counter-productive at best!

JMHO

R


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## NJTransplant (Mar 30, 2012)

Get my MRI results Monday...Kinda nervous since the bruising is getting worse (it's a nasty black/blue/read color). So far everyone I've talked to expects me to need surgery which is the last thing I want. I should heal quickly as I"m 26 but I would be missing some sweet biking trips in the process.

Fingers crossed


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## NJTransplant (Mar 30, 2012)

MRI results yesterday. High 3rd degree separation with 2/3 ligaments being damaged. No surgery needed, out of the sling, and i'm supposed to use it as much as I can (obviously within reason) so it regains full ROM and doesn't freeze up. Still hurts by my ROM is almost back to normal after 2 weeks but it is incredibly weak still. Did a short flat ride last night and it felt great (both the shoulder and to be back on the bike).

So far good news


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## nevadanelly (Mar 28, 2013)

4 weeks post op shoulder feels so brand new. dr. says sling comes off on the 17th cant wait for that. zero pain, sleeping still kinda a pain in the ass just cas I cant sleep on that shoulder. I should be riding and playing competitive golf by mid to late June. after seeing the xray post surgery, its amazing what these Surgeon's can do.


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## Andy17 (Sep 18, 2011)

It is truly amazing what they can do. I am very happy with my choice. It's a long road when your in a sling or doing PT to get the ROM back. I'm almost 6 months out now and still working on my strength which is coming along good. 
Now if the rain would just slow down some it would be nice to get some riding in.


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## Tartaris (May 10, 2013)

Hey guys

I'm not a rider but I've recently done my (R) AC joint on the 27th of April. X-ray the day after showed about a 1cm increase in gap compared to the normal shoulder (L). I had the arm in a sling for the day and a half. Pain was excruciating for the first 3-5 days. From there I worked on ROM with a little movement. Each day it gets better and my ROM is back to around 90-95% although there is still some pain, but I push through it. I don't get to see a sports doc until the 20th to determine degree of damage. I thought initially that I had a grade III sep, but I've hit the gym a couple of days ago (12 days post injury) and my strength is around 50-75% that pre-injury, ie benched 150lb (so long as I kept my shoulder blades squeezed nice and tight. Upright closed row around 130lb and 55lb bicep curls. Pain is a 2-3/10 while doing these exercises. Now I have a couple of questions:

1. Should I even be doing this at this stage of the injury? Am I only slowing the healing process?

2. I'm now thinking that with this kinda strength it might not be as bad as a grade III. Maybe only a grade II? There is a little movement in the AC end of the clavicle but not very much. I do have a 1-2cm bump on my right shoulder though, which is quite sore when I poke it at the front and back of the clavical's tip.

Thanks for your time guys, and hope a speedy recovery to you all. It's a b***h of an injury!!


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## giantfox (Aug 13, 2012)

hi guys. it is a while since i posted but here is the update.

10 months since the grade 3 no surgery.

it probably took a full 8 months, but I have absolutely full use of my arm and shoulder and i can do everything i used to do ( well at least everything i was still doing up until the time of the accident)

the bump is still a talking point and an ice breaker with sympathetic chicks.....

I am not disappointed that i went without the surgery.

no complaints now, 99.5% normality. Just keep using it and moving it.

Hope this is useful for any new readers.


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## Tartaris (May 10, 2013)

Went and saw the sports doc on the 20th. Says he's very happy with the ROM and progress I had made in 3 weeks. Did also say that he thinks that it would be no more than a grade 1/2. Most weights are nearly back to 100% although bench is still a little behind, and dips are still rather difficult as they do cause a bit of pain. I can do pull ups with little pain also. All in all, I think I dodged a bullet and several months of rehab!


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## nevadanelly (Mar 28, 2013)

Post surgery update. Had surgery April 15 grade 4/5 sep, zero pain or uncomfort. Been riding as much as possible but can't play competitive golf till my strength gets back. Which is a tedious processes. Hope all the fellow shredders are doin well. Tahoe is off the chains right now heavenly ski resort is almost done building there downhill and XC trails got a taste test this weekend and let me tell you well worth the trip

Happy trail Nevada nelly


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## J-ay (Nov 22, 2011)

I enjoy visiting this thread once in a while to keep me in the loop on any new developments. 

As an update on my OTB injury from Nov 2011. It was a grade 3 sep but, thankfully, the pain wasn't bad, maybe a 2.5 out of 10. Went to see 3 orthos, 2 of them recommended no surgery and just do rehab/PT while the 3rd advised to have surgery.

I decided to go the non-invasive route seeing that I wasn't in much pain; I had a good range of motion after a few weeks; 2 out of 3 drs recommended it; and, I can live with having that strange bump on my shoulder (I was in the beach last weekend and I still get stares and a guffaw by a friend). 

I was actually able to join my team mates in Feb 2012 (after 3 months) for a 10KM open water swim, with wet suit, as there were many jellyfish, and fins. It was tough due to the strong currents at the end but my shoulder held up pretty well. Needless to say, I felt like a million bucks after.

As of today, my shoulder doesn't feel like its 100% but my ROM is pretty good (around 98%, I think) and I can do most anything with that arm/shoulder. It's not as strong as before as I've been lazy to strengthen it but I can do push ups on a TRX or Swiss Ball. Good thing I'm not big on bball as I don't think I'll play it again as I might risk having someone pull the ball from the back during a rebound and pop my shoulder. It's just my feeling, I don't know if that's possible. 

In any case, good luck to us, who have the injury. May we recover as well as we can, surgery or otherwise.

Long live the bump!

J


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## Andy17 (Sep 18, 2011)

nevadanelly said:


> Post surgery update. Had surgery April 15 grade 4/5 sep, zero pain or uncomfort. Been riding as much as possible but can't play competitive golf till my strength gets back. Which is a tedious processes. Hope all the fellow shredders are doin well. Tahoe is off the chains right now heavenly ski resort is almost done building there downhill and XC trails got a taste test this weekend and let me tell you well worth the trip
> 
> Happy trail Nevada nelly


You have been riding and had surgery on April 15 2013?
I couldn't get on a bike for over 3 months!!!


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## xcguy (Apr 18, 2004)

Andy17 said:


> You have been riding and had surgery on April 15 2013?
> I couldn't get on a bike for over 3 months!!!


His injury was not yours or anybody else's here. "Zero pain or discomfort" doesn't sound like much of a injury or serious surgery. When I broke my wrist I had multiple riders tell me they had a soft cast on for two weeks and then were "good to go". I was in a hard cast for six weeks and it took me a year and a half to get my hand back. Mucho pain and mucho discomfort.


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## NJTransplant (Mar 30, 2012)

I'm about six weeks out from a grade 3 separation that still hurts everday. I ride a few times and week and just deal with the intense pain after. My dr. Told me to "use" it as much as possible so that's what i'm doing. As long as I don't take a big hit to it IE go OTB again and slam it on a rock I should be alright. I just can't stay off my bike for too long.

With that said I wish i could give it a rest for a few weeks but I really can't see myself doing that. My pain when it first happened was at least an 8/10 now it's more of a dull 2-3/10 consistently all the time with spikes after riding or trying to push myself up with that arm.


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## PublicEnemy (Mar 10, 2011)

My ortho doc keep telling me to wait to opt in for surgery. He states it can be done 1 month, 3 months, 6 months or a year down the road. He wants me to wait and see how it recovers on its own. 3 weeks since fall.....type 3.....MASSIVE bump on shoulder.

Is this information correct or shoulder surgery be performed ASAP? My concern with waiting is I feel as if I will be rehabbing it twice.


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## Andy17 (Sep 18, 2011)

It can be done at any time yes. The damage is done its over not going back. If you do the surgery you will get a new ligament all together they do away with the damaged ones. As far as rehab I really didn't want to go thru with two rehabs myself. I k ow a lot of the guys here have good results without surgery but end up with never ending rehab to maintain enough strength to stabilize the shoulder. The surgery has a very long rehab I am 6 months post op now and not regretting a thing. Still working on strength but I'm very happy with the results. On a down side I have a ligament now and can break it again if I were to fall on it just right again. Which does happen as we are all to aware. 
Good luck with your shoulder!


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## Tonggi (May 4, 2013)

Glad to hear this is a normal injury. First day out ever, i take a turn wrong, fly 10 feet into some rocks, luckily i was wearing a roost guard, full face helmet, etc. The pain was incredible. COuldn't lift anything or move my arm at all. It was so painful getting in and out of bed. COughing, sneezing, putting on a shirt!

It has been 2 weeks and 1 day. Had Xrays and the Knicks basketball team doctor (Aunt works at HSS in NYC) and pretty much told me what everyone is saying here.

Rehab, no surgery for stage 3, not on dominant arm, IT consultant by trade. Ha im a bit on the bulky side and I'm glad to say its not super noticeable.

I'm just scared of falling on it again, people say it won't split again but the thought of it and the pain I was in makes me cringe!

On the road to recovery adn back onit soon I hpe!


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## bloodpuddle (Jun 15, 2007)

Hi all

I'm coming up for 2 years out from a Grade 3 on my right shoulder.

Didn't have surgery, but was very diligent with my rehab and got swimming as early as I could.

I've posted a few times in this thread (most recently here: http://forums.mtbr.com/rider-down-i...houlder-separation-300318-19.html#post9669000), but one of my biggest early concerns was whether I'd ever get back to endurance open water swimming with the injury.

Well, the good news is that I just did my longest ever race in open water (12km), swimming out in exposed ocean from Sydney's Bondi Beach to Watsons Bay.

Not only that, but I swam it faster than I ever would have hoped I could and without too much difficulty.

Long story short:

1 - no surgery was a good choice for me (at least at this stage of my life); and

2 - more importantly, no matter how down you are now about having done this injury, you can get back your full strength & motion. So keep your chin up!

Cheers all.


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## PublicEnemy (Mar 10, 2011)

bloodpuddle said:


> Long story short:
> 
> 1 - no surgery was a good choice for me (at least at this stage of my life); and
> 
> ...


That's awesome to hear since I am 3 weeks into my type 3 separation myself. Deciding to rehab like crazy and keep my fingers crossed. As an ex professional baseball player shoulder maintenance work comes naturally. How long was it until you were able to aggressively ride again w/o pain? Right now (only three weeks out) the thought of pulling up the handle bars brings tears to my eyes. For a type 3 I feel like I'm making good progress, however I keep worrying the pain will always be there to some extent.


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## Tonggi (May 4, 2013)

PublicEnemy said:


> That's awesome to hear since I am 3 weeks into my type 3 separation myself. Deciding to rehab like crazy and keep my fingers crossed. As an ex professional baseball player shoulder maintenance work comes naturally. How long was it until you were able to aggressively ride again w/o pain? * Right now (only three weeks out) the thought of pulling up the handle bars brings tears to my eyes. *For a type 3 I feel like I'm making good progress, however I keep worrying the pain will always be there to some extent.


That thought scares me as well. I'm 2.5 weeks in and I have to start PT/rehab, waiting for an appointment. Been looking online for ROM workouts etc but I think I'd rather wait instead of hurt myself more.


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## bloodpuddle (Jun 15, 2007)

PublicEnemy said:


> How long was it until you were able to aggressively ride again w/o pain? Right now (only three weeks out) the thought of pulling up the handle bars brings tears to my eyes. For a type 3 I feel like I'm making good progress, however I keep worrying the pain will always be there to some extent.


The thing that took longest was getting my confidence back, not waiting for the pain to go away.

My timeline went something like this:

At the time I did the injury, I was already entered in an endurance MTB race being held about 2 months later. So it was a goal for me in my recovery to be able to do that race.

I was back on the bike on the road after about 5 weeks - the ortho Dr gave me clearance pretty early "as long as you don't fall off!". I didn't have any pain when on the bike, but my shoulder was clearly still recovering.

I think my first dirt ride was at about 7 weeks and then I did the race at 2 months. It was a completely XC race, with very little technical riding, but I was still pretty cautious.

I got back to more technical riding after about 3 months. Didn't have any pain doing it. Fell on my bad shoulder a couple of times too, which didn't do any further damage.

But it wasn't til about 6 months out that I had all my confidence back. Again, this was purely psychological, and nothing to do with pain in the shoulder.

If you can get your head back together quicker than I did, you'll get back to aggressive riding pretty soon.

For my own part, at the time of the injury I was 38 (now I'm 40). It was the first time in my life that I've ever hurt myself badly. In that respect it was a bit of a wake-up call for me that I'm not actually indestructible. So my riding has backed off a bit - again though, this has been a conscious decision on my part rather than being unable to do it. If I was 25, I'd probably now be well back to developing my freeriding skills!


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## gman_beef (Oct 6, 2012)

Andy17 said:


> It can be done at any time yes.


It depends on what surgery is performed. I had the double tightrope surgery, in the acute phase (within 4 weeks post-op) - this surgery is aimed at getting in there before the ligaments are beyond the point of no return - the surgery brings the shoulder back into its natural position and the original ligaments are expected to heal back together. This can only be performed within a certain period of time after the original injury (that's what acute means).

They also do a double tightrope surgery using cadaver or own body ligaments. This can be done at any time.

Cheers

Greg


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## dwight0 (May 15, 2012)

*Summary for Shoulder Separation corrected with LockDown / Surgilig Procedure*

Had a grade 3. Rehab, waited 7 month until surgery. Still had a lot of pain. Bad arthritis in joint. Had LockDown / Surgilig procedure and in short, I am so glad i had this procedure, it put my life back together. It has been 9 months since the procedure.

Before surgery i would say i was 60% back to normal. Now i would say I am 95% back. I lost a few millimeters of the correction, but i am still happy.

If someone punches me in the screw, or I wear a book bag for a long time, sometimes there is minor irritation near the screw. The trapezius/deltoid muscle that was cut, grew back different, it is skinnier and stick out more, however it functions exactly the same as before.

I play catch, go bowling, frisbee, go mountain biking, everything, just as i did before, full range of motion, lost maybe 5% strength. Actually there is one thing I dont do anymore, the ligament feels strange if i bench more than 180 lbs, i was benching 250 before, I know i can bench more again, but I just dont like the feeling, feels like it puts strain on it, it doesnt hurt. I just want this thing to last the rest of my life. I do 40 push-ups every morning instead, more than I was doing before the injury.

Here is a brief summary of how things went after the surgery.

weeks 1-2, mostly sleeping, absolutely no pain because of nerve block. only needed pain killers for first 3 days. lots of cramping in the arm and had to be out of the sling a lot. Weird electricity sensations and nerve problems. I got very depressed. I never get depressed.

End of week 4 - Out of sling. Bored, cant really do anything, hunched over, depressed. Cant really shower very well. Cant think clearly, even without pain killers. Doc said to wear the sling for 4 weeks. Lots of cramping, hard to sleep. Can lift arm slightly higher than level. Can only open light doors. 50% ROM. Icing several times a day. Hard to shake hands. Hard to open most doors.

End of week 8- Not bad at all. 95% ROM, only when taking advil. Can open most doors except heavy. Hand shaking is fine. Can do dishes, most chores. I wont carry a full laundry basket yet. Depression is gone.

End of week 12 - Running on Treadmill. Some stiffness. Sleep on shoulder. Zero Pain. 15Lb exercises. Pushups on steps. Can do all house chores both hands.

End of week 16 - about 20 lbs exercises. played a light game of frisbee, no problem. arm got tired easy.

End of week 20 - about 30 pushups, no steps. Shoulder look the same. No swelling. No more advil.

End of week 28 - about 45 pushups. Headstands, bowling, frisbee, baseball, tennis, swimming, cartwheels. everything. Even though the joint capsule is cut, I can have a 120 lb girl sit on my shoulder at a concert with no issues. life is good.

Hope this helps someone.

Any questions, [email protected]


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## PublicEnemy (Mar 10, 2011)

dwight0 said:


> Had a grade 3. Rehab, waited 7 month until surgery. Still had a lot of pain. Bad arthritis in joint. Had LockDown / Surgilig procedure and in short, I am so glad i had this procedure, it put my life back together. It has been 9 months since the procedure.
> 
> Before surgery i would say i was 60% back to normal. Now i would say I am 95% back. I lost a few millimeters of the correction, but i am still happy.
> 
> ...


Thanks a bunch for sharing your experience. Sounds to me like something else must have been wrong. 7 months and no more than 60% recovery? Was your rotator cuff torn? Shoulder get dislocated at the same time?

The reason I ask is because I'm coming back from a type 3 (5 weeks ago today). Probably at 60% right now. I'm doing light work in the gym. Chores around the house are no problem. Carrying heavy grocery bags as well. Still can't use the arm to lift my bike on top of my car though or lift anything heavy overhead. Have avoided riding since I'm holding off until after my wedding in another month. It will give it more time to heal so that's ok. I think everyone has a different experience and recovery rate with this injury. I hope I don't get to 70% in another couple weeks and just stop improving! I'm seeing improvements every day though and for only 5 weeks since my injury, I think at week 10 I will be 80% hopefully.

Your shoulder looks great. Sounds to me like you had no choice since after 7 months you hit a flat spot. Are you worried about falling on it again and ruining your surgery?


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## dwight0 (May 15, 2012)

PublicEnemy,

I think for my particular body type, my muscles weren't working right and kept cramping, they needed to be in their original position hanging off the clavicle to work correctly. I also had the bones rubbing together and pinching he flesh and the pain was excruciating. Your separation looks large enough that the bones dont rub together. 

5 weeks is early to tell, i think at about 8 weeks you will be able to predict what is to come and if you want surgery or not. Congratulations on getting married. It is good to have someone to help you. You should continue to improve until at least month 6. 

I am not worried about falling on it to ruin the surgery, however the artificial ligament is so strong that i am worried if i fall on it again, it will rip out the coracoid process or something else while the artificial ligament itself receives no damage. 

I also think i had an optimal outcome for two reasons. The first being because my clavicle only wobbled up and down, I think this surgery only fixes that, and does not fix the side to side movements as well. Also, when the doctor performs the surgery, he has to pull it down further than it originally was, and he has to guess how high it will rise back up after a couple months. My doctor guessed pretty accurately, but i think this is not always the case.

I wish the best of luck to you. Hope you get that range of motion back.


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## giantfox (Aug 13, 2012)

just back in from a great evening paddle. (SUP) Absolutely no issues at all.

should be back in france on the 1st august to face my nemesis (steep switchback) one year to the day.

Might take it a bit carefully, but i'm definitely not going to walk it.


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## Scottwax (Jan 18, 2009)

No surgery on mine, happened in June 2011. Pain was pretty intense, met with an orthopedic specialist. He checked my range of motion (it was 8 days after the injury), took a couple x-rays and then told me to take my arm out of the sling and use it as much as the pain would allow. He said he'd love to do the surgery but in my case, insurance would consider it an aggressive form of treatment and that I would recover just fine without surgery. Plus without surgery, I'd be back to normal more quickly. 

I was able to start working again after two weeks (I have a mobile detailing business), back on the bike in 5 weeks, two years later my shoulder seems really solid. Honestly, without looking closely enough to be kind of creepy, you'd have a hard time even finding a lump in my right shoulder. Range of motion is the same as my left shoulder, strength is the same. No problems throwing a baseball, football or swinging a bat. Done some lifting as well (but nothing regular), no pain with that either.


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## JRegs1 (Jul 9, 2013)

*Broken Clavicle To Separated Shoulder*

Here is an interesting one I haven't read yet. I took a very steep hill and broke my right collar bone (distil-about .5" before the very end of my clavicle). Got surgery 6/13/13 plate with anchor screw into my coracoid to keep the plate down. Turns out the anchor screw broke putting a shirt on, and now I have either stage 2 or 3 separation along with the broken collar bone. I'm seeing the Doctor who did the surgery in 1 week. I already have a 4" scar, and the Doctor was going to do a second procedure anyway to remove the long screw before it broke. Can they remove all of the hardware and repair the ligaments while they're in there? One doctor suggested leaving everything in and heal up, no more surgeries. Not sure I'm happy with a broken screw in there. It didn't even hurt when it happened it just popped. It's just tender again and I have a lump. Most likely because the ligaments ripped during the clavicle break. I need options & opinions. Please reply if you've seen this before. Thank you!


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## rak1793 (Aug 15, 2013)

I an so glad I found this post. I had a grade three seperation about a year ago from a cycling injury. my orthopedic surgeon recommended against surgery due to my age (54). I saw another doc in charlotte and he said that he would do it, and that insurance would cover it. he treated the professional athletes in the Charlotte region. my surgery was scheduled in a week, but I just cancelled it because I have almost no pain, almost complete range of motion, and can do military press (120lb) and chest press (180lb) about what I was doing before surgery. the only thing is this great big unsightly bump on my shoulder that I can willingly push up in the air and make me look like an oddity. so I figure that the only reason that I was doing was for aesthetics and vanity. It looks like most men can retain most all their regular sports function after healing of the joint. I am glad to hear I have a lot of fellow members in the "pointy shoulder club"


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## Ricisan (Aug 30, 2006)

My Surgon worked for the NY Jets. He said I had the second worst that he had fixed.
The X rays showed some damage. The MRI made surgery a Medical Necessity!
Don't play around, spend the money. Mine was $550 and Kaiser refused to reimburse me. lmfao
Kaiser turned me down twice for MRI. lol
If I learned 1 thing through this journey:
You have to be your own advocate!
I am 59, and have the gray hair to prove it.

R


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## szabta89 (Aug 23, 2013)

I have had a mountain biking accident right in the end of July. They diagnosed Rockwood 5 for me and suggested to have surgery. I had the operation two days after the injury in Stuttgart, Germany. They have put the twin tail tightrope in my left shoulder. My shoulder hurt like hell right after the injury and after the operation too, but since 3 days after the operation I have not taken any painkillers. At the moment (2 weeks after OP) I have only minor or no pain and I can move my arm properly, just paying attention to move it in the allowed range. I will start the psyhio next week, 10 weeks long.

Sleeping is kinda hard, nowadays I only sleep on my back (never did that before) and I usually get up with back pain in the morning. The doc said this is because the unusual (for me) sleeping position. What is really surprising for me is that I was only required to wear the sling for 5 days after the OP. Everybody says that he/she had to wear it for weeks.

I am 24 years old and I do (did) a lot of sports (5-6 times a week; running, cycling, gym).


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## palmasi (Sep 26, 2013)

Was diagnosed with a grade 3 AC separation on Aug 1 from a road bike wreck. I think I slid along the pavement for a few feet and stopped when my shoulder hit a curb. 
Hospital for Special Surgery guy said just rehab it and fix it in a few years if I am unsatisfied with the performance. MRI showed no rotator cuff damage, which was a blessing. My pinky and ring finger tingled for a couple of weeks afterwards but other than that no nerve damage. I had terrible cramps and spasms and lots of black and blue in the chest from the leaking shoulder blood. 

It's been around 8 weeks post injury and I wanted to share what I can and cannot do. 

I have a bump a little smaller than an inch and in the beginning couldnt' even move the arm for 2 weeks. Sleeping on it was impossible and I took lots of vicodin in those two weeksn. After 4 weeks I could dress OK but all day there was a dull ache that felt like the shoulder 'hanging'. Doc didn't advise on a sling so I didn't wear one. 

After 4 weeks I started PT twice a week on ROM exercises and some strength training with 5 lb weights. this has continued up to week 8 with 10 lb weights, still at twice a week. 

At 8 weeks I can rock climb with is fantastic. It doesn't feel very good and some moves like overhanging gaston is totally impossible from pain, but I can toprope solid 5.10 with no real trouble. Climbing seems to take away the constant dull ache I feel. 

I can road bike just fine, though my shoulder starts to hurt after two hours. 
I can't do pushups or shoulder presses or bench of any kind. too much lateral movement in the joint. This sucks and I don't expect it will get any better. Still can't sleep on that side without pain and carrying a backpack doesn't feel good. 

Sadly, I can't mountain bike at all yet and that's because any lifting of the bars to hop an obstacle opens the joint and hurts like hell. For some reason I can lift static objects like a 40 lb bucket full of water but the sharp bar pullup kills me. it's a real shame as I really like mountain biking and am pretty bored with road biking.

I'll post up after every milestone but for now 8 weeks out I'm definitely not satisfied and hope to keep improving. Even as I type this at my desk I have a burning sensation behind my scapula. 

Good luck everyone!


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## cabinfever (Feb 6, 2008)

I am about 14 months post injury. Grade 3 AC seperation. Full range of motion and stregnth. No surgery. Only time I ever think about it is when I look in a mirror and see a lump. If I spent a lot of time running around with my shirt off I might have wished I had surgery, other than that have a full recovery. Good luck everyone!


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## Zignzag (Jan 23, 2004)

*May I play too?*

Went over the bars 2 1/2 weeks ago and landed on my shoulder. Grade 3+ AC separation. Ortho doc wants me to have an ortho surgeon look at it because the bump is pretty big, but he's been booked up. Hopefully I can get by with just PT.

The pain has pretty much gone away except when I lift anything over 30 lbs. I can sleep on my right side again.

I hope you guys are doing well.


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## Rustiee (Oct 22, 2013)

*Dos and Don'ts*

For those with Grade 3 (and below) separation (without surgery), did your PTs advise what exercises to avoid, and those that would help in strengthening the surrounding muscles? I am referring to the stage where rehab has been completed, perhaps several months post-injury.

Would push ups, pull ups, swimming, bench/military presses aggravate the joint after "complete recovery". I am thinking in terms of how biomechanics could put (repetitive) stress on the joint. Some say that overhead motions should be avoided. That would mean swimming front crawl, overhead presses and pull ups. Any truth in this?


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## bloodpuddle (Jun 15, 2007)

Rustiee said:


> For those with Grade 3 (and below) separation (without surgery), did your PTs advise what exercises to avoid, and those that would help in strengthening the surrounding muscles? I am referring to the stage where rehab has been completed, perhaps several months post-injury.
> 
> Would push ups, pull ups, swimming, bench/military presses aggravate the joint after "complete recovery". I am thinking in terms of how biomechanics could put (repetitive) stress on the joint. Some say that overhead motions should be avoided. That would mean swimming front crawl, overhead presses and pull ups. Any truth in this?


I had a grade 3 a little over 2 years ago, and found swimming a great help in my rehab. Started off going back to breaststroke, then freestyle, finally butterfly. All with the blessing of my PT at the time.

Swimming better than ever now.

My earlier post on this is here: http://forums.mtbr.com/rider-down-i...oulder-separation-300318-26.html#post10443441


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## hlmrspd (Nov 12, 2013)

I was diagnosed with a grade 5 AC separation 1 week ago. My orthopedic surgeon recommended surgery and I agreed. He also recommended using the Arthrex dogbone for the procedure. Have any of you had this procedure done? My limited search indicates it's a relatively new method but it seems promising.


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## Old Ray (Sep 5, 2010)

hlmrspd said:


> I was diagnosed with a grade 5 AC separation 1 week ago. My orthopedic surgeon recommended surgery and I agreed. He also recommended using the Arthrex dogbone for the procedure. Have any of you had this procedure done? My limited search indicates it's a relatively new method but it seems promising.


I dunno anything about it, but it sure _looks_ good. Reminds me of those really cool hi-tech replacement lumbar discs some German outfit came up with about 5 years ago......titanium, carbon fiber mesh, latest gen. elastomers; made wish that I was German and that I had a blown disc......almost.

Good luck with the procedure. If you have never had shoulder surgery before, be ready in advance for the post-op pain. It can last for a couple of months, in some cases, before it subsides to a less-than-opiod level. 
I'm trying very hard to be a good boy and rehab the latest AC separation on my already reconstructed shoulder, because, a) I really can't afford either the additional debt or the down-time, and b) the last shoulder surgery I had was a real biatch to deal with. I got a good 4" scar from that one. Lots of sensory nerves pass through that area.


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## Andy17 (Sep 18, 2011)

My repair was very similar but with a cadaver tendon. This is a living repair which is better as far as durablity. ( thats what I have read and was told by the doc). If the cord breaks with use your back to grade 3 instantly. So far I am doing great. I still work out more than I use to but thats not a bad thing. My shoulder is 98% normal now the only thing holding it back is total strenght which is coming along good but not 100%. It has been a year on 11-20-13 since my surgery. It is a long slow recovery with a living repair because of the growth of the tendon into a new ligament which can be as strong as the original according to some. 
I didn't have very bad pain with my surgery (pain yes but no drugs after the 3rd day execpt advil) Good luck with your surgery!


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## Giant Chachi (Jan 9, 2012)

Ugh, separated shoulder from a crash this Monday. Not sure on the severity level yet, as diagnosis was in immediate care first after the wreck and a follow up appoinment with my PCP tomorrow morning. Man this feels odd.....small ache at rest, big, sharp pain if I lift it. Weird lump on shoulder that tipped me off on something wrong with it when I felt the lump pushing into my Osprey pack's strap. 

Not looking forward to being down, but will deal with it head on. At least it is winter and I should be staying off the trails anyways. Just not thrilled with this. Thanks for this thread as it is encouraging to read the comments. 

Damn, this post took way too long to type!!!


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## generate (Jun 20, 2009)

Thanks to all that have posted in here about recovery. Definitely a good read.

I'm almost 4 weeks out of surgery from a high grade 3 separation. I had also tore my labrum. I'm feeling pretty good, just some soreness and some odd feelings when I move it wrong. Its been hard for me to isolate my arm and even though I'm in the sling, I still use it quite a bit. I am definitely careful, but I figure if I'm not experiencing any pain, I'm probably not hurting anything. I don't lift anything with it. 

The hardest part is just making the time go by. I'm out of work for another 3 weeks as I need both arms to do what I do for work. I've been going with friends to cyclocross races on the weekends which definitely helps with my sanity. Its also a bummer because I want to be out there racing, but I'm confident in my recovery and that I'll come back stronger next season. 

I have a follow up in a couple weeks and hopefully I'll get the sling off and be able to get back to work. I'm not sure when I'll be cleared to ride again, but I can't wait to get back on a bike. It feels like my fitness is waning and my arm strength is wasting away. Thats the hardest thing for me to accept. I'll post some updates as things progress.


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## Giant Chachi (Jan 9, 2012)

Just an update, I have a grade 2 separation, and as per my doc, on the higher side of the 2. Regardless, he suggested no suregery and cited a 75% success rate of just rehabing for this level of separation. Surgery can always be the backup if this doesn't work out.

Today is one week to the day since my injury, and I have actually had some progess yesterday and today with ROM and overall pain level. I'm just antsy. He advised that I give it 6 weeks of playing it really careful to not injure it further, and another 6 weeks of easing it into daily use and normal activity.

Oh well, I'll the hitting the exercize bike over the winter months that I am down, am thinking of selling my bike and saving for the other one I want, and having that be my intro back into it with a first ride on a new whip!!!! Hell, I won't be diverting my funds to upgrades on my current ride, as it won't be used for the next couple months!


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## Jmartin78 (Dec 24, 2013)

I had a grade 4 separation from a taco grande on a downhill on 9/13/13. ER trip, x-rays, and meds with an ortho shoulder expert on 9/16/13. Activity and mobility was very limited over the weekend. Ortho gave me another anti-inflammatory and recommended the conservative approach which had me in PT for 4 weeks before next evaluation. Immediately after I took new meds, pain disappeared and I was able to get active again; jogging, lifting, yoga etc.... I couldn't do any push up or pull up type movements though. Through the 4 week PT, I was able to regain all ROM and throw passes with a football at the same velocity as pre-crash. Bump, lack of strength, loose feel to shoulder when doing push up moves, inability to do pull ups, major drop in shoulder position, increased chance of arthritis, etc. had me opt to get my shoulder fixed surgically. 10/21/13 was the date. 2 screws, a cadaver tendon, and 5 scars later (biceps tendon repair as well) the job was done. Woke up with a sling and ice machine on and ready to go. Nerve block set to last 24hrs from surgery. Once it wore off, the pain was ridiculous. Oxycodone didn't come close to touching it, however once past the second day, it wasn't that bad. Pendulum swings and arm curls for the first 10 days till first post op visit, then phase 1 PT - stretching ROM stuff. Sleeping sucks, i was in a recliner for 30 days. Then, i had to force my way to bed because my lower back and hamstrings were all kinds of jacked up. i woke up every 2 hours, then every 4 hours, then 6 until i was able to sleep though the night. Slow process. Physically and mentally grueling. Atrophy sets in, so you want to start doing more, however the healing process isn't ready for more yet. About 6-8 weeks out, when the sling is off and you have healed enough, you will be able to do more PT. I am curling with up to 25lbs now, doing tricep extensions, and benching about 50lbs. Over 300 before surgery. This is only due to being very cautious not to destroy the repair. More to follow as I go through PT. 1/11/14 update. The bike has been repaired! And, it will be a recreational bike going forward. Full suspension in my future. I'm up on my 12 week post op review. Current state: Most regular daily functions are no issue. Cross body ROM is still not good. It is no more than 50%. I can throw a football again. Nowhere near the velocity or distance as pre-surg though. I also stated playing basketball again, shooting the ball no further than the free throw line. I am curling 35lbers and benching over 70lbs. 3 sets of 10. These will continue to increase as I get back into the gym. I also started doing pulldowns and can easily get over 100lbs. The weakest muscles seem to be the pecs and triceps, since you don't use them to push off when in the sling. They will need the most work to get back the strength. As for pain, there is a dull throb every other day or so and when I work it real good. I also have sharp nerve pain and pain from busting through scar tissue from time to time. Full size and definition of muscles have not been achieved yet, however I have recovered a good deal back since the onset of Atrophy. Massage and chiropractic work are the next stage of rehab for me. More to follow....


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## Jmartin78 (Dec 24, 2013)

*Ac separation*

Pics of my bike and before/after surgery


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## ascbeerman (Jul 11, 2009)

I read the heck out of this thread post injury and have been hearing voices telling me to take a moment and share my experience. If you have spent anytime reading this thread you will see opinions on both sides of the surgery/no surgery debate. I am not trying to sell you either way. It is nice to hear that some have skipped surgery and say they are now back to 100%. I personally opted for surgery. My type 3 happened May 31, 2012 and I had the "ac graft rope" procedure on June 4, 2012. I did a lot of reading in those four days. What ultimately swayed me was the fact that my surgeon had the same injury and surgery. He tried going 6 months and didn't like the results he was experiencing. The day before my surgery my shoulder's pain was almost non existent so it seemed counter intuitive to be going under the knife. Of course when you lose all of your connective tissue there is nothing left to hurt. I am now fully functional in every way and my strength is at 100%, but I wont lie to you, I think I will always know that I separated my shoulder. I wouldn't describe it as pain so much as sensation. The procedure I had is very invasive. Stuff gets cut, drilled and screwed, so yes, you are going to feel it. I was in the sling for 8 weeks. When the sling came off, I began to realize just how much work lay ahead of me. You have to be patient, that is for sure. Push too hard and you set yourself back. I learned that the hard way more than once. By September I was taking easy rides and had regained a good bit of ROM. I remember that first December though being very paranoid about falling on skis. Fall I did and nothing bad happened. By late winter early spring of this year I was feeling so much better. This years riding season, it was a non-issue. I have crashed (although not right on to my shoulder) and been punched by my son (in the shoulder) with no ill effects. Some days my shoulder is stiff, other days it is pretty normal. I have a scar but no bump. ROM is 100%. Although my shoulder joint doesn't feel like the one I was born with, I am optimistic that it will continue to improve. Whatever decision you make, keep your head up. It gets better with time.


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## Igik (Jan 15, 2014)

*AC joint separation type ?*

Hi all,

I just wanted to thank you all for this very helpful thread. Lots to learn here about AC injury.

It seems I am also coming to the AC injury club. But I hurt it on my gym day doing bench press. At first I didn't think much of it. Shoulder pain is something I live with for a long time. This time pain was sharper and lasted longer. Nevertheless I continued with my training for a next 3 weeks. Going out on bike and doing heavy lifts.

But, suddenly I noticed that I have a small bump on my right shoulder. That"s when I knew something is really wrong. I searched internet and...

I have full RoM. I have o pain when moving my hand , but I can hear popping sounds when moving shoulder in certain way.

I will see my doctor in 2 days and we will make x-rays. Than I will know for sure...

Here are 2 pictures you can look. If you have any comment as what else this injury could be or how severe I would appreciate it very much. I will post my results in 2 days.


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## Jmartin78 (Dec 24, 2013)

Igik said:


> Hi all,
> 
> I just wanted to thank you all for this very helpful thread. Lots to learn here about AC injury.
> 
> ...


It could be that you tore your Labrum. My other shoulder may have this same issue. I injured it doing bench press in the gym. It makes all kinds of popping and cracking noises. I am waiting to recover from the AC before I look at getting this fixed. Good luck with your visit.


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## Igik (Jan 15, 2014)

Jmartin78 said:


> It could be that you tore your Labrum. My other shoulder may have this same issue. I injured it doing bench press in the gym. It makes all kinds of popping and cracking noises. I am waiting to recover from the AC before I look at getting this fixed. Good luck with your visit.


JMartin thx very much for your post. I really didn't think of Labrum hmmm. Will have to check it. But are you sure that Labrum tear would cause this small bump on the picture?


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## socalMX (Oct 31, 2009)

I am curious on the labrum as well. I had a grade 3 separation 1 1/2 years ago and have the life long bump, last week I went over the bars landing on my elbow and did something to the same shoulder. I don't think I separated it again (if that's even possible). My problem is lifting my arm at all, there seems to be absolutely no strength and pain when I try but I don't have the same droop I had as when I had the separation. I am hoping I did not tear anything, weather is beautiful here and not riding & going to the gym is killing me.


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## Jmartin78 (Dec 24, 2013)

No and I am not an orthopedic doctor. What made me say that was the noises that you have with it. I have the same thing going on and was loosely diagnosed with a torn labrum. By loosely I mean that the doctor examined the shoulder and determined it was not a rotator cuff and started leaning towards the labrum. X-ray and/or MRI will tell you what is going on. I haven't done that yet due to my still dealing with my other shoulder recovery. AC joint is usually from a direct impact to the shoulder. Benching doesn't typically cause that injury.


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## teK-- (Dec 3, 2011)

I just joined the club, somewhat unwillingly. Just wanted to say thanks for all the information it has been most helpful as well as comforting and scary at the same time.

Basically what happened with me was my first time going down a fast DH track I cleared all the doubles except the last set. Went OTB and landed on head and RHS shoulder.

Xrays show a class 2, maybe 3 separation of the AC joint. Physio and GP have both referred me to the orthopedic surgeon for a second opinion as to whether recover naturally with physiotherapy or do surgery. From all the reading I have doing here it sounds like natural is probably the way to go.

Got away pretty lucky to be honest with usual soreness all over, hips, neck, fingers, and a very decent and long cork down my inner thigh from the bars. Was wearing a full face helmet and goggles there were scratches across the lens. Arm is in a sling for the meantime and only minor throbbing ache but still useable.

In hindsight should have taken it more easily after spending all day riding up to top of the mountain, so going down a new track should have been a slower sighting lap given the fatigue after such a hot day of riding. Luckily we went in a few cars so my mate was able to drive my car home, since there was no way I could drive those twisty roads back to the bottom with stick shift, a messed up shoulder, and jacked up on painkillers.

Got it on Gopro! It was probably what made me ride like a hero and crash though :/

Take care on the trails everyone I'll be sure to share any updates in the following weeks.


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## socalMX (Oct 31, 2009)

That's an awesome vid, not many of us have a record of our accident. I think you will be fine without surgery. I had a grade 3 and took the advice of the doc and opted to heal up on my own and live with the "bump". He mentioned that many people who have the surgery deal with terrible arthritis later in age. Its a tough frustrating road but do what your told & be patient with it.


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## bloodpuddle (Jun 15, 2007)

Holy sh!t did I wince on your video impact. Takes me right back there - aargh!

Heal up!


Sent from my iPhone using Tapatalk


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## teK-- (Dec 3, 2011)

Thanks for the comments!

I'm 10 days out from the injury and most pain has subsided just he dull ache here and there. Range of motion and strength is OK but I am not reaching above my shoulders or to the extreme left for now.

Saw the ortho surgeon today he confirmed without doubt it's a class 3 separation. The shoulder and clavical are still fairly well aligned fore/aft so he recommended natural healing and to start physio no earlier than 1 month from now. The ligaments should scar over and my shoulder should stabilise somewhat in its current position if I strengthen the shoulder.

So for the next few weeks I am just to take it easy, not do any overhead or far left reaching. 

Got a big race in just under 7 weeks hopefully I'll be right by then!


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## socalMX (Oct 31, 2009)

If you have access to a swimming pool or even better spa/Jacuzzi, works wonders in recovery for strength & range of motion. I am getting some strength back myself but still cannot raise my arm above shoulder height or reach across my body.


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## PeytonP (Aug 29, 2011)

*Unsure of local doctor. I need your opinions!*

I might have joined the club Friday morning, 1/24/14. I thought it would be great to ride in the snow... I hit some ice. You know the rest.

The old doctor at my local clinic never touched my shoulder. She only looked at the x-rays and told me to sling it for 10 days and get an MRI if weakness and pain persists. She said I probably dislocated it and pulled/tore muscles. I'm not entirely convinced.

I have copies of the x-rays. Is that gap at the end of my clavicle normal? Does it look like any of your lower level separations? I'm not sure since the clavicle isn't raised or anything. It's just not touching anything at the end. Hopefully I can get an appointment with my usual doctor in the next few days.

Here's my x rays:

















Thanks for your help.


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## qkenuf4u (Jan 24, 2009)

PTA wife says looks a bit jammed up but that could be swelling...says wont see fracture till swelling is down.... i had this pleasure back in 08 or so... good luck it sucks...


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## teK-- (Dec 3, 2011)

Hi Peyton I think that looks like a grade 1 separation or a sprain (when the ligament is stretched). As post above says, you may need to wait until swelling goes down before further assessment. In meantime stay off the arm and ice it regularly; take some over the counter anti inflammatories.


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## wilkinm (Apr 14, 2009)

That video was exactly what i did last Saturday when i punctured the front sidewall going downhill. Have a grade 4 Separation and am being advised that surgery is the best option. I still cant raise my arm as everything is really out of sorts. Hope you heal up quickly.


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## socalMX (Oct 31, 2009)

Based on what I have read, surgery is the best way to go and a grade 4 is a for sure thing. I just found out my torn rotator will require surgery. With action sports being so big these days, I should have been a surgeon, business is good!


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## LetsRide! (Apr 22, 2010)

Hello everyone. A great big thank-you to all who have posted on this thread. I have been reading it for the last couple of days and I have learnt a lot. I figure that hearing options from a Dr is good, but it’s even better to also hear it from those who have had the injury. I’ve been comparing peoples stories and the choices they made, specifically the whole Surgery V Non-Surgery dilemma. I’m not keen on the idea of surgery, and I usually heal well, being fit & healthy and still young(ish)!!

I feel I owe it to all who have shared to post my own story and recovery progress thus far, hoping it might help others. This post is long, my intention being to give you as much good detail as I can to help fill in the blanks. I have chosen to pursue the non-surgical route for the 1st 6 months, & look at surgery as my back-up plan. My background in Mechanical Engineering and Business. So, I look at most things from this perspective!

My initial impressions: This shoulder injury is especially shitty!!! The clavicle (collar bone) is essentially (in my terminology) a cross brace with anchor/mounting points. When the ligaments tear (mounting points) its simply left to flap about, hence the lump and lack of stability. The shoulder is an amazing bit of biological engineering in my opinion! It’s an absolute roller coaster physically and mentally. As a guy who’s used to being very active, and quite fit, I must confess it’s made me depressed at times being so sedentary. I’ve learnt many things; 1) Each Dr has a slightly different view, which is confusing!!! 2) This injury is a treatment grey-area in many ways 3) there are various surgical techniques to choose from. 4) Hope to hell a bone breaks and not a ligament in the future as Bones heal up much better & faster. 5) How key (and oddly hard this injury makes it as it doesn’t heal fast) to stay positive minded. 6) Each injury is unique. 7) Patience is definitely needed and tested for the natural healing option I’m taking. 

My story : I joined our not-so-desirable club on 6th November 2013. Long story short; fell off my bike on a twisty bit of trail & landed on my left shoulder/arm hard. I've been riding MTB, on and off, since I was a kid in the late '80's. I'll be 40 this year and this is the first time I’ve ever hurt myself badly ... I've fallen off lots of times, of course, but I always saw the fall coming and rolled .... until this one. Once second I was good, then I hear a loud cracking noise, like a tree- branch snapping, from the bush right behind me (animal of some kind I reckon). Got distracted, just for a split second, then wham!!! I slammed into the ground with a big old thud. I got up checking all was fine and realised with a sinking feeling it really wasn't  My left arm wouldn't move & it was hard to breathe. Walked a mile back to the car-park feeling a bit sorry for myself. 

Luckily, I wasn't riding alone and my buddy drove me to the hospital. This was the start of some confusion. Initially the Dr's thought I'd dislocated my shoulder, but, nope, it turned out I had torn (separated) my AC ligament as well as fracturing my arm and 4 ribs. “Do it properly or not at all”, eh?LOL!!!

The Dr at A&E told me he thought it was “a Grade 4 tear, told me to wear a sling and that it'd heal on it's own” .... that’s exactly what he said. The grading score meant nothing to me at the time. Arm was straight and bone lined up, so no cast needed. At this point I was on the strong pain killers they'd given me and pretty stoned. 'OK' I thought. Get my head together. My wife picked me up at the hospital. two weeks later I went to the 'fracture clinic'. This time the Dr there told me my shoulder was a Grade 2 ... which I thought was odd. I told him the first Dr said Grade 4 and he laughed and said 'no' Grade 4 is a Surgery case ... I quizzed him about surgery. He was adamant 'no surgery needed'. I took this as good news and at face value. This did however prompt me to look up the whole 'grading' scale. X rays at the time showed AC separation, but CC distance was normal. 

Where I’m up to right now: I have just passed the 13 week mark. So far, I am healing up quite well. 

The key milestones are as follows:
Week One – Really bad pain. Wow. Could hardly get out of bed. Everything hurt. Bruised to hell, ribs/arm/AC combo 9.5/10 pain rating!! Swollen shoulder makes it hard to see extent of bone protrusion. Pain killers all the time. Combo of Paracetamol and Ibuprofen works well … used some Endone pills for the first 3 days – they’re much stronger – but made me feel lousy. Sleeping very hard to do. Waking up every 30 mins or so. Super cautious of my arm/shoulder/Ribs. 

Week Two - Pain subsiding. Bruising impressive! Sleeping getting much better but still bad. Arm in a sling. See Dr at hospital, got the surprise good news it’s a Grade 2 shoulder injury in his view. Told me to lose the sling and start using my arm very lightly /keep it moving. I was delighted to hear this. Walking every day like normal to keep some fitness going. Lots of vitamin pills, rest, time off work. Focus on healthy eating more than ever. 

Week 3 – Pain is now about 4 out of 10 now. Still very tender. Almost no strength in my left arm or hand (fractured head of the radial bone in my arm meant no grip at all). Shoulder ROM about 70% & very sore. Keep gently moving the arm as much as a I can but with no weights. Just focussing on keeping it supple. Lots of walking helps the mood!!! Arm seems to droop a bit at the shoulder under it’s own weight. Chose to see a Shoulder Surgeon to get the info on the surgery option.. He reckons it’s a Grade 3, not a 2. I was gloomy when he said this, but then, seeing this, he added that it’d heal up fine on it’s own given enough time & my fitness / good health etc. I paid to have an MRI done at the surgeons request. OK. Results seemed vague to me – too much swelling making it hard to read, I was told. Suggested a Grade 1 tear. Couldn’t be 100% sure if the CC ligaments were there or not …hmmm. Surgeon was surprised so he called the MRI joint & spoke to the guy in charge. This clarify’s no CC ligaments can be seen & Grade 3. Bummer. Ah well. So much for the MRI, imagine if the surgeon hadn’t called, eh? A debacle. Focus on healing now full time. 

Weeks 4 – 8. Arm still very weak, but, very gradually getting better. Ribs still sore. Shoulder has a bump. Doing various some very light (3kg) dumbbells. Tennis ball squeezes for the grip. Seeing the Osteopath. Got some specific exercises. Arm drooping less and less.

Weeks 9 – 10. This is where I’ve seen the best improvement. Left arm is much better, grip strength 80 back now. Very tentatively rode my bike on the bike path for half an hour. So good to be out on two wheels. Can’t ever recall being this nervous about something!! Nerves subsided after about 10 minutes. Ride went fine, being super-cautious. 

Weeks 11 – present: Going well!! “Patience, patience”, I keep telling myself. Ongoing Osteopath visits. Arm only droops a tiny bit now, grip 100% back. Full ROM now. 99% pain free; the odd twinge is all I am getting now. Bump on shoulder not that big (maybe ½ inch at the most & goes almost flat when I stand up tall and straight). I can feel a ‘tightness’ in my shoulder most of the time. This is getting less and less though. My Osteopath has been great – she told me right away I was looking at 6 full months before I could be sure it was as good as it would ever be without surgery as ligaments that are badly stretched do take ages to recover fully. The ligaments which are torn get replaced by scar tissue as the bodies natural repair mechanism. Scar tissue can be quite strong, but not as strong as the original ligaments. Scar tissue CAN be worked on with therapy and DOES get stronger with time. My AC joint seems to be ‘scarring up’ well, according to the Osteopath. It’s feeling better, more to the point; my arm doesn’t droop at all under it’s own weight now. I’m thinking of having another MRI done soon to see how it’s all looking internally and also if the CC ligaments can be seen or not now there’s no swelling to obscure the view. Will use a different MRI provider this time!! 

NB: I have not been to the gym since I had the accident. Used to go three times a week. Just seemed like a really bad idea to put the shoulder under too much load to me. Cautious!!! Osteopath agreed. 

NB: Very important to help speed recovery up: Lots of good vitamin pills, rest, time off work (if possible). Focus on healthy eating more than ever. Healthy Eating Nazi Mode engaged!!!

So, non-surgery is working well for me so far. I figure I will stick with my plan of doing 6 months rehab. Surgery can be done at any time. The new Dogbone technique looks very good to me if it comes to surgery. So, at the 3 month / half way point now, I’m pleased with my progress … time will tell. I’ll post an update on my progress in another few weeks in case.

Stay upright and get well soon all!!!!


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## socalMX (Oct 31, 2009)

Good read, will help guide many through. I say you keep going to the gym though. Focus on your leg strength and core that way when you get back to riding you will be ready to go. That is exactly what I am doing, my goal is to shock my buddies at being a climbing beast when I have always been the weakest climber of the group! I still have a few months of rigorous training. It keeps my mental state up!


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## PeytonP (Aug 29, 2011)

*Weighing the possibility of surgery.*

LetsRide!, thank you for that AC tear testimony. I went for a ride in the snow and fell 1/24/14. I did quite a number to my right shoulder, too. Your story alone gives me much to consider as I weigh the possibility of surgery.

On the day of the fall, couldn't lift my right arm or reach across my chest. I could pull it all around with my left arm, but not under its own strength. A local dr. said I dislocated the shoulder and wearing a sling for a while would help. I wanted more info. I saw a sports medicine surgeon last week and after XRAYs he said the injury looked to be a low grade AC separation- something that could heal on its own with rest and PT. I felt good about that and tried the recommended exercises three times over the next week. I am surprised by how uncomfortable the simple ROM exercises are. I don't just have soreness, but a catching/popping/grinding somewhere around the joint or just below. My arm sagged under its own weight, too, but I can feel things becoming more taught each day as the arm sags a little less. I still can't sleep well, though... The soreness seems amplified in the night.

I saw the specialist again yesterday. He was happy that pain had decreased and ROM increased (I can actually wash my hair with both hands and reach across my chest and apply deodorant with that arm now through a little pain- something I absolutely couldn't do for the first week, though a shirt on and off is still difficult). Unfortunately, he's concerned with that popping and grinding and ordered an MRI for next week. His concerns are that when I fell I dislocated my arm and separated the AC, which with all that tearing and moving out of place I tore the labrum as well. :smallviolin:

On Monday, I guess I'll find out what all is torn and where. He gave the usual surgical options depending on what is seen- orthoscopic if there is minor fraying that needs to be cleaned up or more invasive surgery to anchor or reconnect any tissue that has torn or pulled away completely.

I'm quite nervous about the idea of surgery... I'm moving next month, beginning a job that requires me to be quite active playing sports with kids and leading adults to be more active as well. Another part of my job is leading music and playing guitar, too. I'm anxious about the extended recovery time that surgery means, but I don't want to be hindered for the rest of my life by a shoulder than never 
fully gets its ROM and strength back!

After making this post, I plan to read through every post in this thread to get a better idea of what opting for/against surgery will mean for my future of staying active. I'm only 27 and I'd like to give 100% to the kids and adults I'll be working with, my kids one day, and the great hobby and lifestyle everyone in this thread loves.

I appreciate everyone's stories of experience and would appreciate more feedback if my story sounds too similar to yours.

I have a video of my fall, as well. As soon as I can cut and render it in a way that doesn't corrupt the sound, I'll post it on here so you can make fun of how my 165mm Reign X slipped out and slammed me on a frozen sidewalk. I've been kicking myself for that one... :madman:


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## PeytonP (Aug 29, 2011)

socalMX said:


> Good read, will help guide many through. I say you keep going to the gym though. Focus on your leg strength and core that way when you get back to riding you will be ready to go. That is exactly what I am doing, my goal is to shock my buddies at being a climbing beast when I have always been the weakest climber of the group! I still have a few months of rigorous training. It keeps my mental state up!


That's what I'd like to do! I'm moving to the TX hill country next month and will be facing tech climbs I haven't experienced before (rocks and ledges are so much more fun on the way DOWNHILL :thumbsup: )

I plan to hit the local football stadium and start climbing stairs. If I'm stuck in a sling for a while, I might as well get my legs in awesome shape!


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## LetsRide! (Apr 22, 2010)

*Floor Exercising V Gym for Rehab?*



socalMX said:


> Good read, will help guide many through. I say you keep going to the gym though. Focus on your leg strength and core that way when you get back to riding you will be ready to go. That is exactly what I am doing, my goal is to shock my buddies at being a climbing beast when I have always been the weakest climber of the group! I still have a few months of rigorous training. It keeps my mental state up!


Thanks socalMX. I hope so!! Sharing info is the goal. You make some good suggestions. I'm sure you'll leave your buddies for dust in that case.
My osteopath reckons gyms are a bad idea per se as our bodies are not designed to work isolated muscles. This was an interesting take to hear, with me being a long term gym fan and all. She's a good Dr and so I thought 'OK, I'll give it a good try'. She advocates resistance training using therabands and floor work. The last 3 weeks, 10 weeks post accident, I've been doing bench dips, squats, 1/2 press ups, crunches, some (light & nervy) MTB riding in addition to my walking and my physique is changing ... I'm slimmer and leaner but not as powerful ... but I'm feeling overall-toned way more than before. Actually, I'm enjoying this a lot & way more than I thought I would; it's a fresh approach to training for me and change is good. The best thing is that I can do this training easily at home. Convenient.


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## LetsRide! (Apr 22, 2010)

PeytonP, my pleasure & you're welcome. Sorry to hear about your accident. Riding on Ice - nasty - we have the other problem here in Aus - too damned hot + the ground is like concrete to land on :skep:

Ref.ROM; my left arm took *several weeks *for this to come back fully. I'm at the intermittent dull ache stage now ... at 13 weeks now - hopefully by the 26 week mark I'll be feeling 100% normal. I'll be posting an update as I go along. NB One thing that did set me back was to try swimming. I'm not keen on swimming but heard it was good for rehab so into the pool I went; the over arm action of the crawl caused me a real setback. I know a lot of guys swear by swimming, but it didn't work for me. Just my 2 cents.

The body does have strong regenerative powers - it's an amazing machine all things considered. I'm giving mine a fair chance at doing it's repair thing.

I try to think of it like this; we're actually lucky; after all it's 2014, not 1954, we have options for good surgery now we didn't have in the past... hence I'm being patient and seeing how it heals first to be safe. Mind you; I do have to remind myself of this as I'm not a patient person per-se, I want it healed NOW haha! :nono:

More broadly it's also worthy of note that, at the least, we all hurt ourselves doing something healthy & active that we enjoy; be it skiing, riding, whatever at a time when so many people are lazy and sedentary; To me it's better to live life actively and accept the odd mishap than slouch inside on the couch like a lot of folks do! 

Me, I have a 'thing' about not wanting man-made hardware inside my body - if I can avoid it.

Wishing you very Good Luck for Monday's meeting with the Dr!!


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## PeytonP (Aug 29, 2011)

*Video of my fall*

I've read the first 300 posts to this thread. I am now seriously considering opting out of any type of surgery on the joint. My shoulder isn't sagging, nor do I have "the bump". Unless a very minimally invasive procedure can be done soon to reconnect my own damaged ligaments, I really don't see the point.
I fell 2 weeks ago. I still feel pain and disconcerting instability below the joint (think upper armpit) when I reach across my chest, like the arm is wanting to pull outward and attached things at scapula are very strained. If I rock my shoulder forward and back, the joint grinds/pops, but the pain is faint. Sleeping is by far the worst experience after 2 weeks. I toss and turn and sometimes wake up laying on that arm! Mornings then are quite painful still. Washing my hair, brushing my teeth, pulling a shirt on and off, and pulling my pants up still hurt, but the pain doesn't make me gasp like it did during the first week. At least I can wipe my own rear end now with mumbling curses like I'm playing MarioKart! Moving much weight around is difficult, but I'm keeping the arm in a sling at work and not lifting more than my phone and drink at home when not doing the ROM exercises sports Dr. showed me. At any rate, the MRI on Monday will hopefully tell the full story of my shoulder and what is damaged.

Anyway, I have the video cut from my fall. I'm a bit hesitant to share because it is SUCH A STUPID FALL. Feel free to see my other video of jumping around at Angel Fire to redeem my forum cred.  Enough posts have blamed drunken shenanigans to make me feel better about my inexperience with freezing weather, though :ihih:


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## socalMX (Oct 31, 2009)

Have you thought about or have got an MRI? I am going in for one on Wed. Soft tissue damage can be tricky!


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## PeytonP (Aug 29, 2011)

socalMX said:


> Have you thought about or have got an MRI? I am going in for one on Wed. Soft tissue damage can be tricky!


MRI comes Monday morning, with a visit to my Dr. that afternoon for results.


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## wsmac (Sep 5, 2010)

PeytonP,
Hope whatever choice you make concerning your shoulder, it goes well! 
Thanks for the rep!:thumbsup:

You got me looking at my old posts from 2 years ago! :eekster:

In case anyone is interested in someone's update…

So almost exactly 2 yrs ago I blew my shoulder doing a stupid stunt… the worst things ALWAYS happen to me when I'm doing stuff I think is easy, killing time waiting….

Since my injury and surgeries, I've been back to MTB'ing better than ever!
YES! My injury has made me a much better rider… so I keep falling down hoping I'll get good enough in another year to turn PRO!:madman:

Seriously though… I ride without any concerns for my shoulder… no more than any other part of my body, that is.
Last year I raced in the Spring Thaw DH race in Ashland, OR. I took FIRST in my class… CAT2 50+ Men… of course I was the only person IN my class! lol
I did crash 3 times though… everywhere there were cowbells and yelling people wearing bright red speedos and sombreros! :skip:

I also spent a weekend riding lift-served trails at Willamette Pass in Oregon.

This year I'll be back in Ashland defending my title.. .and hopefully not crashing this time (although riding to the finish with my front wheel pointing one direction and my bars another was interesting)

I am also traveling to Crested Butte, CO later with a friend and his son.
I'll be bringing my CHUMBA EVO, hoping it will serve me as well as it did at Willamette.
I scorpion'd in Willamette pretty damn good once, with a few other falls… but no shoulder worries.

I've taken some falls during the last 2 yrs… I keep pushing myself… but I've come out of each one with intact shoulders!
As far as my 'expensive' shoulder… Honestly… when I fall now… as gravity brings me back to earth I do get that fleeting thought, "SH*T! DON'T FRAK UP THAT SHOULDER!" and most of the time I am twisting and turning my body to save it. Not every time… but most of them for sure.

Funny how that worry only crops up between the moment of launch and landing.
I don't think about it while I'm speeding downhill, or down fire roads (hit 49mph according to gps on a mtb hut-to-hut tour around Mt Hood, OR, last year :thumbsup: )

Anyway… my repair has been GREAT! I'm still glad I had the surgery… but I still have friends who are just as glad they did not, and they ride harder then me!


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## PeytonP (Aug 29, 2011)

MRIs went down yesterday. That was my first time. Such a weird experience. My rook is pierced and I couldn't get the bar out! lol After 15 minutes the nurse finally asked if I wanted to try it. I didn't think the little steel bar would be attracted, but I was still very anxious and freaked out as I was slowly slid into the machine. Either surgical steel isn't magnetic or it really was the grace of God that kept my ear from being torn apart!

Anyway, good and bad news. MRIs showed that my AC had stretched apart, but no ligaments actually tore apart completely. So, that's pretty cool! Unfortunately, I do have a partial tear of a rotator cuff tendon (which one, I don't know... one of the front group). At least it's not completely torn.

My Dr. didn't recommend surgery immediately. He said it could be cleaned up later if it continued to bother me. In the meantime, I'll be doing physical therapy on my own. They gave me exercises to build up the shoulder around the joint and cuff tear. I'll be using rubber bands- the PT didn't recommend using any weight over 5 lbs.! I go back in 2 weeks to talk about progress and where to go from then.

Two years ago, I had kidney stones blasted after one got stuck. That was the most pain I've ever experienced and moving around was a nightmare for over a week. Even that healed up and I was bombed Angel Fire a month later...

...but I haven't experienced an injury like this in my adult life. The several-months-long recover timetable is so unfamiliar and frustrating! I want to hold my infant niece and ride my bike again. I'm honeymooning in Santa Cruz in June, and the wife-to-be offered to let me take a bike tour in the redwoods! (She's a dream come true!) Taking a surfing lesson would be awesome, too. I desperately want to be in riding and paddling shape by then!

I guess my question to everyone is, did your AC injury involve other tears around your shoulder, too? If you opted out of surgery, did you heal to a point where you can ride, hike, throw, swim, shoot hoops, etc. with any strength and with manageable pain?

Patience, patience, I know... I'm just ready to get back to "normal"! :crazy:ut:


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## socalMX (Oct 31, 2009)

Wow, you got all of those answers in one day? I am going in for my MRI tomorrow and was thinking it would take days to get the results in. 


Question, are you currently on disability and how long did your doc say your recovery & PT might last?


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## PeytonP (Aug 29, 2011)

socalMX said:


> Wow, you got all of those answers in one day? I am going in for my MRI tomorrow and was thinking it would take days to get the results in.
> 
> Question, are you currently on disability and how long did your doc say your recovery & PT might last?


Well, your results may very! I'm not in a big city and the MRI was done at an imaging center across the street from my doctor who uses them daily as he works with locals and university sports teams.

To answer your question, I'm switching jobs next month but I've been in a county government office for a few years and have benefits through them. I've only used sick time over the last two weeks to take a few afternoons off for R&R and doctor's visits. My boss knows I'm leaving and has been pretty cool about the whole thing. She says, "You've got 70 hours of sick time. Use them because you can't take them with you!"

I honestly don't know how long recovery will last. I'll focus on the exercises they gave me for the next two weeks and try to get a better recovery forecast then.


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## socalMX (Oct 31, 2009)

Cool, thanks for responding. Being in the construction industry there is no way I can even show up and not be productive so I am now on disability. I am with you though, can not wait to get my life back especially since I will be putting together my dream bike next month!


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## PeytonP (Aug 29, 2011)

That's a mega downer, man. I hope you get answers quickly and back in shape soon.


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## PeytonP (Aug 29, 2011)

*PT and Ice Pack*

When I get a chance, I'll scan and post the initial PT exercises given to me for my AC and torn rotator cuff.

I started them yesterday and I am SORE. The ice pack will be my best friend today.

PRO TIP: Ace Tru Fit ice/heat packs are cheap and low-pro. I hang mine over my shoulder and hold it in place with my jacket at work. I have an older plastic version that was less than $5 from Academy. The new one might be a few dollars more, but it's more than well worth it. :thumbsup:


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## Scottwax (Jan 18, 2009)

Rustiee said:


> For those with Grade 3 (and below) separation (without surgery), did your PTs advise what exercises to avoid, and those that would help in strengthening the surrounding muscles? I am referring to the stage where rehab has been completed, perhaps several months post-injury.
> 
> Would push ups, pull ups, swimming, bench/military presses aggravate the joint after "complete recovery". I am thinking in terms of how biomechanics could put (repetitive) stress on the joint. Some say that overhead motions should be avoided. That would mean swimming front crawl, overhead presses and pull ups. Any truth in this?


I was told to do whatever the pain would allow. It will be 3 years in May since my grade 3 separation and there isn't anything I can't do now that I could do before. FWW, I was 49 when it happened and 52 now. Lifting weights, throwing a baseball/football, swinging a bat, bowling, etc, I can do all pain free.


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## LetsRide! (Apr 22, 2010)

wsmac said:


> PeytonP,
> Hope whatever choice you make concerning your shoulder, it goes well!
> Thanks for the rep!:thumbsup:
> 
> ...


Hi WSMAC, thanks for your post. 
I'm now at the 15 week post-injury point and have been trying to get back into my riding. 
My shoulder is still troubling me quite a lot ... I would be interesting to hear which surgical technique your surgeon used for you? I ask as your repair has been great, which I am pleased to read about!

Thanks -


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## teK-- (Dec 3, 2011)

PeytonP said:


> When I get a chance, I'll scan and post the initial PT exercises given to me for my AC and torn rotator cuff.


Hey mate good luck with your recovery.

For the first 5.5 weeks from the injury I was told to rest the arm, avoid heavy lifting and raising arm above my head or across the body too far. I then started physio and they gave me the following exercises done with a Thera-band which may be similar to yours:

- 2 arm seated row (bent arms)
- 2 arm seated row (straight arms)
- 2 arm seated pull-down (bent arms)
- Seated side rotation internal/external, for each arm in turn

I have only been doing these for 1 week and already feel heaps stronger and stable. Having done lots of freeweights and compound exercises including the shoulder previously would have helped a lot.

On the weekend I rode over 140Kms on the road bike with lots of climbing and winding descents and shoulder didn't feel uncomfortable at all except for minor weakness when in the drops.

Hopefully in another week and a half I should be good to ride in a MTB race I had booked many months ago.

I also bought this brace which I'll be using initially until I get my confidence back. It is one of the better ones I could find as the EVS branded ones reportedly fall apart very quickly:

Ottobock - Acro ComforT | 5055


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## giantfox (Aug 13, 2012)

hi guys 
quick update from me for anyone who needs the spread of "advice"

i am now 19 months into my grade 3 separation, no surgery.

My shoulder is 99.5% good. THe only issue i have is that i "know" it is there.

I do everything I used to do before the injury, just as well as before

of course i have the occasional twinge.....

And my bump has not got bigger and my arm has not sagged.

Use it or lose it...

I'm 49 btw.


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## LetsRide! (Apr 22, 2010)

*About 8 months until you felt healed without surgery on a Grade 3 AC Seperation?*

Hi giantfox

Thanks for your post, that's useful. I'm at the 3 month point now, following my Grade 3 separation. I'm kind of struggling a bit mentally (it's getting me down not being able to ride/gym!!) :madman:... the bike riding is a still a no-no. I'm doing floor work at home for core and back maintenance and heaps of walking, so i'm still fit. I'm 39 years old. 
I noticed in one of your earlier posts that you mentioned it took you around *8 months* to feel really good - have I got that right?

If I asked you try to comparing my injury to yours; I'm pretty fit and used to ride/gym each week. My shoulder has not sagged, but, when I (try to) ride my MTB on the trails I can feel the collar bone bumping about and I'm 'aware' it's not 'right' all the damned time, too.

How does this compare with where you were at the 3 month point? I think maybe I just need to give it more time ... ?

Thanks mate - 
Get Well Soon to all of us MTB'ers on here!


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## teK-- (Dec 3, 2011)

Hi LetsRide!,

Did/are you see a professional physio or someone who does rehab? I'd have to say it was the best thing I did as the first 5 weeks living a sedentary lifestyle and being afraid to do much with the arm was a big downer. After seeing the Physio and being assessed then given the exercise was a huge morale booster. It helped a lot physically as well so I am surprised you are still not clear to do much activity at 3 months when I am feeling confident that I should be good to get back on the MTB next week which is 2 months.

Have you tried a shoulder brace such as the one I posted?


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## LetsRide! (Apr 22, 2010)

teK-- said:


> Hi LetsRide!,
> 
> Did/are you see a professional physio or someone who does rehab? I'd have to say it was the best thing I did as the first 5 weeks living a sedentary lifestyle and being afraid to do much with the arm was a big downer. After seeing the Physio and being assessed then given the exercise was a huge morale booster. It helped a lot physically as well so I am surprised you are still not clear to do much activity at 3 months when I am feeling confident that I should be good to get back on the MTB next week which is 2 months.
> 
> Have you tried a shoulder brace such as the one I posted?


Hi teK--,

Thanks for that. Yes, I have seen a Physio and Osteopath, both helped (esp the Osteopath) I've been doing various exercises, and I have gotten 99% of my shoulder movement back. My should is actually OK for all non-sporting activities. I am constantly 'aware' it's not right though. The thing is, I want to get back to my sport ... specifically the GYM and MTB ... 
I have got a shoulder brace, yes bought via eBay - but it's not as 'serious' looking as the one you posted pics of!! Thanks for doing that, by the way. 
Hmm. I might get a brace like the one you're talking about - did you find it helped much?


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## giantfox (Aug 13, 2012)

hey letsride.

yes, it took me 8 months to get to "normal"
but now it is virtually as good as it was before. I say virtually, because obviously some **** happened and it isn't the same. 
But it doesn't stop me doing anything that i didn't do before.
my trail riding is as good as it was, I sail, SUP, climb, ski, 
I do them all to the same degree as before.

it has definite4ly been the most frustrating injury I have had. A lot of that was trying to get a definitive treatment agreed.
It doesn't help that there are 2 camps - surgery and non-surgery.
I can only speak for the non-surgery route and I am very happy with my shoulder so far. I took my advice from the surgeon who operated on my knee. He told me there was nothing to gain from surgery on the shoulder and i believed in his judgement.

However, you can see from this thread that no 2 injuries are the same and each individual has his own story.
I am just happy to share my experience with people who are at the beginning of the journey back to fitness.
It isn't quick, but the destination is worth the effort and you should be back to normal.

Don't lose heart


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## socalMX (Oct 31, 2009)

I opted out of surgery on my grade 3 as well and am happy with my long term recovery.

My recent torn rotator not so lucky, I will have surgery next Friday, March 7th. I am such a big wimp, how will I sleep next week???


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## LetsRide! (Apr 22, 2010)

*Running about in circles; Surgery V Non Sugery + Long Healing Times.*



giantfox said:


> hey letsride.
> 
> yes, it took me 8 months to get to "normal"
> but now it is virtually as good as it was before. I say virtually, because obviously some **** happened and it isn't the same.
> ...


Hey giantfox,

Thanks very much indeed for your encouraging post :thumbsup:

That's very useful info indeed ... esp. about the 8 month time frame & final outcome. Now, I'm thinking that, at this stage, I am better off giving it another 3-5 months to see how it'll heal up ... I figure I can always go and have surgery after the 6-8 month point if I need to ...

Can I ask you: Where were you at the 3 month point (where I am now)? I _think _one of your previous posts said you were feeling not-so-good at this point but I can't find that specific post again (!) here ...

The most frustrating injury you've had? Hell yeah. Agreed!!! 
Added to the long healing time on this as well as the whole '2 camps' - surgery and non-surgery as you say, has been causing me to run around in mental circles:madman:

I am feeling (even) more positive now because my view on this deal is starting to focus better.

It's so good to hear from other riders who've had this ... the medical guys are good, of course, but there's nothing like speaking to others who've bounced down this same road on their own shoulders!!

Happy Trails!


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## LetsRide! (Apr 22, 2010)

socalMX said:


> I opted out of surgery on my grade 3 as well and am happy with my long term recovery.
> 
> My recent torn rotator not so lucky, I will have surgery next Friday, March 7th. I am such a big wimp, how will I sleep next week???


Thanks socalmx,

Can I ask you: How long did you find it took before your shoulder was feeling it's best?
Torn rotator cuff?! Yikes. Sounds nasty. I hope your operation goes well for you


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## socalMX (Oct 31, 2009)

My AC separation was about 3 months of PT including my own Jacuzzi range of motion strengthening before I started really getting into my normal routine. It is all about range of motion no matter the pain. Every week there after it got better and better. That was only a year and a half ago. I would say I was 95% up until my more recent injury. Being I will be in surgery Friday, I will be riding every day until then...


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## PeytonP (Aug 29, 2011)

Thanks for the updates, everyone. 
I'm a month in on my injury. I don't have to ice the joint all day, and I've backed off of consistent anti-inflammatories and painkillers. I have most of my ROM back, but I don't think it is my joint being the hindrance.

I had a low-grade separation. Now, don't get me wrong. I feel the weakness, instability, and paint in the joint when I try to lift anything over a few pounds or move my arm too fast. It still hurts to sleep, though I'm learning how to prop my back on pillows on my left in order to lay a little on my injured right side. That's helped my back after a month of sleeping differently.

I'm pretty frustrated with my PT. The ROM and strength exercises aggravate the joint, though I know it's helping, but I have at least one rotator cuff tear. I say at least one, because I can feel the pain/disconnect at the front of my armpit and at the back in two distinct places. That's really making it hard to push the exercising as much as I want to because I'm scared to tear any tendons further.

I saw my Dr. on Monday. He's not convinced the MRI showed everything it needed to. They only have something like 70% accuracy. I never would have imagined that the margin of error could be that high (for something so expensive).

Surgery isn't out of the question for me yet, unfortunately. Doc wants to give a little more time to see if the rotator pain diminishes and strength improves. Problem is, I move 5hrs away in two weeks to the mountain biking hub of Texas. Hopefully, I won't further injure myself in the move and I can ride again soon. Hopefully, I won't need rotator cuff surgery! My Dr. said he has peers in the Austin area he'd be happy to refer me to, but I can't stand the thought of being tortured by not being able to ride all of the new trails!

I'm only a month in. Maybe another month or two will see more progress. I'm still keeping my fingers crossed for being strong enough in June to take my fiancé's offer to ride the Soquel Demo State Forest outside of Santa Cruz and Aptos during our honeymoon. Realistically, that will probably be a once in a lifetime chance. I'd really hate to miss out on that opportunity because of stupid mistake on a sidewalk!

Happy and fast healing to you all.

Again, I'll post all of my PT exercise sheets when I'm able to scan them.


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## LetsRide! (Apr 22, 2010)

Hey PeyntonP,

I'll be 4 months into my Grade 3 separation on the 6th March. I didn't injure my rotator cuff, luckily. I did fracture my arm and 4 ribs though (d'oh!!). 
Although I've not been to the gym, other to drop by and say 'hi' to my mates there, or been riding my bike on the trails (just on the bike paths), I am seeing steady improvement. I'm walking heaps and doing resistance training at home (floor work) 

One thing I know now is that ligament injuries can simply take ages to heal compared to a lot of other ways we might hurt ourselves.

The other thing is that I stopped doing some of the PT exercises my Physio had told me to do because they were causing me pain and making things worse. I just went with my gut. If 'it' hurts, then I back 'it' off or stop it, regardless of what the physio said. Actually, I gave up on my physio. She was making it worse. There may be great physio's out there ... but I haven't met one yet 
My osteopath is excellent. Way better - far more knowledgeable - an actual Dr.

Finally, I found the MRI was a total waste of time $310 AUD.
Funny(ish): The report from the MRI operator said I had a Grade 1 tear .. at which point I was breaking out the champagne in celebration as my Surgeon had said Grade 3!!! BUT when the surgeon read the operators report, he made a call to the guy in charge of the MRI joint, who wrote ANOTHER report saying, in my words "whoopsie, my Bad, we got it wrong, it's a grade 3 after all". Go with what your experienced surgeon says!!!

I reckon it's better to be patient and heal up right. 
Don't stress yourself out – this injury is like the watched kettle that never seems to boil!


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## hlmrspd (Nov 12, 2013)

I severely separated my shoulder on Nov 4th 2013. The Doc said it was a grade 5 on the 1 to 6 scale. Basically my collar bone looked like a chicken wing pointing almost straight up. So there was not any debate on surgery we both agreed right away that it needed done and he elected to do arthroscopic surgery with the arthrex dogbone. After the surgery the Doc informed me that,"It looked like a bomb had went off in my shoulder and he had to open the shoulder up for the repair".

I spent 5 weeks in a sling my pain wasn't severe but it did hurt, was very uncomfortable and could only sleep on my back. At the 5 week check up he had me start rehab and wanted me to raise my arm above my head in a month but not to use any weights. After about a week of rehab I was able to raise my arm over my head and finished the rehab on my own at home. 

At the 9 week check-up he was very pleased with my progress and told me I could start doing weighted exercise. Over the next six weeks I would work my shoulder 5 to 6 times a week using bands light weights and push-ups (I started with 5 girl push ups). I had to back off a few times due to the pain and the pain usually wasn't during the workout it was later in the evening or the next day. I also had to stop taking Aleve it was tearing up my stomach. From the 9th to the 15th week my shoulder has strengthened to about 60% with 95% ROM. I've been riding a road bike since week 5 and I'm up to riding 3 to 4 hours now without a lot of shoulder pain but the muscles in my upper back and neck bothers me quite a bit. 

The Doc has released me but he recommends that I get deep tissue therapy to loosen up the scare tissue. 

I plan on getting back on the mountain bike in a month and will be looking for some kind of shoulder protection. I just don't know what I'm buying yet. 

Also, I do have a lot of numbness in my shoulder because he had to open it up with a six inch scare to perform the surgery. I highly recommend doing arthroscopic surgery unless you have no other options. My numbness should eventually go away but it will take a while.


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## socalMX (Oct 31, 2009)

My shoulder surgery this Friday will be full open, wish I could have it scoped! How is the scar healing up?


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## hlmrspd (Nov 12, 2013)

The scare is very visible but it doesn't hurt or bother me at all


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## Andy17 (Sep 18, 2011)

A little over a year later my scar is hardly noticable now. And the numbness I had on the should at the incission site is now gone but did take a while for feeling to come back. I had a lot of itching at the site for a while too. I have had great progess with my shoulder and I am very happy with it.


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## socalMX (Oct 31, 2009)

fresh out of surgery, drugs


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## Stefan Nielsen (Nov 22, 2010)

Hi just thought ill trow my 2cents in.. Now 9month after my grade 3 seperation of the AC joint i ride mtb/bmx at 100% (shoulder feels solid, and i dont worry about it.), weightlift 70-80% of before injury, full range of motion, painfree (but Cant sleep on the side as it hurts my shoulder)...All in all its getting better all the time. Has a small muscel inballance right vs left side (working on that.).... i whis all of you a speedy healing process


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## ride the biscuit (Jun 4, 2009)

socalMX said:


> fresh out of surgery, drugs


heal up well!

I didnt see a dislocation thread, so mines a little different but didnt feel need for new thread

i am 2 months post op for shoulder repair. had a bad dislocation almost 3 years ago (not the same as AC separation). shoulder came back fantastically after the initial injury (riding and strength training at full capacity) but unfortunately, due to the unusual way my shoulder came out the back, was prone to coming out after that. last summer had some more bad outs that sort of "greased it up" to come out too much and decided to go in.

luckily it was scoped, and it didnt hurt too bad.

rehab is going fine, although it is definitely more of a challenge than when i had my knee done years ago. waiting until full recovery before I judge, but it does seem like surgery was the right move in my situation...esp since im only 31 with plenty more years of "hard" riding

the one thing i'm trying to decide is when to start back MTB? do i wait until im strong enough to get after it or start really easy? you know, MTB at slow speed over tech terrain is sometimes more dangerous than going fast. i know this is totally just up to me and my doc/PT, but interested to hear how others approached the process of gettting back at it

i am hoping this turns out to be a miracle march for me...just starting easy push exercises at PT. thinking when i can comfortably do turkish getups and about 20 pushups i will be safe to get back into MTB, and hoping based on way things are now this will be sometime in april


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## teK-- (Dec 3, 2011)

Hi there,

The best advice both the surgeon and PT gave me (I didn't opt for surgery) was that only I would know when I felt ready to ride again.

My road to recovery for a Stage 3 separation has been as follows

Week 1: Arm in sling on advice of the PT.

Week 2: Sling is now off after having seen the surgeon. He advised very light movement but avoid reaching overhead or across body, do not lift anything and to do nothing until another 4 weeks then start PT.

Week 3: Increase movement with daily activities but still don't lift overhead or across body.

Week 4: Same as above. I also started riding on the stationary trainer bike with limited discomfort.

Week 5: Same as above.

Week 6: Commenced physio; light range of motion and resistance exercises.

Week 7: Same as above; added more exercises and increased resistance. I also went on a long road cycling sportive event (150Kms) and shoulder felt fine but little uncomfortable riding on the drops.

Week 8: More physio exercises added, more resistance. I can start doing more daily activities overhead and across body to limit of any pain.

Week 9: Went for a light 15km XC MTB ride with a shoulder support brace and felt fine, decent strength and stability. The following 2 days I did a 50Km XC race at Mount Buller, and also a 4 Hour alpine gravity enduro which covered about the same distance mostly downhill and very rocky. Shoulder felt stable, no irritation, pain or fatigue, and I only had to stay careful from falling on it which the PT said may mess me up pretty bad.

I am now continuing my physio and the only limiting factor is minor pain at certain extremes of movement or resistance, but I think it will only get better. Exercises which are still out of bounds are:

Shoulder press
Bench press
Turkish Getup
Deadlift
Pullups

I can do rows, bicep curls, chest fly, wall pushup, and tricep pulldowns as well as a few other things with the resistance band to stabilise and strengthen the shoulder but mostly keeping my arm level below my shoulder for now.

So there you go, listen to your body and progress when you feel ready 



ride the biscuit said:


> heal up well!
> 
> I didnt see a dislocation thread, so mines a little different but didnt feel need for new thread
> 
> ...


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## FM (Apr 30, 2003)

ride the biscuit said:


> I didnt see a dislocation thread, so mines a little different but didnt feel need for new thread


Ride the biscuit! I am healing up from a nasty dislocation now- an inferior (luxatio erecta) dislocation, which I understand is like .5% of all shoulder dislocations- pic below. I also fractured the greater tuberosity of my humerous.

After getting a few opinions, its healing without surgery. I did 4 weeks immobilization in an airplane brace, and I'm 2 weeks into PT- passive RoM.

It's feeling pretty good now- I think I'll be bike commuting in 7-10 days, and riding offroad in 2-3 weeks. I'm optimistic for a full recovery.

F'ing not a fun injury however! My arm was stuck upwards & behind my head after the crash. took two attempts with me out cold to reduce.

If I understand correctly it will mainly only be prone to disclocate again when my hands are up above my head, as they were when I fell (long story, freak crash).

Yours was not the weird inferior dislocation, was it?

carnage:


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## ride the biscuit (Jun 4, 2009)

Tek, yeah, i think i am actually leaning towards holding off on MTB until i have progressed fairly far back into my strength training. I have "over done it" a few times already, which is easy to do, and want to be reasonably confident. This may mean as late as June for real MTB, but at least the good news is I still have reason to expect complete recovery.



FM said:


> Yours was not the weird inferior dislocation, was it?


Whoooa!!! FM, your injury looks like it was gnarly! Mine was posterior, around 3% of all dislocations. Different but prone to similar areas of instability. While still very painful, mine was less a traumatic initial injury and went back in easier later that day, but i did break a piece of the socket (glenoid) when it came out. That became a "floater" which doesnt heal back and decreases long term stability.

Sounds like a lot of your discomfort and rest time was to heal the part of your humerous that broke off. Initially, I was able to get fully back into MTB basically within a couple weeks.

I did make complete recovery in terms of what I could do, and seems like you will, too. I think your outcome and how prone it is to coming out long term depends on two things: 1) the extent of your damage that wont heal up on its own (like stretched ligaments and torn laburm) and 2) how much you can avoid further outs.

For me, the main thing that caused bad outs and lead to eventual need for surgery was going OTB. It was actually the way that you reflexively throw your arms up overhead in mid-air that ripped it out rather than the actual impact with the ground.

It took a handful of big ones over 2.5 yrs to "grease it" for further outs to the point where I needed surgery, and I didnt realize at first how much further damage I was doing. I am planning simple things like bars with a bit more rise on the big bike for that extra little bit of insurance against OTB when I get back to aggressive riding, but hopefully I'll be safe to go OTB when I'm healed.

Other than that, after you heal up strength training is crucial. Turkish getups, one arm planks, one arm pushups, overhead press, ect...will really protect your shoulder and keep it "packed in".

I wish you the best of luck on your recovery!! With being mindful and a bit of luck you could never need surgery, but if you do it isnt the worst thing ever compared to the other major injuries/surgeries I've had.


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## FM (Apr 30, 2003)

ride the biscuit said:


> Whoooa!!! FM, your injury looks like it was gnarly!
> 
> Sounds like a lot of your discomfort and rest time was to heal the part of your humerous that broke off.


Yep, right on both accounts. I slid under a fallen tree, tried to stop the fall by grabbing it, and basically got my arm levered sideways over my head until it dislocated. But the good news is that my rotator cuff is in good shape, and since 90% of crashes don't involve having your arm above your head, I think I've got less chance of re-dislocating.

I don't think I could have done a 1-armed push up before the crash LOL. Good tips though, thanks! I think I start weight bearing PT tonight. Happy to have the worst behind me!


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## tgus (Sep 7, 2007)

*My Story*

Hello-
I never post but am motivated as this thread was big benefit to my education. Really nice to see comments and opinions from people who are using their bodies similarly.

My story:

*47 yrs. Fit. Getting older. Mtb'd off and on for 20 yrs. Mostly off in my 30's. I mtb'd then seldom in favor of my love which was tournament karate and kickboxing.

*Feb 21 went otb nightriding. I was on a friends ss, digging it, and I disregarded the steep'ish head angle. I think had I gone over in daylight, I would have seen the ground to roll out. Maybe. BTW - I'll probably build a slack ss when I recover.

*Feb 24 had an xray diagonosis of grade 3 separation. Not sure if that was correct as I craddled the arm and learned one must hold a 10lb weight in the injured arm to determine.

*Feb 25 saw sports med ortho surgeon #1. Used existing xray. He diagnosed grade 3. He asked a lot of questions about the nature of my work, if I was an overhead sheetrocker, etc before advising rehab. He advised the shoulder would come back with rehab, it's a bump v scar tradeoff, his proceedure is identicle if done today or in 6 mo, and the ac lig would be lost or rerouted.

Feb 27 saw sport med ortho surgeon #2. Used existing xray. He diagnosed 3 or possible 5 and mentioned the Rockwood 10lb grading method. He said 90% of people with this injury would not have surgery. We talked about the types of sports I enjoy and he advised I'm a surgery candidate.

Feb 28 after some study on the proceedure, decided to seek surgery. The product/system used is the biomet zip loop. In essence holes are drilled through the clavicle and caracoid process, a toggle is inserted to the bottom of the caracoid, poly threaded, button is placed on the top of the clavicle, pull clavicle to natural position, and surgically sew the shredded ligs. If done well all 3 ligaments can be saved and the joint is returned to natural position. Supposedly this tech is only possible within 4 weeks of injury. I liked the idea of only one rehab and intuitively I wanted to return the joint to it's natural state. I will also say, I fully detached my pectoral off the humuros 12 years ago on the same right/dominant arm. The pect surgery was a bigger surgery and without the repair the arm would not have come back to fighting form. I went on to a lot of competitive success after the pectoral repair. The arm healed a little 'different' but in time, it was rock solid. I wanted to reduce the # of anomalies to the rt side.

Mar 5 night had the surgery. I was out about 80 minutes and released for home that night. Frankly, I was very lucky to get in with a very reputable surgeon so quickly. He fit me in to a big schedule that day.

Mar 6 abt noon the nerve blocker wore off and a good amount of pain.

Mar 7 stopped opiates cause they screw up my sleep and I needed some mental ability. Did some light work from home.

Mar 10 back to work.

Mar 11 follow up with the surgeon. Took an xray to assure the hardware was in the correct place. The bandage was removed for steri strips. I noticed the scar is y shaped and bigger than described, could care less.

The 4 week go forward is my elbow needs to be within 0 - 12" of my waist. Wearing a velcro 'girdle' with elbow/wrist attachment night and day. I can take the arm out of the wrist restraint for typing. Have the go ahead for walking, riding the spin bike, sit-ups. No jolting. No at risk activities. Keep it light. And, of course no lifting of the repaired arm. Seem to be managing in the office just fine. I'll see the surgeon Apr 7.

So, it's much too early to judge the success of the surgery. And, I have learned well from prior injuries that 80% of the success is what you do after the injury.

I can also say, the day I walked in for surgery the arm was starting to feel pretty good and gave a glimps of recovery without surgery.

I wanted to share and will report back in 6 months. I really wish everyone well. We play hard and enjoy doing so. All good.

Cheers,
Tim

PS - FM - I think I descended with you on Alpine 4-5 years ago. You had a good crew. A good day.


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## FM (Apr 30, 2003)

tgus said:


> PS - FM - I think I descended with you on Alpine 4-5 years ago. You had a good crew. A good day.


Yeah AT MBO? Very likely. I was on a Yelli Screamy. What were you riding?

6 months- heal up! Hopefully things will come together sooner.


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## tgus (Sep 7, 2007)

Yes MBO FM. I was on a red spot and fell in mid pack with you guys on the lower half of Alpine. My younger brother is jgusta, although I don't always claim him...Yes, heal up!


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## FM (Apr 30, 2003)

tgus said:


> Yes MBO FM. I was on a red spot and fell in mid pack with you guys on the lower half of Alpine. My younger brother is jgusta, although I don't always claim him...Yes, heal up!


Oh yeah man, I remember!
Haven't been back since, but I'm pondering for this summer. I suppose I should make up my mind pretty quick.


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## heatstroke (Jul 1, 2003)

Grade2 here. I consider myself fairly lucky that this is my first fairly serious injury in close to 20 years of mountain biking. 

Slammed into the side of a slope,falling was ok, it was the sudden stop that did it 😄. Riding the 10 miles out was not much fun, though the downhill single track was awesome. I wish it had happened at the end of the trip, I missed the last 4 days of my mtb trip 😥. I have decent tolerance to pain so avoided meds. Sleeping was not easy though.

I am now 4 weeks into the recovery, out of the sling after 1 week. Full rom in 2 weeks. Negligible pain and a small bump at week 4. Still can't contract my upper trap muscle on the injured shoulder with ease, takes concentration and effort to fire that muscle group. That side of the shoulder feels " dumb" 

Back on the bike after 2 weeks, starting with the road bike, and in the third week the mountain bike. Road biking would leave the shoulder more sore than the mtb due to a lot more effort supporting the my weight and the riding position..

Anyway feeling reasonably confident about this, thanks to all the posts here.


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## ride the biscuit (Jun 4, 2009)

ride the biscuit said:


> heal up well!
> 
> I didnt see a dislocation thread, so mines a little different but didnt feel need for new thread
> 
> ...


well now were headding into the latter half of april 3mos and 2 weeks postop. and my shoulder is feeling SOLID. definitely more work to get to 100% but i ll eventually get close and so far feeling like i did the right thing to have surgery.

I will note that 3 weeks to a month ago i was actually having major doubts and then it started improving more rapidly, so hang in there and seek out special stretches for your injury (got to meet with my physical therapists mentor who had some awesome new drills that helped)

I basically could be already riding; actually did one uphill-only ride on tech trails a few weeks ago (just happens I could take road down). it went fine. But Im only weeks away from real MTB riding up and down. Im sure ill go easy but this is being way cautious...i've just got so much time invested in this thing. had been doing PT 2x / wk for almost 3 mos.

anyways mines' looking really good and promising for some hard charging rides late summer and plenty of more mellow rides and hard xc this spring/summer

Good luck all

EDIT: one drill that has really helped me restore strength as soon as I was able to start doing it was the farmers loaded carry. (think holding a heavy suit case and walking slowly). note that this may not be good for AC separation and that I am rehabbing from surgical repair for instability. also doing sumo deadlifts with KB has done wonders


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## heatstroke (Jul 1, 2003)

week5. Spent the last week exercising daily, working up to 5kg on middle and upper deltoid. Will continue with light weights for another week, then add another 5 if the shoulder can take it. 

No issues with pushups.

Still some pain on upper deltoid, strength is only about 50% and the shoulder tires easily. But it is improving.

Month 5 update : Been working out. Mainly mainly pushups to try and pull the collarbone into position. Went from 40 - 120 a day, and the bump has dissapeared, though my tits are getting bigger. Shoulder looks normal. Also doing other weights for the delts too. 

Apart from creaking and popping sensations there and occasional feelings of tightness across the joint, I've no other issues, though I suspect I may have some in the future as the ends rub...

Month 8 update. Had been maintaining 100-150 pushups a day, just started tapering off this last month or so. Still a little creaking and popping now and then.


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## Georgia_Rider (May 6, 2014)

Wow this is a big thread. Must be a lot of us separating our shoulders eh?
I separated my left, grade 3, on 4/10. No surgery needed (yet) according to the orthopedic surgeon. 
The weird thing is most of my pain is between my left shoulder blade and spine. I get sharp pain there, spasms, and tightness. In fact the other day it was so bad I could not work. 
Yes I have a bit of pain in my upper arm but mostly in the back. Is this common?


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## wreckingrob (Aug 24, 2007)

Georgia_Rider said:


> Wow this is a big thread. Must be a lot of us separating our shoulders eh?
> I separated my left, grade 3, on 4/10. No surgery needed (yet) according to the orthopedic surgeon.
> The weird thing is most of my pain is between my left shoulder blade and spine. I get sharp pain there, spasms, and tightness. In fact the other day it was so bad I could not work.
> Yes I have a bit of pain in my upper arm but mostly in the back. Is this common?


Sounds like a pulled muscle, which I got badly after I suffered my grade 3. Think about it. Your in pain, swollen and under/over compensating for the damage. Your posture and upper back is all out of wack. Your spine probably looks like the chicanes at Monaco...

I wouldn't go near a chiro at the moment however. Sounds like muscle relaxer time!

Hope you feel better...


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## Old Ray (Sep 5, 2010)

Georgia_Rider said:


> Wow this is a big thread. Must be a lot of us separating our shoulders eh?
> I separated my left, grade 3, on 4/10. No surgery needed (yet) according to the orthopedic surgeon.
> The weird thing is most of my pain is between my left shoulder blade and spine. I get sharp pain there, spasms, and tightness. In fact the other day it was so bad I could not work.
> Yes I have a bit of pain in my upper arm but mostly in the back. Is this common?


Lots of ways for these injuries to manifest symptoms, but you wouldn't be a candidate for cardiac problems, would you?


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## Georgia_Rider (May 6, 2014)

I don't think I have cardiac problems. I am 47 and I'm in great shape, eat right, non-smoker, and have about 2 drinks a month.



Old Ray said:


> Lots of ways for these injuries to manifest symptoms, but you wouldn't be a candidate for cardiac problems, would you?


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## Georgia_Rider (May 6, 2014)

wreckingrob said:


> Sounds like a pulled muscle, which I got badly after I suffered my grade 3. Think about it. Your in pain, swollen and under/over compensating for the damage. Your posture and upper back is all out of wack. Your spine probably looks like the chicanes at Monaco...
> 
> I wouldn't go near a chiro at the moment however. Sounds like muscle relaxer time!
> 
> Hope you feel better...


What your saying makes sense. Forgot to add that at times my thumb and index finger tingle while other times my pinky and the finger next to it tingle. Most of the time I get a dull ache in my middle finger.


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## socalMX (Oct 31, 2009)

What kind of work do you do? You should have your doc put you off for a few months, take the time to allow it to heal properly!


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## Georgia_Rider (May 6, 2014)

socalMX said:


> What kind of work do you do? You should have your doc put you off for a few months, take the time to allow it to heal properly!


I sell Toyota's. I really don't have to do any physical work other than stand, sit, walk.
I saw my Orthopedic Surgeon and he said the back pain is not necessary the typical pain you get with the separation. I am getting an AMG test tomorrow and an MRI Wednesday, he thinks I may have a broken vertebrae or disc problem. Not fun.


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## dbjohnso67 (May 17, 2014)

AC-3 Seperation + 3 cracked ribs (the ribs are all that hurt right now due to alot of bruising) on 4/10 ----
A couple questions ... Is it strange that there was never any swelling to speak of and the pain was a 5 out of 10 in my shoulder?? I'm in the stage of being very cautious about everything/every move I do ---wearing the sling , doing everything possible to not prolong getting back on the bike which brings up the second question ..I finally got in to Leadville this year and am wondering what people think my chances are of being ok to start the race ? August 9th is the date....I'm no pro and never expected to "compete" other than to make the 12 hour cutoff and aside from any general fitness type inadequacies just wondering what people think ? Its about 12 weeks of recovery time.....


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## teK-- (Dec 3, 2011)

dbjohnso67 said:


> AC-3 Seperation + 3 cracked ribs (the ribs are all that hurt right now due to alot of bruising) on 4/10 ----
> A couple questions ... Is it strange that there was never any swelling to speak of and the pain was a 5 out of 10 in my shoulder?? I'm in the stage of being very cautious about everything/every move I do ---wearing the sling , doing everything possible to not prolong getting back on the bike which brings up the second question ..I finally got in to Leadville this year and am wondering what people think my chances are of being ok to start the race ? August 9th is the date....I'm no pro and never expected to "compete" other than to make the 12 hour cutoff and aside from any general fitness type inadequacies just wondering what people think ? Its about 12 weeks of recovery time.....


Hi John and welcome,

(I have an AC3 separation and opted not to have surgery)

At 4 weeks you should really have been out of the sling for a while (I was out of mine after a week). Limit picking up heavy items and raising your arm above your head or across your body.

My surgeon told me to start physio at 5 weeks which I did. By 8 weeks I rode a 50Km XC Race and finished it without incident whilst using a shoulder support brace.

By 12 weeks I felt pretty strong and I resumed doing my usual weightlifting programs starting very light weights. I think you will be fine with your race at 12 weeks just be careful not to crash.

Sticking to a good physio routine is key. Good luck.


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## dbjohnso67 (May 17, 2014)

teK-- said:


> Hi John and welcome,
> 
> (I have an AC3 separation and opted not to have surgery)
> 
> ...


Thanks for response! Good you tell me which support brace you went with ? There are just so many to pick from and since you did a 50K in one your feedback is very valuable.

Thanks
-Dean


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## teK-- (Dec 3, 2011)

Ottobock - 5055 | Acro ComforT Shoulder Support

Very comfortable and durable. I wore it for first 4 weeks of riding now I am fine without it.


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## Old Ray (Sep 5, 2010)

teK-- said:


> Ottobock - 5055 | Acro ComforT Shoulder Support
> 
> Very comfortable and durable. I wore it for first 4 weeks of riding now I am fine without it.


Thanks for that. I'm looking for a brace, as well, and I know there are a whole lotta pretty nice-looking (and expensive) ones out there.


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## Old Ray (Sep 5, 2010)

Georgia_Rider said:


> What your saying makes sense. Forgot to add that at times my thumb and index finger tingle while other times my pinky and the finger next to it tingle. Most of the time I get a dull ache in my middle finger.


Those finger symptoms often relate to the cervical spine, and it's not uncommon to have neck and shoulder problems arise from a single trauma. 
Differential diagnosis in a case lie yours can be tricky.

Keep your eyes and your ears open at all times when going through the various medical hoops.
Btw, I only mentioned cardiac because the symptom distribution pattern you described corresponds to some patterns of angina pectoris. I have no idea what your medical history is, your family history, etc. That's stuff that a SAVVY Primary should be on the ball about. But don't take it for granted that they are.


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## lanceuppercut (Mar 9, 2010)

Has anyone had AC surgery using the LockDown device? I have surgery next week, and it is one of the methods I have to choose from.


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## mrsa101 (Jul 19, 2011)

Just went down yesterday, going to see a doctor today, but pretty certain ive got an AC separation. doesnt seem as bad as the grade III's ive heard about, I can reach overhead, have pretty good range of motion, can use my arm for most things, carry stuff, etc.. only hurts when i stretch it across my chest or stretch it over my head, or just put a lot of strain on it. 

So hopefully this isnt as severe, anyone else have a similar case? what should recovery time look like?


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## teK-- (Dec 3, 2011)

I'd say until you get the proper scans etc that you ice the shoulder and keep it in a sling.

At first after doing my ACJ grade 3 separation I thought it was nothing more than a sprain; I could lift my arms up etc without much discomfort and even the doc thought it was no big deal until I got the xrays and they put me in a sling right away.

Took me 8 weeks to get back on the MTB and another 4 weeks to feel strong.


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## mrsa101 (Jul 19, 2011)

teK-- said:


> I'd say until you get the proper scans etc that you ice the shoulder and keep it in a sling.
> 
> At first after doing my ACJ grade 3 separation I thought it was nothing more than a sprain; I could lift my arms up etc without much discomfort and even the doc thought it was no big deal until I got the xrays and they put me in a sling right away.
> 
> Took me 8 weeks to get back on the MTB and another 4 weeks to feel strong.


I cant get into the doctor until Tuesday, so trying to do a bit of self-evaluation until then. I did go see a family friend/doc that gave me a quick and dirty X-ray, but he doesnt know shoulders at all, didnt know what to look for, or what position to x ray it in. anyway, he did both shoulders to compare, both shoulders pretty much look the same, the x rays were in slightly different positions so hard to tell for sure. definitely not an actual separation like some of the x rays ive seen.

I can steer my non power steering car with my bad arm, carry groceries, pick stuff up out of overhead cupboards, do girl pushups (too scared to try real ones yet) and the overhead stretch that hurt it on day 1 is now significantly better. i can pretty much use it like normal but with mild pain. only have sharp pain if i really stretch it or do fast jerky movements.

any recommendations on stretches/exercises to start with? ill probably give it today to rest some more, then start moving it around more tomorrow.


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## scarpia (Jun 13, 2014)

Work you deltoids and rotator cuff. Don't do any exercises that make it click. After my 3rd degree separation I had to give up dips upright rowing and I couldn't do things like jumping jacks. That has kept it doing ok for 20 years. But now it has developed arthritis and needs a distal clavicle resection. But I can't even get in to see and orthopedic surgeon. I saw a NP a month ago and I have to wait another month to see a surgeon then wait 2 more months probably for surgery. It's ridiculous. I'm in so much pain that I can't use the arm. I can use it but if I do the pain gets so bad that I can't take it. 

So I just want everyone to know that if you have a separation insist on getting surgery as soon as possible or you may have to suffer months of agony before you can get surgery to fix it when it gets arthritic.


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## JoshuaP84 (Jun 6, 2014)

Well I am 2 weeks out of surgery and not feeling good! I woke up out of surgery not only with a sore shoulder but with a paralyzed left arm. Apparently the doctor either placed the clamps over my nerves during the surgery and put them to sleep or it might have something to do with the anesthesiologists...I am not sure and neither is my doctor...so basically I have a left arm that I cannot use as of right now. The doc failed to mention that this surgery could result in nerve damage. So now not only is my shoulder recovering but I have to wait and see if I get any feeling back in my left arm over the next few weeks. My shoulder is actually doing better than my arm. I have pain that shoots down from my shoulder to my finger tips because of the nerves and it sux. Makes me kinda regret getting the surgery. Apparently this is a rare thing so it only makes sense that it would happen to me.


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## scarpia (Jun 13, 2014)

JoshuaP84 said:


> Well I am 2 weeks out of surgery and not feeling good! I woke up out of surgery not only with a sore shoulder but with a paralyzed left arm. Apparently the doctor either placed the clamps over my nerves during the surgery and put them to sleep or it might have something to do with the anesthesiologists...I am not sure and neither is my doctor...so basically I have a left arm that I cannot use as of right now. The doc failed to mention that this surgery could result in nerve damage. So now not only is my shoulder recovering but I have to wait and see if I get any feeling back in my left arm over the next few weeks. My shoulder is actually doing better than my arm. I have pain that shoots down from my shoulder to my finger tips because of the nerves and it sux. Makes me kinda regret getting the surgery. Apparently this is a rare thing so it only makes sense that it would happen to me.


Get to a neurologist as soon as you can. Get many doctor opinions. There is a lot of incompetence in the medical profession. If a doc butchers you put a review up on ratemd so others will be warned.


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## socalMX (Oct 31, 2009)

Although you probably can not move your arm much rite now you should have feeling back. I recently had open surgery on my shoulder for a rotator tear and they gave me a nerve block injection while I was out. When I woke I freaked out because the nerve block also numbed one side of my chest & I could hardly breathe!


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## JoshuaP84 (Jun 6, 2014)

I got a MRI and I did a EMG nerve test the other day and they say that it is my radial nerve that is damaged and that it was probably caused by improper positioning during the surgery or they said the blood pressure cuff might have been to tight around my arm. So I am basically stuck waiting to see if the nerve will recover on its own. They say it could take 2-6 months. U know doctors spend all of their time in books and learning new ways of doing things in our advanced society that it just amazes me how little common sense they have so now I have to suffer for who knows how long because the doctor and his medical staff were to smart to realize a simple mistake. Very Frustrating!


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## NJMTB (Aug 1, 2010)

Really late reply, but this should encourage anyone with this injury...

It healed back in place. I don't even remember when it happened, but for a long time now my clavicle has been back in place. I mean you'd never know it.

I mean, I had another minor problem with my shoulder, had X-rays, and the doc literally didn't believe I had a Grade III.

Not that my shoulder is perfect, maybe it's been 90% since the AC separation, but I'm just sayin' it's not the end of the world.

Anyway you can't take it with you, right?

Happy trails everyone.


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## BermudaBrown (May 28, 2012)

Grade III, two weeks ago. Am riding mountain bike on gravel roads again, no trails. 80% range of motion, no strength. All in all, I think I'm doing well. There's hope folks!


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## JoshuaP84 (Jun 6, 2014)

Well its been 12 weeks since the surgery. The shoulder has healed nicely. I can move my arm freely without any pain expect for when I cross over my chest and grab my other arm, there is still a little pain. I still cannot sleep on my left side. I used the resistance band to strengthen for 2 weeks and then added 5lb weights to my workout. Its still weak but making progress. I was able to swim laps in the pool the other day so was stoked about that. I am able to move my wrist and fingers again but still not back to normal. I notice small changes over 2-3 week periods so yes its taking a long time for the nerves to heal in my arm but they are slowly healing. I just hope I make a full recovery. Overall I am happy with the shoulder surgery other than the fact that my wrist is ****ed but I guess there is always a risk when going under the knife. The scar is not bad and definitely looks better than that big ass deformity that was there. I am still out of work but maybe can get back to it in another 2 weeks or so.


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## notting (Oct 10, 2014)

7 months after my injury and I'm still very much torn on whether I should be having the surgey or not.

Someone else posted a timeline and I found it very useful, so here's my timeline:


Big fall on Mar 17 2014 
Plenty of morphine immediately afterwards 
Followed by plenty of painkillers for the next 10 days 
Initial AE doc xrayed and noted it was a grade 3 separated shoulder 
Shoulder consultant xrayed again and gave me an MRI scan and confirmed it was a grade 3 separated shoulder 
Week 1 - I spent the first week on a sofa (and in a sling) unable to move my body at all for fear of nudging my joint (out of work) 
Week 2 & 3 - Moving about the house with a sling. Lots of pain moving. I was unable to bath or dress myself properly (what fun!) 
Week 4 - Moving about and going into work. Started physio with no weights, aiming for range of motion. 
 Week 6 - 90% range of motion. Very little strength. 
 Week 7/8 - Full range of motion. Very little strength. 
 Week 9 - Began some physio with light weights to start to build strength. Still unable to lean on arm or on side of body. Generally quite painful still. 
 Week 12/13 - Some strength coming back to arm in certain directions. Unable to do any press ups (even from the knee). Consultant happy with progress. 
 Month 4 - Overall feeling pretty unhappy with progress. Frequent pain when moving arm across body. Excellent strength when moving arm in certain directions, very little in others. 
 Month 6 - Bit of a breakthrough. Much happier with overall strength, can do 5 knee pressu ps with a bit of pain. 

I'm now on month 7 and:


Am using 8kg weights for arm exercises 
 Can do about 10 press ups 
 Can swim 500m front crawl and 100m breast stroke (breast stroke is hard) 
 Generally "notice" my shoulder when doing any physical activity 
 Day to day, do not get much pain. But still get the occasional twinge. 
 I do get a lot of clicking day to day 

It has really improved in the 6 months, but reading other people's reports I sense that mine has been a bit more difficult that some people's injuries.

If I didn't want to ever do any more physical activities for the rest of my life I'd be quite happy. However, I dont't trust my shoulder for more extreme sports such as biking, white water rafting, abseiling.

I'm in a bit of quandry as to whether I should bite the bullet and get the surgery done or wait longer (I'm going travelling shortly so it's now or 6 months time).

Does anyone have a view on possible improvement from month 6 to 12?


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## SmittyPDX (Oct 25, 2011)

Sunday was the worst day of my life. Crashed hard on a drop that I've landed many times resulting in a grade 5 separation. 40 minutes later on the freeway driving home I was rear ended by a guy. Me sopped, him hitting me at 45mph. Surprising enough, I'm not hurt from the car accident, just a little sore. The bike, rack, and car didn't fair as well. 

Now I'm researching orthopedic surgeons and hoping that I can get in soon to start the recovery process. this crash has really made me think hard about the future of my biking. I halted my new dh bike build and began selling the parts. I think I'll be sticking to all mountain riding moving forward and leave the dh/freeride stuff for the kids. 

Wish me luck!!


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## PeytonP (Aug 29, 2011)

Update:
I was put on ice (literally, hard) and came up with a torn up shoulder on 1/29/14. When I hit the ground, my arm dislocated causing a low-grade separation and torn rotator cuff. I was on painkillers and in a sling for two weeks. MRIs showed that one of the bicep tendons is partially torn where it connects to the chest below the a/c... no way to heal without surgery which I have not undergone.

In May, I was finally able to do a pushup. In June, I opted out of riding in Santa Cruz on my honeymoon for fear of blowing the whole trip by tearing the tendon more. I'm still bitter about that one.

I was doing pt on my own for a few months, but in July I started leading an exercise class for seniors twice a week. The low-weight range of motion exercises we do has been excellent for the a/c side of recovery.

By the end of summer I could manage to sleep on the injured side for short periods of time. My back has appreciated that.

Nine months later, the a/c aches if I have my truck air conditioner pointed at it for too long, but it's otherwise healed. The ongoing problem is my r/c. I can't play basketball, throw a Frisbee, throw a football, do many pushups, or more importantly, ride a tech trail without it aching for days. Instead of a new Nomad, which was my dream bike, I recently bought a 5010 a size smaller than recommended because it gives me a more upright posture- something now needed because I can't stay in the more stretched out stance most new bikes are going for these days. 
I can't charge downhill as well anymore because I can't throw the bike around like I formerly could. Every bunny hop to get over a rock garden or even to climb a ledge is a roll of the dice- I never know when I'll feel that familiar painful twinge of the compromised tendon "unthreading" just a little bit more.

Obviously, this is very frustrating, but I'm thankful that my a/c separation was not more severe with surgery being absolutely required. It took all summer to pay off the doctors and MRIs. I'm hoping that as more time passes, the muscles around the problem area will continue to compensate.

Has any one other than me suffered tearing of the shoulder beside the a/c separation? Did you have surgery or wait it out? What is the result of either option?


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## SmittyPDX (Oct 25, 2011)

Update: Got a 2nd opinion...and a better opinion. Doc says it's not a grade 5, but a grade 3!!! 

Question I have for everyone is when should I start PT? I'm reading that some of you started a couple weeks after your accident and then others months after. Any insight on what route you took and whether or not you'd recommend it now. 

Thanks


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## BermudaBrown (May 28, 2012)

SmittyPDX said:


> Update: Got a 2nd opinion...and a better opinion. Doc says it's not a grade 5, but a grade 3!!!
> 
> Question I have for everyone is when should I start PT? I'm reading that some of you started a couple weeks after your accident and then others months after. Any insight on what route you took and whether or not you'd recommend it now.
> 
> Thanks


Start moving and PT as soon as you can move it without pain. I've talked to numerous people who didn't... they regret it! That said, MAKE SURE it's all without pain.

I'm 5 months from a massive separation - full movement is back, very occasional stiffness, and about 70% strength on things like push-ups, bench press, shoulder-specific weights, etc. I hope to get 90% by a year out and think it is entirely possible.

Good luck, it's not the end of the world, even though it will seem like it today (and tomorrow...)


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## Giant Chachi (Jan 9, 2012)

Alright boys and girls, tomorrow is my one year anniversary of my grade 3 separation without surgery. I will say that although I have the nasty and dreaded "shoulder bump", my shoulder feels pretty good. After a year, I would say that I have about 95% range of movement, and strength around 90%. Overall, my recovery has been pretty good. The wreck happened on 11/11/13, and I was back on the bike in February. Granted, I wasn't anywhere near where I am now, but riding is a big part of my fitness, and sanity. But I did work really hard on shoulder exercises and getting the strength back, as I understood that to be a key to the recovery. 

Yesterday, I rode the same trail that took me out a year ago, and while I stayed off the feature that I slide out on to injury my shoulder, I was pushing myself like I normally do, and enjoying every second of it. 

I wish you all the best on the road to recovery. This sure seems to be a common injury for us MTBers. Good luck all!


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## g00mba (Mar 9, 2011)

notting said:


> 7 months after my injury and I'm still very much torn on whether I should be having the surgey or not.
> 
> ...
> 
> ...


Hey Notting,

I put up with the injury for a year. At first I hoped it would heal or that I could grow to live with it, but all I can say is that after 6 months I was miserable with it and I had to get it fixed.

I think you are right in pointing out that some separations are worse than others. My Surgeon didn't grade mine, but my whole shoulder was out of whack. A lot of people say they don't really notice it anymore, but I was aware of mine every single day. Every time I picked something up, carried a shopping bag or got up off the floor, even walking around or sitting down I could feel my shoulder blade against my shirt or the back of a chair because the whole thing was rotated from my sagging arm.

I put myself in for surgery because the whole thing was driving me nuts, and its the best decision I ever made. Sure the recovery was months and I had to work for 4 weeks with my arm in a sling (I have a desk job so its manageable), but now I can do things easily that I couldn't do before, what you say about press ups really struck a chord with me because I could only manage one or two and that was while ignoring the sensation that my shoulder was coming apart.

2 years later and I'd almost forgotten what a hideous experience it was to have that injury. Sure some people get on fine, but not all separations are the same and if you are really struggling after 6 months then I think you should really consider surgery.

The only thing I regret is not finding the best surgeon to do it. I;m in the UK nad had the surgery done free. The procedure was the Nottingham Surglig, but the surgeon didn't have much experience. As a result the surgilig he put in is too long and I still have quite a bit of movement in my collarbone(probably to the same degree now as people who have had he injury but say they cope with it), but nothing like how it was before.

I don't know where you are or how you are set for health insurance, but if you can get it done and you find a surgeon that's done it a few times before then I say go for it.

I'm back on the bike, training hard and doing everything that I was doing before the accident including press ups, swimming, weights etc. Like I said the surgery could have gone better, but I don't regret for a minute getting it done. If you are going travelling and have 8-10 weeks to get over surgery then you have plenty of time to recover fully.

Oh, here's what my shoulder looked like. I think its a bit worse than some of the others posted up, so maybe yours is a bit like this too?

Good luck with whatever you decide to do.


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## g00mba (Mar 9, 2011)

Notting,

So thinking about this I thought I'd do a little reading again and I'm pretty convinced that I had a grade 5 injury, and maybe you do too. According to Wikipedia:

Type V
This is a more severe form of a type III injury, with the trapezial and deltoid fascia stripped off of the acromion as well as the clavicle. This is type III but with exaggeration of the vertical displacement of the clavicle from the scapula. Distinguishing between Type III and Type V separations based on radiographs is difficult and often unreliable between surgeons.[5] Type V is manifested by a 2- to 3-fold increase in the coracoclavicular distance.[4] The shoulder manifests as a severe droop, secondary to downward displacement of the scapula and humerus due to loss of the clavicular strut.[4] This injury generally requires surgery.

That pretty much describes my injury. I definitely had a drooping arm which felt like it was always dragging me down, and displacement of the scapular that I mentioned in my earlier post that I was always aware of. So if you aren't sure of the degree of your injury then maybe this description helps you to make up your mind. I'm pretty sure that most people that say that they are fine after a couple of months don't have a grade 5 injury.

Anyway, hope that helps a bit with your decision.


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## redpoint (May 23, 2014)

*My advice ...*

I thought I'd offer my own experiences/advice.

First of all, for the average human, shoulder separations aren't a huge deal unless they become chronic. For really active people, or people who occasionally hit the ground like us mountain bikers, even a minor separation can lead to a lifetime of shoulder instability. It's a nasty injury largely because the shoulder is an inherently unstable joint and minor physiological defects [from dislocation] can lead to instability and reoccurrence.

Here's my timeline:

Right Shoulder

1997 - dislocated right shoulder when I took a minor [could have been *a lot* worse had I landed differently] ground fall while rock climbing. Rehab'd went on to live life pretty normally.

2004 - had a bad ski fall, dislocated right shoulder again. Rehab'd, but shoulder always felt unstable at times, especially in the cold. Scared the crap out of me given my love of exploring wild places deep in the backcountry with no help available [skiing, hiking, mountaineering]. In some situations, a shoulder dislocation would have left me in a real bind.

2011 - Decided to have a Bankart Repair - awesome decision. Shoulder has been stable, feels great. Arthroscopic procedure, about the same recovery time as dislocating your shoulder.

Left Shoulder

2008 - slipped while hiking in the backcountry [totally lame]. Dislocated my good shoulder. Rehab'd, shoulder responded well. Felt totally solid. Decided to hold-off on getting any surgical work done.

2014 [Nov. 11th] - After a long hiatus from mountain biking I get back into mountain biking this past June. Love-it, ride a lot, bought a new bike. Head-out for a ride last Tuesday, climbing-up a climbing trail, rear tire spins-out on a root, bike stops, I put my foot down and for whatever reason, lost my footing and rolled onto my right side. Note that I said right side. Came away with a dislocated left shoulder - wtf? A 90 year old woman with severe osteoporosis could have walked away from that one! Anyway, I guess it wasn't as stable as I thought. I've had lots of nasty spills over the past few months with no injuries. Took the emerge docs a long time to reduce the joint; they eventually had to knock me out on Propofol and Fentanyl [the only upside to shoulder dislocations].

I will definitely be trying to get surgery on my left as well.

Advice:

1] Get it rehab'd by a good physio. When it feels better, KEEP IT STRONG with weights etc. Having been so pumped about getting back into mountain biking, I had long since given-up on weights. That was most likely the reason my shoulder dislocated as a result of such a ridiculous "fall".

2] If you've had a couple of dislocations, go see an orthopaedic surgeon. I was insanely nervous about my shoulder surgery and it was really no big deal. If I could get my left operated on tomorrow, I would. Unfortunately, I'm probably looking at a year or more wait time.

Anyway, I feel for all of you, it's a tough injury to deal with.

Anyone have any experience with braces like these: SB03 Shoulder Brace - Shoulder Support - Support/Belts - MOTO

Seems like a better alternative to giving-up skiing and mountain biking for a year or more.


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## jimw (Aug 10, 2004)

redpoint said:


> Anyone have any experience with braces like these: SB03 Shoulder Brace - Shoulder Support - Support/Belts - MOTO


I just bought one of those. I had a very mild AC separation a few weeks ago. Barely grade 1, just felt like a sprain. Didn't bother me unless I pressed directly on the AC joint. Went to the doc anyway just in case; confirmed no fracture and probably mild AC sep. Specifically said to stay off the bike for a while. The next week it felt fine so I thought I'd go for a ride and "take it easy"... which apparently I can't do. I randomly crashed in a spot where I've never crashed before and went down hard on the same shoulder. Fortunately even that wasn't too bad, and I'd say it's still at grade 1. Anyway I picked up an SB03 brace just to try it out. I figured it should keep the joint more stable during the healing, and later it would help when I feel good enough to ride.

I actually rode with it the first time yesterday. Like I said my injury is really mild compared to most here, though I do have some experience with worse - my other shoulder has dislocated several times. I'd say the brace gives some support, but not a ton. Like you would want to feel pretty good/strong *without* the brace before considering doing a ride *with* the brace. Mainly it pulls the arm towards the body at the shoulder. It's not going to prevent re-injury, but gives you a little bit of additional shoulder support.

I also tried using some KT tape, and that helped a bit too... though it's a pain in the ass to try to put that on yourself! 



> Head-out for a ride last Tuesday, climbing-up a climbing trail, rear tire spins-out on a root, bike stops, I put my foot down and for whatever reason, lost my footing and rolled onto my right side. Note that I said right side. Came away with a dislocated left shoulder - wtf?


The worst part about this is that since you were going uphill, you probably had your GoPro turned off, so you didn't even get some cool crash footage out of the deal!  At least, that's usually one of the few things that has helped me keep a sense of humor through my various mtb injuries...


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## jp08865 (Aug 12, 2014)

MRI shows I'm the latest victim of an AC Cartilage Injury. As soon as it feels better I can have the other shoulders Rotor Cuff repaired (rough season).
There goes my 'SES 15' Boarding Trip to Aspen. 
Thanks for all of the good information here!


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## SparkyAlumni (Jul 22, 2005)

*Guess I can hang out with you guys now...*








Yesterday, I became the victim of a seperated shoulder (off a drop that I've done several times... apparently, I landed fine, but, my tire washed out!). I didn't even have time to realize I was gonna crash... Shoulder hit, then my head.
Had to walk down the steep trail (about 45 mins, then another 10-15 on the fire road). Couldn't believe the pain that was involved. Got to the E.R. and after meds (I asked to be put out!), woke up to a reset shoulder. Doc said no breaks or tears, just lots of rehab in my future. 
This $ucks, because I'm freakin' out about how long I will be unable to do anything and how long before I'm "almost" back to normal (I know I'll never be - its the price we pay for what we do - but, [email protected])
Oh well, all in all, guess I'll have more quality time with my new couch/TV.


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## FREEDUM (Oct 30, 2014)

me about to go otb

just got the x ray today was lucky enough to only have a grade 2 ac joint separation last tuesday. i already have pretty much full range of motion with almost no pain unless i do quick movements. slammed otb on a fairly big jump. making me reconsider my dirt jumping.


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## yboc (Nov 4, 2012)

This thread makes me feel really lucky. I had a grade 3 separation last September. I didn't really have much pain and had my full range of motion back after a week and was back on the bike after 3.


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## Sally Gibson (Jan 14, 2015)

Hi there, I've never posted before but this thread is exactly what Ive been looking for. I have this exact injury and have been desperately searching for advice from people in similar situations. I suffered a fall on the 12th December causing a grade 3 separation... or so the Dr says, I am in disagreement with his diagnosis and am currently waiting for a second opinion. One month later I am still out of work as I have a physical job and even walking more than 10 minutes solid causes a painful ache that lasts for hours. If anything the dislocation looks worse to me, however my ROM is back about 80% but can still bear no weight with it.







__
Sensitive content, not recommended for those under 18
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I would like other peoples opinions who have had the same injury whether mine really is a grade 3 seperation as I have only ever had one xray at the time of my injury. 
Many Thanks.


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## TranceX (Dec 24, 2011)

Sally Gibson said:


> Hi there, I've never posted before but this thread is exactly what Ive been looking for. I have this exact injury and have been desperately searching for advice from people in similar situations. I suffered a fall on the 12th December causing a grade 3 separation... or so the Dr says, I am in disagreement with his diagnosis and am currently waiting for a second opinion. One month later I am still out of work as I have a physical job and even walking more than 10 minutes solid causes a painful ache that lasts for hours. If anything the dislocation looks worse to me, however my ROM is back about 80% but can still bear no weight with it.
> View attachment 955461
> View attachment 955462
> View attachment 955463
> ...


Welcome to the lumpy shoulder club! Grade 3 here back in 2012....no surgery. I'm fine and ride all the time. It takes awhile but things get better... not sure why but even my lump seems to have gone down a little. Surgery is an option if you want it. Good luck!


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## socalMX (Oct 31, 2009)

That is not grade 3! I had a grade 3 and my bump was half that size. I would def get a second opinion. I had a few x-rays taken on mine confirming it was a grade 3 and opted out of surgery. Get that looked at for sure!

Crazy thing with mine is, I did let it go and felt ok, a year later I had another crash and that completely tore my rotator cuff. My surgeon said the AC separation most likely weakened my rotator causing it to easily tear (crash wasn't even that bad)....So, had full open surgery 8 months ago, IT DID NOT WORK, had ANOTHER surgery last week. :madman: This time around the surgeon cut off almost 3/4" of the tip of my collar bone and added much more anchors to hold my rotator together. If all goes well I could be back out on the trails in 6-7 months! Knocking on wood...


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## tgus (Sep 7, 2007)

*Follow Up 11 months after injury and 10 months after surgery*

In the earlier post I advised I had a RW 3 and possible 5 separation, surgery in March with biomet zip loop 3 weeks after injury, and simple sutures on the 3 ligs.

After abt 2 months after surgery I noticed the bump coming back and less strength. The work progressively came apart.

Now 11 months after injury and 10 after surgery my separation is at a 2+ or 3. The AC is gone and the CC's are likely stretched.

I visited surgeon #3 (a guy I really like, who put my pect back together, but was on sabbatical in Mar) last Friday and he advised my clavicle was stable enough to not warrant another surgery. Meantime, I've returned to mountain biking after 9 months of strengthening and quite happy about that! Not confident enough to return to sparing.

What I've learned: This injury is a bich. Surgeons are often reluctant because of higher than acceptable failure rates. In hindsight, I think that had my clavicle been better tied down and had either a graft or additional pins been introduced the results would have been better. I suspect the multitude of surgical methods available is evidence the medical community cannot agree on the single best practice. Importance of rehab cannot be understated. Pay attention to body position and all rehab needs to be measured.

What to do: Get this thing in the best working order as possible and use it! I'm not getting any younger.

My best to all of you. Tim


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## FREEDUM (Oct 30, 2014)

Sally Gibson said:


> Hi there, I've never posted before but this thread is exactly what Ive been looking for. I have this exact injury and have been desperately searching for advice from people in similar situations. I suffered a fall on the 12th December causing a grade 3 separation... or so the Dr says, I am in disagreement with his diagnosis and am currently waiting for a second opinion. One month later I am still out of work as I have a physical job and even walking more than 10 minutes solid causes a painful ache that lasts for hours. If anything the dislocation looks worse to me, however my ROM is back about 80% but can still bear no weight with it.
> View attachment 955461
> View attachment 955462
> View attachment 955463
> ...


i only had a grade 2. but yours is sticking out way more then mine haha


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## Ruffstuff (Jan 12, 2015)

I had an ac dislocation from a motorbike accident 12 years ago, damaged the end of the bone, all ligaments etc, it was out for 5 months but i never got the lump ?? Weird huh, my collarbone sticks out a bit more at my chest tho.
Worst injury ive ever had and ive had a few. Ive actually developed phantom limb with it after a decade of rubbish doctors ignoring me telling them there was something up.
Has anyone suffered something similar ?
Im currently getting physio to try an build some muscle in the joint to try and stop it getting strained on the bike and pain management for my brain weirdness ha 

Give it death


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## Rickster00007 (Jan 15, 2015)

Sally, I got a grade 3 after going over the bars in November. It felt like someone was sitting on my shoulder up until about 2 weeks ago. I started physio a week ago. The bump wasnt as prominent as yours and mine doesnt really stick out at the back. Interestingly i was back at fracture clinic this morning and the surgeon said if it was sticking out at the back they would look at surgery. I would deffo get a second and third opinion as it doesnt look too good. Dont be put off. Is going private an option for you ?


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## Sally Gibson (Jan 14, 2015)

Thanks for the input everyone. I am visiting a physiotherapist as per the first doctors instructions tomorrow, as I'm still waiting for an appointment with a different consultant at another hospital. Unfortunately private is not an option for me  My bump moves a lot, when I move my shoulder in certain positions it can come out about an inch and it crunches and grinds, in other positions it goes right down (like the last photo in the precious post) I'm undecided as to whether I'm doing more damage by moving it though :/ it seemed to steadily heal for about 3 weeks when I was in a sling and since I've been out of the sling the healing seems to have nearly stopped and the more I move the more it hurts. I will update after my next appointment.


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## Rickster00007 (Jan 15, 2015)

I had mine in a sling for 2 weeks and when that came off they said not to really do anything with it for the next 4 weeks as the scar tissue is starting to form. After the 6 week point i started using it again and started physio and it now seems to be getting stronger every day and the pain is subsiding.


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## ez3330 (Jan 19, 2015)

hey everyone, week into the ac separation club, grade 2-3, over the bars on my fatbike
ortho doc is leaning towards open surgery done by weaver-dunn with allograft procedure.
does anyone has experience with this type of surgery?
my shoulder feel very good only after week, already biking on my road trainer etc. however i'm a swimmer and i'm planning to swim about 9 hours a week. 
does anyone here has a experience with often and long swimming after ac level 3 separation without surgery? i'm worried that if I will not do surgery than I will not be able to swim as often and as long as I used too.
thanks!


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## Burning Matches (Mar 14, 2011)

ez3330 said:


> hey everyone, week into the ac separation club, grade 2-3, over the bars on my fatbike
> ortho doc is leaning towards open surgery done by weaver-dunn with allograft procedure.
> does anyone has experience with this type of surgery?
> my shoulder feel very good only after week, already biking on my road trainer etc. however i'm a swimmer and i'm planning to swim about 9 hours a week.
> ...


I am a swimmer also and had a grade 3 about six years ago. Per my doctors, surgery was not recommended. It took about a year to get all my ROM and strength back, and swimming felt very strange for while (almost like my collar bone was poking up through my neck). Eventually I got used to it and don't think about it anymore.

But long story short, yes, swimming was affected by the injury at first but eventually it was no longer a problem. If you stick to your therapy and allow it time to recover, you should be OK.


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## ez3330 (Jan 19, 2015)

Burning Matches said:


> I am a swimmer also and had a grade 3 about six years ago. Per my doctors, surgery was not recommended. It took about a year to get all my ROM and strength back, and swimming felt very strange for while (almost like my collar bone was poking up through my neck). Eventually I got used to it and don't think about it anymore.
> 
> But long story short, yes, swimming was affected by the injury at first but eventually it was no longer a problem. If you stick to your therapy and allow it time to recover, you should be OK.


Thanks a lot! I appreciate your input.


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## Sally Gibson (Jan 14, 2015)

Now 6 weeks since injury and after one physio session I'm getting a little movement back. Have also been advised to strap it up and have been using rocktape which seems to be helping too. I'm going to have to wait roughly 2 months for a second opinion from another consultant though, so physio is my only option until then. Despite how majorly my bone is sticking out, healthcare professionals seem to think it will still be fine with just physio. Fingers crossed!!


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## Vince D (Dec 10, 2014)

I suffered a grade 4 separation to my left shoulder last august. The injury had ended my competitive archery life but I am still riding. As for my "lump" I plan to get a little smiley face tattooed on it!!


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## Zignzag (Jan 23, 2004)

Vince D said:


> I suffered a grade 4 separation to my left shoulder last august. The injury had ended my competitive archery life but I am still riding. As for my "lump" I plan to get a little smiley face tattooed on it!!


Grade 4? Are there different classifications of ac separations? All I've ever read about was 1 2 and 3, with 3 being all ligaments severed, hence the bump. How can it be worse than that?


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## Vince D (Dec 10, 2014)

Zignzag said:


> Grade 4? Are there different classifications of ac separations? All I've ever read about was 1 2 and 3, with 3 being all ligaments severed, hence the bump. How can it be worse than that?


There are actually 6 types. If you google shoulder separation,wikapeda has a real good informative read.


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## jp08865 (Aug 12, 2014)

moved


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## Sally Gibson (Jan 14, 2015)

So my consultant has now decided I do need the operation, Yay  Has anybody else had the ligament reconstruction at the same time as the shoulder construction?


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## socalMX (Oct 31, 2009)

Shoulder construction? Not sure what you mean but my surgery 3 weeks ago, while repairing my rotator cuff the surgeon cut off the end of my clavicle about 1/2", apparently my grade 3 from a few years back (did not have surgery from that) left the clavicle in the way of good rotation!?

You will be just fine and when fully recovered, happy that you did it, just make sure the surgeon has plenty of experience!


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## Sally Gibson (Jan 14, 2015)

Sorry, I meant reconstruction, that's what the surgeon called it. I think by his explanation, he's going to pin the ac joint back where it should be and put in an artificial ligament. I have been told by a quite a few colleagues of the surgeons now that he is the top shoulder specialist in my area, so all my faith is in him now!


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## TheKetchupMan (Jun 8, 2010)

I joined the club almost 5 weeks ago (the "I don't need an AC Joint" club). Went OTB because I was trying to be careful going over a boulder and landed pretty hard on my right shoulder. My friend who was with me (who coincidentally had separated both of his shoulders) was a big help and took me to an urgent care, where they took an x-ray, gave me a sling and vicodin, and said to see an ortho asap. Ortho said I have a grade 3, but over the past few weeks I've been noticing pain that makes me think that not all of the ligaments were severed (maybe I'm a grade 2 instead). The first few days were horrible, but within a week I was out of the sling in fear of getting a frozen shoulder. I've been going to PT for 3 weeks now, and they have been giving me some great shoulder exercises. A big part what I get from PT is them helping me get my confidence back in my ROM (instead of just completely babying the shoulder). I have most of my ROM now (no real strength above the shoulder yet), and I think my biggest limits now are fast movements and moving my right hand completely across my torso toward my left shoulder. I started riding my road bike on the trainer 2 weekends ago, and the shoulder is uncomfortable but not painful, and started trail running last week. I'm a rock climber too, and immediately after the crash I was pretty angry at myself since this is the second time in 8 months I've had to stop climbing because I suck at mountain biking. I went through the 5 stages of grief within an hour of my injury, and have just been working as hard as possible (without causing any pain to my shoulder) to get back to everything as soon as possible.

Update (4/3/2015):
I'm close to 3 months since the injury. At almost exactly 7 weeks, I started rock climbing again. I used to lead climb 5.11 indoor and high 5.10 outdoor, and I'm just now breaking back in to the 5.10s outdoor again. This is more due to not climbing for 2 months than due to the injury. At first I could feel a bit of pain, now I only really notice a bit of discomfort. I started mountain biking again at like 10 weeks. I probably could have started earlier, but I didn't want to screw up and hurt myself again. Good news is that I don't notice the shoulder at all mountain biking (haven't fallen on it yet, and I hope not to). I think the only real thing I notice about it now is that I still can't reach across my centerline or behind my back as well as I can from my non-injured side, and I think my scapula is kind of pointing the wrong way (I'm guessing due to my shoulder now hanging on its own instead of from the clavicle).


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## giantfox (Aug 13, 2012)

hi
just dropping in with an update, mostly for anyone new who is confused with the different opinions/advice.

i am now 2.5 years post my grade 3 separation (no surgery)

apart from the occasional twinge, i have absolutely no issues. it is 99.5% good, strong, full range of movement.
i do everything i did before, ride, ski, SUP, golf, climb, no issues.

i started body pump class at my gym 5 months ago, absolutely fine.

i would only say two things.
1. don,t expect a quick recovery, mine took 9 months to "heal"
2. you really need to keep using it - right from the beginning. Move it and use it as much as you can stand the pain.

hope this helps.


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## giantfox (Aug 13, 2012)

duplicate


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## giantfox (Aug 13, 2012)

Sally Gibson said:


> Hi there, I've never posted before but this thread is exactly what Ive been looking for. I have this exact injury and have been desperately searching for advice from people in similar situations. I suffered a fall on the 12th December causing a grade 3 separation... or so the Dr says, I am in disagreement with his diagnosis and am currently waiting for a second opinion. One month later I am still out of work as I have a physical job and even walking more than 10 minutes solid causes a painful ache that lasts for hours. If anything the dislocation looks worse to me, however my ROM is back about 80% but can still bear no weight with it.
> View attachment 955461
> View attachment 955462
> View attachment 955463
> ...


i would definitely get a 2nd opinion on that. Unless you had terrible posture before....


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## Sally Gibson (Jan 14, 2015)

giantfox said:


> i would definitely get a 2nd opinion on that. Unless you had terrible posture before....


Well actually according to my physio my posture is pretty bad and I roll my shoulders in when Im sitting naturally, I hunch my back a bit. However the dislocation I still think was worse than a grade 3, the bone literally moved about all over the place in my shoulder and was incredibly painful. The surgeon however still called it a grade 3, despite other health professionals saying it was worse. I've now been operated on, I had the ac joint pinned back together and a new ligament attatched 5 weeks ago now and its healing really well, Just have about a 4 inch scar down my shoulder now. Its week as hell but after being a sling since december pretty much Im not surprised. Now I have to really stick to the physio to get the strength back. Id say its 100% better after the operation but as you can see by the photos from before, Im actually a little amazed I was left with such a badly dislocated bone for nearly 3 months without it being operated on!!


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## SCtriton (Mar 29, 2015)

Hi giantfox

I spent 2+ hours reading these posts going back 3+ yrs. It's been quite sobering in that it is crystal clear this will be a long term recovery - months, potentially years not the 4-6 weeks posted on some medical Web-sites. 

I recall from your previous posts that you attempted to resume surfing. You did not mention in this last post. If so, were you able to surf again?

I am in the same situation now that your were in. I'm 54 and suffered Grade 3 two weeks ago late night downhill skateboarding on a hill I owned but this time the street was wet and the wheels slid out on a steel sewer cover.

My current status is very similar to other posts at the 2 week period. I am riding a stationary bike in a gym (painfully boring) and use machines to work my body using my healthy arm. I started working the injured arm doing hi reps with 5-10lb weights. Its feeling better but far from normal. It hurts to just hang from a pull up bar when I could do 25 in a row before the injury.

Saw 2 orthos (day 3 next day 10) sticking with the 2nd as the first guy did nothing other than prescribe a sling for 4 weeks. 2nd ortho did my knee surgery and I trust him; he's my age and surfs a lot - given my options he would not do surgery if he were in my shoes. He said its 6 mos pain and no guarantee it will take.

He did several ROM tests on my shoulder, said I can lose the sling and prescribed PT ASAP (my first appt is this week - 2.5 wks from the injury) He said that surgery is still an option but will know more in about 8 wks. He confirmed there is no risk to waiting. 

I spoke with 4 buddies, 2 did the surgery and are fine. The 2 that did not; one says he is 100% - swims 2miles 2-3x's week, does triathlons, swam Alcatraz, etc. But, the other guy still has issues 4 years later with pulling or pushing (means pull ups and push ups that I need for surfing).

If there is even the slightest risk that I will not be able to surf again (short board barrels - not longboard) with the same strength then I am going to push for surgery. Its 4-6+ at my local beach breaks but I am off to the gym. This sucks.


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## The STIG (May 20, 2011)

i tagged a tree on a section of downhill singletrack, june 2014. self medicated and bought a sling and a shoulder brace. went and had a few xrays a week later...24 mil separation..whatever grade that is i dont know, my other shoulder measured at 11mil.

to many surgeries to list, so i just let it heal with the bump. 7 days after the wreck i was riding my road bike, did that for 3 weeks. got back on the mountain bike at about 4 weeks. shoulder would twinge at times, although i could tell it was getting better mountain biking kinda plateaued my recovery. i had to back out of some great races i had signed up for..sucks. finally pulled the plug around late november for a month or so and just stayed off the bike. all in all mine took about 8 months to get back to it doesnt bother me at all, riding ...working [carpenter] ...im back to my old self with no limits


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## TreedodgerBob (Apr 1, 2015)

Just had a grade 5 separation a couple days ago. In regards to surgery... I know that they tie/screw the clavicle and acromion back together. But do the ligaments actually heal after surgery?? Or does surgery just bring the bones closer and a bunch of scar tissue and artificial hardware hold them together?


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## Gravey36 (Apr 5, 2015)

I too suffered a serious Grade 3 to my left shoulder. I just reached 5 weeks yesterday. I've been playing hockey for 34yrs and this is my first injury (knock on wood), so obviously it scared me. After reading several posts in here my mind is at ease that I will have a full recovery without surgery. I have a very significant bump on the top of my left shoulder from my collar bone being pushed up. I started physical therapy just over a week ago and I can barely lift my own arm without significant shaking. I have minimal pain 5 weeks in, but my range of motion is not back to normal yet (hopefully soon). 

I saw an Orthopedic Doctor who treats the local AHL Hockey team affiliated with the Calgary Flames and he said they typically do not perform surgery and most, if not all of the players have full recoveries. I was told that 8-12 weeks I could be back on the ice with no lasting effects of the injury (other than the deformity on my shoulder). 

Thanks for this forum to setting my mind at ease.


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## The STIG (May 20, 2011)

you could be back on the ice now..... but dont hit it again while its not healed!!! or you'll start all over again. you'll feel the occasional twinge now and then for months, thats the sign that says back it off a bit. when the twinges go from now and then to "doesnt happen anymore" i consider it fully healed. its what/how far/hard you push it in-between that determines the length of recovery time, in my opinion.

im a carpenter and own my own business, i pushed it everyday at work and then trying to keep my legs mtb'ing. it prolonged my recovery. if i had a desk job and only pushed it riding, i feel it would have been a little quicker. but it is what it is. about 8 months for me. dont rush it man, and pay attention to the "signs". get better!!!


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## SLKRick (Apr 8, 2015)

I suffered a grade 3 separation about 4 weeks ago after I went over the handlebars with my full weight directly down on the point of the shoulder. 

So far, so good. My doctor advised against any surgery, and, like others here, I know I'll have the bump now which really isn't so noticeable unless I point it out to people. 

I've been doing basic band exercises my doctor showed me (arm straight up, sets of 10: pull forward, rearward, and then each side, repeat), which makes the shoulder feel great. 

Are there any specific exercises anyone here has noted helps them the most in terms of strength and ROM? Thanks in advance.


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## geetarmano (Apr 23, 2015)

*Grade 3+ sep*

Hello fellow bumpy shoulder peeps!

So my story goes as follows. Approx 5 weeks ago got a grade 2 on my road bike. Got pretty down and was starting to get depressed due to pain, discomfort, realization of permanence of appearance and all the other fun things that go with this injury. Two weeks later got a dream job on the water as a bartender a block away (make 3x what I used to as a cook). Bump went down, got back to biking, hiking, jogging, surfing and playing guitar. Put injury behind me. I wish I had continued to read this forum...

A week ago riding some neighbor kids kicked a basketball out in front of my tire and it hit perfectly to where I got speed wobbles and crashed. Now I've graduated to at least a grade 3 (I suspect it might be 4 due to the fact my shoulder blade sticks out my back somewhat and collarbone has vanished. My neck is hurting like hell and have constant muscle spasms in my shoulder blade. Of course the pain is pretty bad (still about a 6/10) and everything in that area feels out of place. The lump and droopy shoulder are really messing with my mind as I now look like a circus freak. The hardest part is dealing with fact that I just feel physically of balance. I can handle the pain but the thought of one side being different than the other is really disconcerting.

After reading this forum quite obsessively for the last week or so I have compiled a broad overview of surgery v. Non surgery routes. There are many variables with both sides (ie types of surgeries, PT excercises, Dr. Advice, degree of injury, etc) so my findings might differ from someone else's.

I have found that (approximately) with the non surgery route 27 were mostly pleased, 12 were mostly unhappy, and 16 were split (due to either not full recovery or dissatisfaction from appearance). 3 eventually bit the bullet and got cut.

The ones that went the surgery route were as follows. 39 were happy, 3 were not and 3 were split. The ones that weren't happy suffered complications from surgery such as infection, nerve damage, and or loss of ROM/strength. All of them stated that the surgery was incredibly painful and recovery time was slow/tedious.

I have state funded insurance so the treatment at the hospital is hardly top notch. Met with a specialist 4 days after the grade 3 and he asked what I do for a living. I told him bartending and was sort of dismissive saying I'll be fine with time. I explained that tending bar is somewhat laborious being that I have to move full kegs in and out coolers, grab cases of beer from walk in, and reach for bottles at above head height. He then suggested fixation. I go back in 4 days to decide.

As much as I would like to just deal with the pain and go back to work, resume bike riding/hiking/guitar playing, avoid surgery and all the details with that (there's a lot), I think I'm going to go for it my insurance covers it (come on Obamacare)!

My questions are for those of you that went with non surgery,
How long did it take before you felt your body "normalize" to a more even balance?
Did the bump (more like a lump) go down after you recovered?
Do you worry about falling on it again?
(Could it get much worse like collar bone getting into the neck or lungs)
Those with surgery
What foods/diet worked best for recovery?
How long did the pain last from surgery?
What were risky movements post surgery that could snap ligament?
What devices are beneficial to recovering quickly and comfortably?

This is a really tough injury both mentally and physically. I was really depressed the first week and pray to the universe that can scheduled next week for an op. I going to just stay positive, proactive and hope for the best because that's all I can really do right now. I Know It Will Get Better. It can't rain forever

Decided against surgery after all. I didn't want to lose my job and and prolong recovery time. The thought of not being able to ride or play my guitar for 6 months with the surgery route was my deciding factor. I'm still coming to terms with the aesthetic value of it all as I'm not used to having a physical abnormality. I kinda felt that it would limit my chances of finding a girl that would find me attractive. I'm looking for a long term relationship and am over the "hooking up" phase of my life so in the end if said girl can't see past the bump then she probably isn't good for me anyways.

The silver lining that I've found is this injury was the final straw with my relationship with alcohol. I initially suffered a grade 2 from drinking and riding so even though the injury sucks it's helping me be a better version of myself in the long run. Like a lotus flower I had to suck up some shitty substance to eventually blossom. I just hope the conservative route doesn't affect my guitar playing stamina.


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## Scottwax (Jan 18, 2009)

geetarmano said:


> My questions are for those of you that went with non surgery,
> How long did it take before you felt your body "normalize" to a more even balance?
> Did the bump (more like a lump) go down after you recovered?
> Do you worry about falling on it again?
> ...


I did not have surgery. The orthopedic specialist I saw said while I was an excellent candidate for surgery, my insurance company would consider it an aggressive form of treatment and he assured me my recovery would be quicker without surgery than with. And he was confident I would make a full recovery.

I wasn't able to tie my own shoes for about a month after my grade 3 AC separation, it was pretty painful for quite a while. After that though, it seemed to improve pretty rapidly. I was able to ride again after 5 weeks with minimal discomfort although my range of motion still wasn't that great. It was probably 4-5 months before I felt pretty close to normal.

It will be 4 years since it happened in a couple weeks, other than an occasional clicking feeling when I rotate my right arm over my head windmill style, no problems. I am able to throw a baseball, football, bowl, swing a bat, lift weights, etc. Range of motion is at least as good as my other shoulder. No issues sleeping on my right side either. No worries about re injuring it, we all know that bike riding has inherent risks and when you get on a bike, you are accepting the risk of potential injury. I've taken a couple tumbles on my MTB (been a roadie for years, got a MTB right after Christmas this past year) and no problems at all.

No real lump either, you really have to look to see it. I do have more upper body size than the average cyclist though, maybe that helps hide it?


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## Burning Matches (Mar 14, 2011)

geetarmano said:


> Hello fellow bumpy shoulder peeps!
> My questions are for those of you that went with non surgery,
> How long did it take before you felt your body "normalize" to a more even balance?
> Did the bump (more like a lump) go down after you recovered?
> ...


Non-surgery grade 3 here.  
I was about 80% back to normal after about 3 months, then eventually about 95% after a year. At this point I can do almost everything I did before the injury.
The bump never went away. It has been there for about six years since the original accident. It's permanent (and hideous, IMO).
Yes I worry about falling on it again, but not enough to make me stop riding (or doing anything else that I would have done otherwise).

I will mention that I get a strange stabbing pain in a spot in my trapezius muscle, just to the right of my spine (the injury side), whenever I ride for more than two or three hours. Not 100% sure it is due to the injury, but it is only on that side and I only started experiencing it after I was injured. I can mitigate it with special back and neck strengthening exercises, but have never completely eliminated it. I consider it my biggest weakness in endurance racing, since it is a major annoyance and can be quite painful. Off the bike, I am pain-free.


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## SCtriton (Mar 29, 2015)

I am going on week 8 of my grade 3. Both orthos initially recommended no-surgery. Had full ROM by week 2 with good strength and really no pain with basic tasks. 

Started physical therapy week 2. Focus was on building back muscles (scapula and lats) that helped get my strength back. Running and biking by week 4. Started free style swimming and doing sets of 10-15 pull ups by week 5. Weight amounts in gym increased to 50-70% of healthy shoulder depending on exercise by week 6. Resumed all "normal" activities and mostly forgot about the injury by week 7. 

BTW, the PT strongly advised against doing any of these activities for "several more weeks" as I need to let the shoulder "heal" before I can rebuild it. I told her it feels good, my body likes it. What am I supposed to do, watch my chest and arms deteriorate? This will just prolong the recovery.

So I was feeling pretty good and decided to paddle out for a surf last weekend (wk 7) in 3-4 ft waves. Other than the occasional sting in the deltoid/clavicle area everything seemed fine. However, I was tight for 2 days after in the same area. I paddled out again today in bigger 4-6+ft surf that put more stress on the shoulder and I felt pulling by the clavicle when I pushed it. I have no pain but the "bump" is noticeably bigger now as I can feel more separation between the clavicle and acromion. 

So, I am going back to the ortho tomorrow to do find out WTF is going on. If the grade 3 recovery period is 6-12 weeks then am I past the "healing" stage and into the "rebuilding" stage? What is their definition of "full function" at week 12? Brushing my teeth or paddling, swimming, biking, etc.? If I can't surf now then when?

I discussed with another PT and ortho I met at a party last weekend and both said I shoulder strongly consider surgery. The 2 people I know that got surgery are happy. Ones that went without are mixed. 

If the ortho recommends surgery then I am doing it. I would rather bite the bullet now and get it done rather than dragging this on for months or potentially years and risk never getting back to normal.


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## SCtriton (Mar 29, 2015)

Going in for surgery in 2 weeks. 2+ hours outpatient.

Surgery involves small incisions to harvest a healthy tendon from behind the knee and transplant it (graft) to the clavicle. No screws, plates, etc that I heard were problematic with earlier surgical techniques. 

4-6 weeks in a sling w minimal ROM exercises, then PT and 4-6 months full recovery; like it never happened with the exception of 2 minor scars.

Basically, I am going back to square one and lose the 8 weeks I put in to nonsurgical recovery. Good news is I know what to expect (basically same recovery process weeks 1-8) and perceive this loss of time as a relatively small tradeoff for a much better shot at a 100% recovery.


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## geetarmano (Apr 23, 2015)

Any guitar players suffer from a grade 3 and go the non surgery route? Did it affect your playing with stamina and or pain in neck?


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## zero85ZEN (Feb 11, 2015)

I joined the club on 4-29-15. Road biking, second in paceline when lead rider grabbed two fistfuls of brakes going UPHILL at about 18mph and skidded to an immediate stop. 

Level III separation that was repaired yesterday (5-14-15) via arthroscopic Dog Bone procedure. I will post updates as I recover. But I can report that I was back out on the road bike 11 days after the crash and 4 days before surgery. I choose to repair immediately during acute phase because of extreme amount of displacement especially noticeable on my 5'10" 145 lbs. climbers frame.


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## zero85ZEN (Feb 11, 2015)

Update: 6th day post surgery and I'm pretty much completely pain free and I've been off narcotic meds since 2 days post surgery. Riding recumbent stationary bike and watching a lot of cycling videos. Starting very basic range of motion rehab on arm of injured shoulder.
Not looking forward to long road to full recovery but even at this early stage VERY glad I opted for surgery! 100% sure I'll recover to 100% functionality of injured shoulder via this route.


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## SCtriton (Mar 29, 2015)

1 week post surgery for Grade 3; less painful than original injury at same time. Not sure this is because of the 10 weeks of PT before the surgery. Pain is in muscles affected by pulling the dropped shoulder back in place (pectoral/upper bicep/deltoid area-not clavicle/acromion area with the original area). ROM is coming back quickly and hope to start PT in a week. Recovery is expected 4-6 months.

AC and CC joints repaired. There is a temporary screw that replaced the damaged end of the clavicle (was cut) holding repairs in place. Torn joints replaced with artificial tendon (new string like material that is super strong - can tow a boat) so no need to harvest a tendon from my knee.

No regrets. Shoulder is normal, no bump and square (not sagging) with my other shoulder. I am a lot more optimistic this will result in a 100% recovery than with the nonsurgical conservative method that was causing nagging pain while paddling, running, throwing, virtually every athletic thing I do.


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## Bradical (Feb 18, 2013)

Day six from a grade 3 , I'm a freak of nature it seems.
I already almost have full range of motion, can do self assisted push ups , yesterday and today I did the elliptical and then today decided to try my pump track, all good. I spent 20 mins pump tracking hard and only had one twang or twinge in the shoulder, unbelievable.

I have been icing 4 times daily and hitting my Infar Red sauna, along with doing anything that doesn't hurt it (much) like mowing the lawn etc.
Lucky lucky so far....

I'm considering doing a bunch of fire road climbs tomorrow on day 7 with green difficulty descents.

My guess is that I already blew this shoulder 10-15 years ago playing rugby or mtb and that why it's healing so fast? 
I hope it continues on healing with no set backs, common sense and listening to my pain is key. Will update weekly or as anything occurs

Happy healing to all.


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## Bradical (Feb 18, 2013)

I should say that day one an 2 were hell , full of pain , I dropped the sling on day 3 and things started to improve, by day 4 I could brush my teeth, by day 5 I could spike my hair.
My gut feeling is that I'm a fluke, and that perhaps ice and sauna (infrared ) are a super great combo for healing.

Healing vibes to all


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## Tanre (Jun 6, 2015)

Hi all, first off, I am not a biker, but after searching and reading all these posts, I figure I may have something to contribute and maybe someone else could help with what happened to me. I have a grade 2-3 AC tear, small bicept tendenosis and labrum tears. I did not get them from impact and I did not feel pain for at least 2 months. I am a kiteboarder and took a month long kite trip to Brazil. To say the sport is intense is an understatement. I lost 35 lbs in that one month simply from kiting.

I do not know why I did not feel pain. A picture during that time shows that I have a huge bump but I thought it was just my bone showing since I lost so much weight. About 2 months later, I wake up in pain&#8230;probably slept on it wrong, or snapped it during sleep. That hurt a bunch and of course I did the stupid thing and went on another kite trip. Did a few sessions, and I was done&#8230;too much pain.

I am 40 years old and pretty fit. I did not have surgery because of all the before mentioned comments. It is now 8 months after the injury. I have just had my 2nd round of PRP shots. Previously I have had prolotherapy, PRP, lots of PT, and 2 MRI's. The recent MRI showed zero improvement. PT started with rage of motion. Initially was unable to raise hand above head. Now, I have full range of motion and 1 week ago was able to do 4 full pushups. Nowhere near where I used to be, but it's a start. Pain is mostly gone with the exception of a few workouts. Think the AC is the best it has been in awhile and now I can feel the pain the torn labrum caused, but that too is low now. What amazes me is that most of you guys are recovered or out riding after 3-8 weeks. 3-8 weeks into it I was devastated!! Everyone does heal at different times, but that's huge. I had vey limited kiting sessions with approval of my PT this month. My shoulder was fine, but my body told me my muscles weren't developed enough to handle the stress. Will have to build to it. I do not foresee me being where I was for another few months, so overall, it looks like a full year of recovery. Anyone take this long? Maybe I should have went with surgery. Maybe its not too late. Like you all, I am very passionate about my sport and need to be 100%, not 90%.

Has anyone else developed the AC tear over time without pain? I did read about that one guy who did pull-ups afterwards. Has anyone else taken this long to heal? Even at 40 y.o., a full year seems damn excessive.

I have done 3-5 day sessions of PT for a few weeks&#8230;but am also concerned that that does not allow the muscles to rebuild. Any input?

Hope you all get back to 100%

BTW, the 2nd MRI sowed no improvement at all. So, if there is no regrowth of ligaments, why do we feel better?..and is it just as prone to injury now? Yes, the muscles stabilize the joints and rebuilding them makes them stronger, but you still have torn ligaments. Inflamation causes pain. I take Triflex and Wheat grass everyday now. Will I have to work out to this level to continue to keep my muscles from degrading in hopes to be active for the rest of my life?...we'll see.

PS..in response to my question about doing PT with pain and whether or not its beneficial, my PT found this article. It was extremely helpful and kickstarted my PT:

Ligament Injury and Healing: An Overview of Current Clinical Concepts - Journal of ProlotherapyJournal of Prolotherapy


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## boarderdan (Jun 11, 2015)

I don't mountain bike but snowboard faithfully, got 115 days in this season before my season ending injury. This thread has been extremely helpful to me throughout the process of my Separated shoulder so I promised myself I would post here.

I had A high grade 1 separation on my right shoulder in the beginning of january snowboarding in whistler, and after about a month I was back to normal like I never even did it. On April 20th I really did my right shoulder in with a grade 3 separation snowboarding yet again. Initially I was in shock and thought I dislocated as I felt a huge bump on my shoulder, went down to the park and felt extremely nauseous, and almost fainted. Went to the doctor and gave me a sling, wore it for 3 days than got rid of it. It hurt like a ***** but not excruciating pain and only took t3s for the first 3 days at night to help sleep. During the first week I did lots of meditation to help keep myself calm and not go crazy. After week 1 I was at 50% range of motion and had a little bit of strength, couldn't lift my arm above my shoulder. 2-3 week went to PT(only time I went cause I don't have insurance, got a bunch of ROM excercises, was told to do as strength training within my pain threshold) I started on the stationary bike almost everyday to keep blood flowing, and did ROM exercises faithfully everyday. Also went to the hot tub after working out, and would Ice/ heat about 2 times a day( always after I worked out) when I got home. Week 4-6,100% ROM by now, started doing light yoga( able to do downward dog without pain) Strength training exercises (mostly with bands and light weights). Back to normal weight from before injury with bicep curls. My gf gave me acupuncture 4 times which really helped to ease the pain around back, neck, shoulder. Now I am in week 7 and am pretty much normal with everyday activities, I still can't sleep on the shoulder for more than 10 minutes without a dead/ arthritic feeling. I get the occasional twinge when I do an awkward movement and also it cracks like crazy when i'm doing random stuff. I am glad I choose the non-op route, Only thing I would've done different was if I had coverage PT at least once A week, also Osteopath does wonders (couldn't afford it at 120 an hour), massage therapy also. It has been a long tedious process but being patient and having a positive outlook makes the process way easier.

Age- 23 years old- Bump on shoulder also went down a little bit (lucky i have pretty broad shoulders so not to noticeable) very noticeable when I cross my shoulders or lay on my left side it sticks out like crazy.
Supplements- D3, Zinc, fish oil, Chondroitin and Glucosomene with MSM

I will post an update at weeks 8-12


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## zero85ZEN (Feb 11, 2015)

Well, at almost 5 weeks post-op (Arthrex Dog Bone procedure) for level III separation with considerable displacement I've ditched the sling (I know, I know...wear the sling 24/7 for six weeks...but it was just not needed anymore after one month post-op...I've just restricted movement of the arm and don't reach overhead, out or too far to the side).
I'm waiting another week before I start active rehab and strengthening exercises. I probably could ride the road bike right now for shorter distances but I'm not going to push it that far. 

All and all I'm completely satisfied with my decision to have surgery. In another month I'll be "good as new" and the injury will just be an unpleasant memory.


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## L84Beer (Jun 24, 2015)

I just stumbled on this thread today, and I am so glad I did. I'm 44, drive a desk professionally, and I am an avid recreational MTBr in the spring/summer/fall, and downhill skier in the winter. I could not be more disappointed to be off my bike with a level 3 separation. I saw the Orthopedic doctors at Columbia Presbyterian, who come highly regarded in their field, and they said to give it 8 weeks of therapy and see were I stand before thinking about surgery. 

I went down on June 14th. The pain was pretty intense for the first 36 hours, but I quickly transitioned of the pain killers and rested for 3 days working from home. I started PT on June 19th and am going 3x per week. So far, things are going pretty good. ROM today is much better than was expected per the PT and far ahead of what he typically sees. 

As such, the PT has cleared me to drop the sling and is encouraging me to get a brace to help pull my shoulders back and push the bone down. Has anyone had an experience with these braces and can make a recommendation? He did not have one in mind, but was going to research it.....


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## LyncStar (Feb 16, 2006)

So many Grade IIIs!! I had a grade V about 6 years ago. Last thing I remember was throwing my leg over the demo Moots I was test riding. Next thing I remember was wandering in the middle of the trail and being brought back up to the trailhead by some fellow riders, that also happened to be off-duty Colorado police officers!! 

Had surgery and 6 years on have absolutely zero problems! They had to put screws in, and took those out at around 8-10 weeks if memory serves. 

Rock on!!


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## cdodom (Jul 8, 2015)

Hey everyone! Hope everybodys shoulders are healing up well! 

I have a question about my injury. I messed up a good jump at the Canyons last thursday and ended up hitting my shoulder pretty hard. The day it happened I could move my arm outwards and a little forward but would feel pain and lifting it over my head was out of the question. A few days later after icing it and applying heat occasionally I could move my arm pretty good with just a little bit of mild pain/tightness in certain spots. 

would now be the time to start getting back to my daily GOLF regiment. Im not talking about hitting a ton of balls at the range but easing back into chips and pitches and in to full swings. 

Is it right to think that I dont want to be too static with the shoulder?


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## L84Beer (Jun 24, 2015)

Obviously the correct answer is you should check with your doctor. That said, my PT has been guiding me to use pain as my guide. If it hurts, DON'T do it. The thing to remember is that ligaments take a very long time to heal (6 to 18 months) and your joint will be in a weakened position until you've had time to strengthen the muscles around the joint. After ~2.5 weeks form my Level 3+ separation, the swelling has gone, bruising has cleared, and most of the pain has subsided. What I am noticing now is stability is compromised. While I think I can make a near full recovery with a pretty major lump on my shoulder, I am beginning to question if "near full" will be full enough for the active lifestyle with active, sports oriented little kids I want to resume. We'll see with the ortho says next week.....


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## Tanre (Jun 6, 2015)

L84Beer....dont wait...just my suggestion, but I am SERIOUSLY FRUSTRATED that no one told me 8-9 months ago, that I will not get back to a very active lifestyle withour surgery. I went to 2 dr's and a PT...they all seem tobe programmed to tell you to do it without surgery. I say, seriously consider surgery. Granted, I had a combo (AC tear, SLAP tear and Bicept tendenosis), but in my opinion, just wasted 8-9months of not being able to kiteboard!!!...and now will probably end up down for another 8-9 months if I opt for surgery...or just keep trying without the ability to do my sport. Not worth it. Good luck.


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## L84Beer (Jun 24, 2015)

Tanre, sorry to hear your recovery has been challenging. I've been combing these posts for a few days, even going back to the beginning, and what I am seeing pretty clearly is the surgery/no surgery option is controversial. 

Like you, I desperately want to get back to "normal" as quickly as possible. Today I am 25 days post injury and the pain is virtually gone, except sharp pains I get every once in a while on top of the joint while I'm trying to feed myself or talk on the phone--weird. From days 5 to 20 I would experience some pretty intense cramping in my shoulder blade, particularly when I do small motor skills like preparing guacamole, or standing holding a drink. Days 20 to 25 were a mix of cramping in the shoulder blade, or a couple of days where the whole shoulder would just get very tight, like a cramp, but around the whole shoulder.

When this happens, it feels like I need to manipulate my shoulder to realign the bones to take away the impingement. I have not figured out the magic manipulation to realign things and wish I could.

I'm willing to give this 2 months to see where I'm at on the non-surgical route, but I want to make sure I don't screw up my ski season. I feel like I could get back on the bike to do some light trail riding, but unfortunately most of the trails around here are fairly technical, so I don't want to chance it until I've seen the doctor next Wednesday.

I could accept a near full recovery, if I could ride a bike on our technical terrain, ski aggressively, and probably more concerning, throw a ball and swing a bat with my kids who are competitive baseball players and otherwise athletic kids. I've read about some success and struggles with throwing both with and without the surgery, further complicating the decision. 

Trying to stay positive, and motivate to stay active and eat healthy are my biggest challenges right now.....staying active is constrained by the shoulder, eating too much is my downfall when I have setbacks like this.....


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## Tanre (Jun 6, 2015)

Cool video on youtube about eccentric exercises (AC tears...actually, it was a SLAP tear)....really visualized what we have (he used a plate and weather stripping). Good luck.


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## L84Beer (Jun 24, 2015)

Where would I find this video on YouTube?


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## Tanre (Jun 6, 2015)

I figured you would google with the above words...but here ya go:

http://www.mc.uky.edu/athletic_training/docs/nzsmsc-2010/Eccentric_Training_Spring2011.pdf


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## palmasi (Sep 26, 2013)

An update for the forum: 

I am 2 years out from my Grade III from a high speed road bike crash and slide into a curb. No surgery was recommended and things are good, not 100%, but better than I expected. Overall I would say 95% recovered but I'm unlikely to ever get to 100% only because the scapula is not in the same place as it used to be and this provides for some weird sensations. Range of motion is 90%, only limit is touching my opposite shoulder blade. The bump certainly isn't going away and it's pretty weird to be able to move it by pressing on it.

Here are some details: 
I was 37 2 years ago when I get hurt, so 39 now. Mostly I'm a rock climber who MTB and road bikes on the side, which if you climb you will understand the frustration with hurting yourself engaged in a non-climbing activity. 
The Weill-Cornell surgeon group here in NYC did an MRI and diagnosed the grade 3 separation and suggested PT. I did 12 weeks of band, weight, hand cycle and table pushup PT, which was useful and kept me on a recovery schedule. I didn't continue with PT after the 12 weeks, but did light iron and ROM at the gym every week. 

A return to climbing took 2 months, and there was still some pain and clicking with certain motions. After 2 years I am back to bouldering V6 and toproping 5.12 at the gym, though I won't even try certain shoulder intensive moves like steep gastons. Crack and vertical face climbing is OK.

It took a full year until I could sleep on my side without pain and a full year until I could pull up on MTB bars hard enough to clear larger obstacles larger than curbs. MTB seems 100% now, but I am much more cautious and that's less fun. Road biking is totally fine.

I can throw a baseball with no issues, swing the arm around, pump light iron at the gym, do pullups, and carry pretty heavy objects. Pushups don't feel great. But mostly I'm grateful to climb and bike with no pain.

Hiking with a heavy pack (45lbs) is a little challenging as the strap slips off my clavicle onto the AC joint and that kind of hurts. I still do it weekly because it's fun to hike with a toddler on your back. I run sometimes and can feel the shoulder then becuase of all the bouncing.

In summary, you can call me satisfied. The nagging clavicle 'sensations' and occasional clicks have gotten a lot less intrusive in year 2 and I can do what I want in sports. Once my kid gets older and doesn't need to be picked up every 5 minutes I would consider surgery if pain returned or there was some long-term deterioration happening.


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## Tanre (Jun 6, 2015)

Palmasi...Great to hear that you are back to somewhat of a good routine. I too am recovering, but I have some serious disdain for professionals who look at your lifestyle and tell you to go the conservative route. Im doing the same now. Yes, I have kiteboarded 3 times, but only at 1.3rd the capacity.... I wish dr's would've been honest with us in the beginning and told us that as athletic people, we will not recover without surgery. Post in 2 more years and let us know if you are in the same health as someone post op after 12 months.


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## soulshaker (Sep 23, 2013)

This thread is giving me hope. Suffered a Grade 3 this past Friday. Sleeping is the worst. Clearly, time healing is the main factor. Being 63 y.o. and an apparently bad MTBer isn't the greatest combo. Too bad my otherwise awesome bike lacks air bags and a seat belt.


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## L84Beer (Jun 24, 2015)

5 weeks post crash (yesterday) and I have full range of motion and no pain. I would estimate the strength is somewhere between 30% and 65% of what it should be, depending on the type and direction of the exertion. I can see why many people pass through a Level 3 without any surgery.

However, my shoulder is very unstable (or at least I am very in tune with the instability) as the head of the humerus passes forward and under the clavicle with certain movements like hitting a ball off a racket. I also periodically pinch the clavicle and head of the humerus when I do simple mundane tasks like talk on the phone, which is moderately painful but painful enough for me to cut most calls short. I am a fairly active 44 year old in reasonable shape. Beyond biking in the summer/fall and skiing in the winter/spring, I want to be able to swing a baseball bat, through a softball, play golf, and be able to control a racket. As such, my doctor and I have concluded I am a good candidate for the surgery. While the published research of a controlled set of common every day tasks suggests there is no difference between surgical and non-surgical routes 2 years post, I believe there likely would be a difference between how two athletes (think rock climbers or baseball players) would report their rock climbing abilities two year post for the surgical and non-surgical routes.

Could I recover without the surgery; sure, I guess if I was content to give up or limit myself materially in many of the activities I love--but I don't think I am. Surgery is scheduled for August 13th, with the hope I will be fully cleared to start my ski season late December/early January. 

The only reservation I have is the potential for re-injury in skiing and mountain biking in particular.....


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## Mr.Wizard (Feb 4, 2015)

soulshaker said:


> This thread is giving me hope. Suffered a Grade 3 this past Friday. Sleeping is the worst. Clearly, time healing is the main factor. Being 63 y.o. and an apparently bad MTBer isn't the greatest combo. Too bad my otherwise awesome bike lacks air bags and a seat belt.


3+ last Wednesay.
First two days were bad.
Saw the Surgeon yesterday. She said I was lucky. No damage to the Rotator Cuff. Surgery probably not necessary.
Home PT and ice. Getting some ROM back. Pain is starting to lesson. (Only Motrin once in a while.) Also 60+ years old...

I'll check back in a week.

(Next, I'm going to check on some armour...)


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## ClimberXC (Jul 31, 2015)

*My AC Separation Story*

This threads usefulness has compelled me to also share my story. July 18th, Grade 3 separation from bad crash at mile 32 of the High Cascades 100. Managed to finish the race so was optimistic maybe I didn't do too much damage, Although the giant knob on my shoulder told me otherwise.

An ER visit along with the diagnosis of 3 different orthopedic doctors all confirmed a bad Grade 3. The uniform recommendation from all doctors was no surgery. This didn't sit well with me. Aside from the deformity, it seemed some effort should be made to fix the shoulder structurally.

I then began doing my own research as many above have done. One thing I noted was that you do have more options if you act in the acute stage of the injury (first 4weeks). So the advice that you lose nothing by waiting to see how it heals is not entirely correct.

I decided to have AC tightrope surgery arthroscopically. They surgery was performed 11 days from my injury so my own ligaments are expected to heal/reattach. I'm now 2 days post op and so relieved to be on the other side of this and to have the hope of a full recovery.

I'll update with my post surgery progress for the benefit of others who are trying to make the surgery / no surgery decision. Good healing thoughts go out to everyone who has had to deal with this injury.


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## Mr.Wizard (Feb 4, 2015)

Mr.Wizard said:


> 3+ last Wednesay.
> First two days were bad.
> Saw the Surgeon yesterday. She said I was lucky. No damage to the Rotator Cuff. Surgery probably not necessary.
> Home PT and ice. Getting some ROM back. Pain is starting to lesson. (Only Motrin once in a while.) Also 60+ years old...
> ...


3 week update:

ROM about 80%. Strength about 70%.
Been on the fatbike on some intermediate trails.
I'll try the black trails next week.
Can't sleep on that side yet.
Hoping not having surgery is the right thing.
So far so good.
(Ordered some POC armour. Thinking another fall on that shoulder would be bad...)


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## Naetha (Mar 2, 2015)

I'm so glad to find this thread!

I dislocated and separated my shoulder last week falling off a stupid skills park obstacle. Crazy amounts of pain - taken to hospital in an ambulance and given truckloads of morphine.

I've had my gallbladder removed and given birth twice, and the pain from this was right up there.

One week later I have very little ROM and still crazy amounts of pain. Seeing the orthopaedic surgeon next week to look at options in terms of surgery vs non-surgery. GP wasn't sure of the separation/grade - definitely a 3+, maybe a 4 or 5.

Good to see some recovery stories. I just want to get back on the bike!


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## SCtriton (Mar 29, 2015)

10 week post surgery update for Grade 3 suffered mid March 2015 at age 55. 

My shoulder got infected with staph immediately after surgery that I was battling for 9 weeks before removing the infected hardware and will now let the shoulder heal naturally. The MD team did not catch the infection until 20 days after the surgery despite obvious symptoms of chills, fever, pain and swelling in the surgical area. I lost over 10 lbs in 10 days fighting this infection with 102+ fevers before finally getting on antibiotics. I never had staph and rarely get sick. Initially, I really did even pay attention to the chills and mild fevers. Just continued working, etc. thinking it’s all part of the healing process until later in the cycle when the fevers and pain got real bad. 

I highly recommend that anyone considering surgery ensures their MD triples all the necessary precautions to prevent staph. That means pre/post opp antibiotics, testing you for staph (simple nasal test), etc. If artificial components are being used then make certain there are no natural alternatives from either a cadaver or harvested from your body. If the hardware (i.e. screws, etc) gets infected with staph you are screwed because the antibiotics can’t kill staph once it attaches to the hardware. Staph is everywhere: gyms, airplanes, on your skin, etc. Avoid any post surgery activities that generate sweat until the incision is completely healed.

Fortunately, my shoulder looks normal (i.e. no bump, even with my other shoulder) after the hardware removal and is very strong. I continued to do self-PT and run/bike during this entire ordeal: 3 surgeries (initial, cleanse/debridement, removal) and multiple antibiotic treatments (oral and IV). The surgery excised the tip of my clavicle so it longer digs into the deltoid/acromion area; a major annoyance when paddling, throwing, swimming. The hardware held the clavicle in place for 10 weeks allowing the scar tissue to develop and I am hopeful it will permanently hold this position. I will stick with a safe regiment of high cardio and PT exercises that do not pull the clavicle for at least 2 more months allowing the scar tissue to continue reinforcing this position. 


Found this in a medical journal. Guidelines seem accurate based on my experience.

For Surgery

Youth (or middle agers like me who still think/act young cuz I have young athletes to raise)
Athletic pursuit—particularly throwing sports (mandatory as my kids play football, basketball and baseball)
Manual occupation (nope)
Dominant side (?? - type A? then perhaps)
Joint very unstable anteroposteriorly and vertically (yes particularly with high frequency overhead motion like swimming, paddling, etc.)
Clavicle lying subcutaneously (yep, thin skinned)
Prefer a scar (vs a bump??? - no brainer!)
Thin patient (yep)
Reliable enough to take part in postoperative program (overly active - how I got the injury in the first place)

Against Surgery

Age
Nonathletic
Sedentary life-style
Nondominant side
Joint relatively stable
Overlying muscle
Prefer a bump
Thick subcutaneous fat
Unreliable patient (alchohol, drugs, mental subnormaliry)


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## Mr.Wizard (Feb 4, 2015)

SCtriton said:


> Against Surgery
> 
> Age
> Nonathletic
> ...


Wait a minute.

I'm not subnormal!


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## zero85ZEN (Feb 11, 2015)

Just over 3 months post-op for level III separation of my left (non dominant) shoulder I am back to 100% activity level and riding full on. 

Super happy I choose surgery. AC Seperation is just a bad memory for me. Nothing better than fully back to normal.


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## L84Beer (Jun 24, 2015)

I figured I would provide an update for anyone else, who like me is following recovery stories and trying to decide between surgical and non-surgical routes for a Level 3 separation. I was scheduled for surgery for August 13th, which was ~9 weeks post crash. After consulting with with another orthopedic friend of mine, and my bike mechanic, I came away with the feeling that I will be completely fine and perhaps better off going the non-surgical route. My decision to "indefinitely post-pone" surgery was based on the following:
- My orthpedic (hip specialty) friend informed me that surgery comes with risks (i.e. nerve damage, infection, allograft rejection, etc), albeit small
- Full recovery would take 4 to 6 months with significant physical limitations for 8 weeks
- Orthopedic friend's brother-in-law suffered a level 3 playing hockey 6 months ahead of me and recovered 100%
- Risk of re-injury is relatively high, given my active lifestyle. Re-injury could be problematic because the clavicle bone is weakened by the holes drilled in it.
- My bike mechanic had the same injury about 10 years ago and is totally fine, except for the cosmetic lump
- The bike mechanic has gone back down on the same shoulder without sustaining major re-injury--the tears were slightly worse as a result, recovery was quick, functionality is full
- While I can't confirm the statistic, I heard that ~70% of NHL players have had an AC separation and ~0% have had surgery to repair it
- Studies suggest that surgical and non-surgical cases experience the same rebound in functionality and outcome (although I personally believe this may be misleading because it doesn't control for "all" activities. i.e. I would want to see a study comparing groups rock climbers, tennis players, athletes in general at their respective sports)
- My functionality continues to improve, any pain is very manageable, and I can do virtually anything I want to do. Throwing a ball (ie. baseball, softball, football) are all possible, but probably only back to ~65% of what I was able to do before)

There is a significant part of me that wishes I had forced the surgical route immediately, so as to avoid the "double" recovery periods. However, I would still be very concerned about the risks of re-injury, especially given the clavicle would be compromised. Changing out the lump for a scar [immediately] after the injury and likely having functionality that would be at least as good, if not better, than the non-surgical route may have been a preferable path.

If you're new to the level 3 injury and in the very early days post injury, I suggest researching the potential complications of re-injury post surgical route. If you can get comfortable with those risks, the surgical route may leave you with less 2nd guessing. At this point, I can attest that I probably don't "need" the surgery, and if I knew at the time of the injury what I know now, I would focus on the re-injury risk. If I were able to get comfortable with that, I would most likely have the surgery.


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## JOHNRB (Aug 13, 2014)

Hi guys and gals
I have just been told i have a grade 2 AC seperation, typing in asling now and seeing specialist on Tuesday. 
My question is regarding after it gets better and im back on the bike, im concerned with loss of confidence and reinjuring even from a minor tumble.
anyone had experience with some sort of shoulder protection, don't want Armour as i only do trail riding. anyone used these or something similar do you think they would help with minor bumps etc Exo Ss Jacket - Black - Bike


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## Vegard (Jul 16, 2009)

I had a somewhat bad fall 2 weeks ago where my shoulder and cheekbone hit what I think was a rock. (I didn't really take notice as I got right up and shook it off, continued riding for a few hours without any issues.

After a week of healing up the swelling I noticed that I couldn't even complete a single pushup, just staying in the top position of the move would hurt so much that I had to immediately get off my bad side.

My swelling is gone, as is the bruising, but whatever has gone wrong in there persists. The clavicle feels fine, but at the end of the clavicle; just about where the AC joint sits there's a tiny lump that's sore to the touch.

The movement of my arm isn't limited at all, I can do supported biceps curls, pullups (!), various rowing excercises and lat pulldowns. But benching, flies and rear delt work is all but impossible. 

Any ideas what I hurt?
From researching online it's either a rotator cuff injury or the ac joint.

Going to the doc tomorrow to request a checkup and xrays either way so this is just me being curious.


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## JOHNRB (Aug 13, 2014)

Sounds like a minor separation, mine was initially thought to be a grade 2 but after seeing a specialists and more scans it's now a 1 which is ok but it's been a month and can't MTB ride yet as pulling on the bars hurts. I would recommend not aggravating it and requesting a weighted X-ray to show how much separation ther is. Seeing a sports physio has helped and regular taping to him it altogether helps a lot. Take time and get it right no matter how much it sucks not being able to ride or exercise.


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## Speeder500 (Oct 9, 2012)

Hey guys, from my understanding is when you get a grade 3 or higher separation, isn't your collar bone not anchored down anymore by the ligaments?

Since ligaments can't regrow, once they're separated they are gone, how do you guys expect to ever get good functionality back?

I ask because I think I may have lucked out with just a collar bone break, but it broke real close to the ligaments and I'm worried if I lost some of the ligaments.


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## TranceX (Dec 24, 2011)

Speeder500 said:


> Hey guys, from my understanding is when you get a grade 3 or higher separation, isn't your collar bone not anchored down anymore by the ligaments?
> 
> Since ligaments can't regrow, once they're separated they are gone, how do you guys expect to ever get good functionality back?
> 
> I ask because I think I may have lucked out with just a collar bone break, but it broke real close to the ligaments and I'm worried if I lost some of the ligaments.


Hey Speeder, the good news is that even with the ligaments ripped out and my collar bone floating where it used to connect to the AC Joint, there is enough stabilization in the area to make it a non-issue. I ripped it out back in 2012, Grade 3, no surgery.....and I'm good. I can still do pushups, ride/jump my mountain bike, surf, standup paddle, etc just fine. Arguably not as strong with overhead lifts and bench press but at 55 I don't care about that stuff anymore anyway.


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## Vegard (Jul 16, 2009)

JOHNRB said:


> Sounds like a minor separation, mine was initially thought to be a grade 2 but after seeing a specialists and more scans it's now a 1 which is ok but it's been a month and can't MTB ride yet as pulling on the bars hurts. I would recommend not aggravating it and requesting a weighted X-ray to show how much separation ther is. Seeing a sports physio has helped and regular taping to him it altogether helps a lot. Take time and get it right no matter how much it sucks not being able to ride or exercise.


Got a bunch of xrays today, and they didn't show anything out of the ordinary. I guess it's good that I don't have a ac separation, but bad in the sense of not knowing what's up with my arm.


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## Acme54321 (Oct 8, 2003)

I think most people that have grade 3 or less end up fine on their own. I had a grade 2/3 a little over a year ago and don't notice it anymore. I was off the bike for 6 weeks to be safe, then a couple weeks of road riding and back on the MTB after 2 months. The orthopedic specialist said as long as I didn't impact it while it was healing I was good to go. I do know a couple of people that had separations and put their arm in a sling and they feel like they ended up worse off for recovery because they immobilized it for too long.


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## davidsthubbins (Dec 14, 2009)

Grade 3, open surgery dogbone procedure w/distal clavicle excision. I'm 1 month post op and all is going well so far. Doc wants 4 more weeks in a sling then PT. 

Anyone have any insight on the following; Many times when looking in the mirror, it somewhat looks like my injured shoulder is narrower than the non-injured side...ie closer to my body. Today I actually measured, and was blown away to see that it was actually up to an inch more narrow. This was with both arms relaxed hanging straight down. Anyone else notice this with your separation injuries/surgeries? 

It doesn't look like muscle atrophy or something like that, it just looks like my shoulder is shoved up in there more so than the good side. The only thing I can think of is it might be just a side effect of having my arm in a sling nearly 24/7, and once I start PT everything will loosen up and straighten out.

Any thoughts or previous experience?


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## Jhal (Oct 26, 2010)

Yep, I've unfortunately joined the "club".

About 3 weeks ago, I was riding down single track at pretty good speed, and veered slightly off the trail. When coming back onto the trail, my front wheel caught loose dirt and a rut that caused my handlebars to completely turn sideways. I went over the handlebars landing on my right shoulder.

Jumped right up off the ground feeling fine, then after about a minute knew something was wrong. Felt the notorious "bump" but had no idea what it was at the time. Told my riding friends with me that I thought I had broken something or dislocated my shoulder.

Was about 4 miles into a 12 mile ride (where going the remaining 8 miles would be easier than backtracking the 4 already covered). During the remainder of the ride, my shoulder felt ok when going downhill when the trail was smooth. But, it hurt quite a bit when had to take drops, go through rocky sections, or go uphill.

Went to ER after and after x-rays, doc thought I had a grade 2 AC separation. Wasn't until I followed up with an Orthopedic Surgeon 10 days later that I found out that it's at least a Grade 3 and could require surgery. Will follow up with him in another couple of weeks to decide for sure if I need to go that route.

So, that's the bad news. The good news is that I captured the fall on video. 

First, here's the x-ray:








And, here's the video. 
The video is from the whole ride, but my fall is at about the 1 minute mark.
Also note that when I compiled the video, I hadn't seen the Orthopedic Surgeon yet and thought it was just a Grade 2.


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## brettex (Jul 29, 2014)

David, 
I too had a grade 3 and had the same procedure this past May. I wore a sling for 6 weeks post op, but I also noticed my shoulder was significantly smaller than the non injured shoulder. What I noticed more was my bicep and pec on the injured side lost its muscle tone, but it was from wearing the sling for 6 weeks. I also waited 4 weeks to have the surgery so I wore a sling for roughly 9 weeks. My PT told me that my shoulder blade was out of place, but with pt for 4 weeks and keeping up with the regime they gave me everything has gone back to normal, mostly. I can't work out like I used to, but I did start riding after 2 months post op and now I am riding like before with no issues. The only problems I have is doing certain exercises in the gym, I have been avoiding workouts that strain the shoulders. Like you stated though once you start PT everything will start getting better. Good luck with everything, it gets better.


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## davidsthubbins (Dec 14, 2009)

brettex said:


> David,
> I too had a grade 3 and had the same procedure this past May. I wore a sling for 6 weeks post op, but I also noticed my shoulder was significantly smaller than the non injured shoulder. What I noticed more was my bicep and pec on the injured side lost its muscle tone, but it was from wearing the sling for 6 weeks. I also waited 4 weeks to have the surgery so I wore a sling for roughly 9 weeks. My PT told me that my shoulder blade was out of place, but with pt for 4 weeks and keeping up with the regime they gave me everything has gone back to normal, mostly. I can't work out like I used to, but I did start riding after 2 months post op and now I am riding like before with no issues. The only problems I have is doing certain exercises in the gym, I have been avoiding workouts that strain the shoulders. Like you stated though once you start PT everything will start getting better. Good luck with everything, it gets better.


thanks for that, good to hear. I also have noticed that with both arms hanging down and trying to be relaxed as possible my injured shoulder is higher as well as narrower. I'm looking forward to ditching the sling and started PT to get everything back to normal. I'm thinking some chiropractic massage will be very beneficial as part of my PT.

Was your surgery arthroscopic? interesting that the dog bone procedure was invented to do arthroscopically but my surgeon still did open. Oh well, scars not too bad.


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## brettex (Jul 29, 2014)

Mine was open surgery, I had some pretty bad tissue damage around the area so they had to do some graphing. It took me a while to actually get the surgeon to tell me the exact procedure he did. He briefed me before surgery but my wife and I were clueless as to what he did until later. I had read a lot about AC joint surgery and read mixed reviews on how long the recovery time would be, which made me worry. I feel no pain unless I work out now but then its only temporary while I am exercising, it goes away after. My surgery was 4 months ago so I think I am doing pretty good so far. My PT had said that since I was in good shape prior to the surgery that it shouldn't take that long to recover, but both my PT and Dr. told me to avoid Dips and Pull ups mainly body weight workouts for 6 month or more after surgery. Its been 4 months and I can do push ups but they are pretty uncomfortable. I would just recommend you keep up with the workouts that the PT gives you, I was doing them more than I should but at the end of 4 weeks I was able to use light weights during therapy instead of the bands. Good luck with PT and your recovery. Oh and my scar is crazy looking maybe close to 2.5 inches long and close to a 1/4 inch thick lol.


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## Jopowapash (Oct 13, 2015)

*AC Seperation Grade IV*

I have found most of the messages this thread to helpful to my situation, so I thought I would share my experience. I have had surgery a week ago.

*How it happened*
Snowboarding. I was going across the hill when another snowboarder who was going way to fast collided directly into my right shoulder. We went to the ground, I remember hearing a ringing in my head and everything going dark for a second before seeing stars, as I tried to get up by pushing up using my arms I felt a sharp pain in my shoulder and I knew something was wrong. I take off my bindings and grab my board and walk all the way down to a nearby cafe to get help. 
On my way down I rubbed my right shoulder and I could feel a deformity. This was confirmed by a ski patrol aid, who suspected I had separated my AC joint. After checking me for signs of a concussion she helped me get to a clinic.
At the clinic, I had to wait a while before being seen and I think the adrenaline had worn off because the pain got pretty sharp. The clinic had me take xrays and they were looked over by the emergency doc over there. He thought it was a grade 3 separation and even showed me a bump on his shoulder as he also had separated his AC joint. He said that I would most likely not be needing surgery and will be able to get back to normal after rehab.

*Process to surgery*
I saw a physical therapist a couple of days later who after looking at my xrays instantly recommended I see a surgeon. I got booked in a couple of weeks later. During this time I kept my arm in a sling for a week and weened off it on week 2 post injury. The bump on the shoulder was not even sticking out that much and was hardly noticeable.
The surgeon examined me and sent me to get more Xrays done. He said that he highly recommends surgery as he believed I had a grade IV and he though I would have problems getting back to MTB and snowboarding. His notes mentioned that I had a 200% greater than normal displacement and my bone had been mildly displaced posteriorly. I agreed to go ahead with the surgery and asked him to place an ACC claim for it (I live in New Zealand healthcare is free).
I did some research on the surgeon and he seemed like one of the best I could get.
I had to wait another 4 weeks for ACC to approve my surgery and another 2 weeks to get a surgery booked in. Therefore, my surgery was 7 weeks post injury.
At the time just before surgery. I had gotten about 80% of my ROM back with about 50% strength. The surgeon was going to tie down my clavicle using some sort of super strong polymer rope and connect my CC ligaments back up but he was going to let the AC scar up on its own.

*Surgery Experience*
I was really scared of the surgery as this was the first major thing I had done to myself. However the experience of the surgery was not painful at all. Only pain I felt was the IV drip going in. Other than that they give you stuff to make you calm and you wake up at the other end of it feeling like you have had a nap. The pain from surgery was minimal as they drug you up. I had to stay overnight and had a pleasant experience at the hospital, given what it was. 
I stopped taking all drugs 4 days post op. Started showering whilst avoiding the wound in a sling. And I do have a dull ache which is to be expected.

*1 week post OP*
I am one week post OP atm. To be in a sling for 6 weeks. I return to work in another week as I can choose to work from a desk.
I am going to see the surgeon in another week to have a progress check. Will update after week 2.

Concerns I have atm:
-Man i hope i can get back to MTB and snowboarding
-Ive got a backpacking trip to Japan 11 weeks post op which i hope ill be ok for. (doc says will be allgood)

Hope that helps. 
*
3 weeks post OP Update
*I am currently sitting at 20 days post op. to be in a sling for 3 more weeks. I have returned to work and feel fine other than minimal stiffness and pain sleeping well too.
Went to see the surgeon for a check up and got some sort of bad news. According to the xray taken my clavicle is not sitting as its supposed to post op. it is still a bit higher than its supposed to be. It had been lowered down a lot and bought forward since it was a type 4, however, not according to the xray it looks like a type 3. the doc thinks the repair might have stretched. I have been religious with the sling and have been following instructions. It was disappointing to hear this.
The doc palpated the site and there was no pain which was a good sight. I expressed my concerns regarding the outcome and he said that they got it down good when they did the surgery. He also thinks that I will still turn out all right. Guess I gotta keep going and let the chips fall where they may.


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## zero85ZEN (Feb 11, 2015)

Jopowapash said:


> I have found most of the messages this thread to helpful to my situation, so I thought I would share my experience. I have had surgery a week ago.
> 
> *How it happened*
> Snowboarding. I was going across the hill when another snowboarder who was going way to fast collided directly into my right shoulder. We went to the ground, I remember hearing a ringing in my head and everything going dark for a second before seeing stars, as I tried to get up by pushing up using my arms I felt a sharp pain in my shoulder and I knew something was wrong. I take off my bindings and grab my board and walk all the way down to a nearby cafe to get help.
> ...


You'll be fine mate! I had surgery the middle of May and was back riding on the road the end of June. I weened myself out of the sling after about a month...I still was careful with the arm of my injured side...I'd keep finger looped in jeans belt loop most of the time...but the sling was just so uncomfortable that after I was really on the mend I ditched it ASAP. 
I'm now 5 months post surgery (level III) and have what I'd consider 100% use of shoulder: Push-ups without pain, full range of motion, no limits on any physical activities I do, etc...
You'll be great to go on your trip to Japan. ;-)


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## Sluker (Jun 8, 2015)

I joined the club about 7 weeks ago, grade 3 separation diagnosis to my dominant side. Yesterday I had my follow up with the Ortho surgeon. Before he even examined me he said that I need to decide whether I want surgery or not based on how happy I am where my shoulder is now as it will only improve another 10% from here. That sucks because I feel I am at 50%, where I now have 90% full range of motion but still lack strength, experience pain and instability with the arm raised above shoulder and crossed in front, of chest. I have ben out on the trail bike 3 times in the last 2 weeks and any big hits, drops, lifting the front causes a shot of pain. The joint does not feel stable and certain movements result in a feeling of grinding between the rotator and the AC.
I wanted to ask you guys how much improvement you saw from week 7 to 15 in comparison to week 2 to 7? 
I really was hoping to avoid surgery


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## mrsauce (Oct 22, 2015)

Thanks to all who contributed to this thread. Super helpful to see what others have been through.

My story, and what i learned

High level

AC separation, grade 2 or grade 3 depending on how you look at it. In either case, surgery is not necessary, and I opted not to have it. The more I read, the more happy I am about not opting for surgery. Recovery time (measured as being able to ride again legitimately): 13 weeks.

Here's a bunch of detail

Measuring whether it was a grade 2 or grade 3
The traditional way is to look at the distance from the tip of the clavicle (where the AC, or acromioclavicular ligament sits) and the acromion on an x-ray. The more reliable way, according to my ortho, is to measure from the middle (not the tip) of the clavicle to the coracoid process, where the trapezoid / conoid ligaments sit. If that distance is between 110-160% of what it should be (using the other shoulder as a comparison), then it's a grade 3 ... you know you have a good ortho if they spend the time trying to figure this out ... also, I am going off of memory here, so I might've gotten the ranges slightly wrong.

Implications of grade 2 or grade 3
No surgery for grade 2. Grade 3 is a grey area. The majority of orthos that I spoke to cite the same research when it comes to deciding whether to have surgery or not. The research followed hockey players, who have a high incidence of AC sep, crashing into barriers and such. They found that for grade 3, the prognosis is the same whether you have surgery or not. The ortho will likely say something like "you can choose between a bump (the clavicle sticking out a bit) or a scar (from the surgery)". It seems like a rationale reason for the surgery is if you care about how you shoulder look (e.g. you are a young lady). For me, I didn't see any benefit and a lot of downside: pain (apparently shoulder surgeries are quite uncomfortable to recover from), longer recovery time, and risk of infection etc... . So no surgery for me.

Recovery process
The day of, it hurt like a *****, and having no concept of AC separations, I was really worried that it was the end of my riding, tennis, golf and everything else days. I had a minor concussion, felt nausea, heart was racing, I was sweating like a dog ... I calmed down when they stuck me with morphine at the hospital. I was surprised at how much strength i still had in my arm when they tested it various ways at various angles. They sent me home that night, which I was also surprised with as I thought I would be admitted for some sort of surgery. Interesting side note ... every single medical professional I met had had an AC sep (ER nurse, ER doctor, Ortho Nurse, Ortho Doctor, Physio). I guess that's how they roll in San Diego!

Week 1: I took the prescription painkillers for the entire week, and stayed home the first 2 days, though was able to work (conference calls, writing one handed emails etc...). I took a lot of naps, and could sleep ok, but not great, on my good side. The pain was dull and constant, and I wasn't able to do much of anything with my shoulder. I also had flesh wounds, which my wife helped me with. Generally I was using 1 hand for most if not all of my activities. My wife drove me around, I had to sit in the backseat on the side where I could put the seatbelt over the good shoulder. Whenever the car went over a bump, I could really feel the instability in my shoulder ... it was quite uncomfortable. I also had to wear a sling. It caused pain on the other shoulder, partly from carrying the weight of the arm. It was all a big pain in the ass.

Week 2: Still wearing a sling. Switched from the prescription painkillers to over the counter, though had to go back on a couple of occasions because I needed the pain to go away. I was back at work every day, and still being driven. I could do a little typing on the computer with the bad hand, but it got tired quickly. I used voice recognition software a lot, which is not as much of a time saver as I thought.

Weeks 3-4: Ditched the sling, started driving myself around. tried to cut down on OTC meds ... generally succeeded ... started physio. once I found a PT I liked (the difference between an average and good PT is shocking), i was very aggressive ... twice a day, 15-20mins min per session. Most of the exercises were trying to get the neck and shoulder muscles to relax (they freeze after trauma, for protection). Still in some occasional pain, limited arm movement, couldn't lift my arm above my head, couldn't shave with that hand, had to wear button down shirts so I didn't have to bend my shoulder into a t-shirt. Generally was getting worried that recovery was going to take forever, given the incredibly slow pace of improvement.

Week 5: saw a step change improvement the day after being in the pool for an hour or so. Shoulder and neck muscles seemed more relaxed, and was able to do quite a bit more. Arm still got tired easily. At work, I always looked for ways to rest my arm on something (arm rest, table).

Week 6-8: gradual improvements, but no step changes as observed in week 5. Continued aggressive PT ... could raise arm above my head by walking fingers up a wall. Now back typing on a computer, almost normally, though was getting tired easily. Taking occasional OTC pain killers. Can only sleep on good side or on back. Still couldn't use my arm to shave my head, because of awkward reaching back motion.

Week 9-12: Rapid progress being made over these weeks. Was finally able to put my hands behind my head. Able to put on a t-shirt without screaming. I could hold planks legitimately (more of a week 11-12 thing), ventured out on the bike week 11, though on the road. Lifting the front tire to get on/off the sidewalk was a little painful, but manageable. Arm tired easily, and I took painkillers after the ride.

Week 13: Did my first legit mountain bike ride. Still a little soreness at the tip of the clavicle, but good amount of strength. I walked the bike on harder segments ... no point in taking risks this early. Confidence is certainly lower than before, but I expect it will come back as I put the miles on. Had to take pain meds the next day.

Week 14: Did a bunch of riding, and it all felt solid. I am also swinging a racket, and hitting a ball with good strength. Taking pain meds the next day about 50% of the time after physical activity. Wished I had done some exercising throughout this ordeal as I lost a lot of fitness (I've seen others say the same thing), but it's coming back. Graduated from PT, though I continue the exercises. I just recently was able to shave my head with no discomfort from the awkward reaching. A lot less instability inside the shoulder ... but I still can't sleep on my side, and there's no way that I can do a push up. I heard that takes 6 months to 1 year.

In closing
I hope this helps others set expectations on how the recovery goes. For me, it was definitely a story of no noticeable change / no noticeable change / no noticeable change / big change / no noticeable change and so on.

One of the important aspects seems to get those muscles to relax ... I tried massage and that was very helpful ... being in the pool also helped, so recommend all that. Be patient with the recovery, do the PT and try to get some exercise in.

Good luck and see you on the trails soon!

Note: I had to go off memory for a bunch of this stuff, so consider this directional, and thanks in advance for any corrections (primarily on the medical explanations!)


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## Pkovo (Aug 22, 2012)

Grade 2 seperation here. Occurred 2 days ago, on the last quarter mile of a 9 mile ride. At least I was close to the car. 

Got it X-Rayed and diagnosed right away, nd it was put it in a sling and I was told to see an othopedist. Went to the orthopedist Ive seen for other injuries(sports ortho), and he immediately told me to take off the sling and keep it off. He said use it and move it to the extent I can when I can. Gave me exercises to do in a few days that essentially entail me pulling the injured arm through range of motion movements using the other arm, using a towel, a broomstick etc. Essentially to make sure it doesn't heal "stiff" as he said that will slow things up. He said moving through low-med pain is OK, extreme pain no, so that's what I'm starting to do. 

Thing is I have a lot of pain in the shoulder, but also alot in the whole region around the shoulder; through the rib cage front and back etc. Pain if I take a deep breath, sniff, basically do anything that tightens the muscles in that region. For example, I got a peanut caught in my throat earlier and started coughing....the pain from coughing was so intense, I wasn't sure if I should be laughing or crying. I've had several breaks, cuts muscle tears etc, but this might be the most painful injury I've had to date. 

The ortho said he expects in 1-2 weeks I will feel substantially better, as a grade 2 seperation should heal fast, but if the pain isn't much better in 2 weeks, I likely have something else going on that the xray didn't pick up and they'll need to explore further, via MRI I assume. It's so painful I kind of expect I have something else going on. Then again, maybe I'm just getting sissified in my old age.

Reading this thread has helped though. I didn't realize this was such a common injury for cyclists. I surf, and I'm more concerned about the range of motion I need for paddling on a surfboard.


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## Sluker (Jun 8, 2015)

Pkovo said:


> Grade 2 seperation here. Occurred 2 days ago, on the last quarter mile of a 9 mile ride. At least I was close to the car.
> 
> Got it X-Rayed and diagnosed right away, nd it was put it in a sling and I was told to see an othopedist. Went to the orthopedist Ive seen for other injuries(sports ortho), and he immediately told me to take off the sling and keep it off. He said use it and move it to the extent I can when I can. Gave me exercises to do in a few days that essentially entail me pulling the injured arm through range of motion movements using the other arm, using a towel, a broomstick etc. Essentially to make sure it doesn't heal "stiff" as he said that will slow things up. He said moving through low-med pain is OK, extreme pain no, so that's what I'm starting to do.
> 
> ...


The pain sounds strange as with a grade three I did not have extreme pain when at rest.
Are you sure you didn't break/bruise any ribs, what you are describing reminds me of that.


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## mrsauce (Oct 22, 2015)

geetarmano said:


> Any guitar players suffer from a grade 3 and go the non surgery route? Did it affect your playing with stamina and or pain in neck?


Yes, that was exactly my situation. I started playing again after the 3rd or 4th week with an acoustic. My arm and shoulder did get tired easily, with stiffness around my neck after playing (we are talking right shoulder having the separation, and playing normal right handed guitar).

I play in a worship team, and based on healing progress, I was able to come back after 8 weeks. Might've done it sooner, but wanted to be safe. I couldn't lift the guitar over my right shoulder with my right hand ... Had to use my left. It all cleared up after 12 weeks and now back to normal.

Hope this helps


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## mrsauce (Oct 22, 2015)

I had something similar, and found out that the impact on my right clavicle created subluxation of my left clavicle. Once they diagnosed and adjusted it (by body slamming me), whatever pain I had stretching / breathing went away, with only the right shoulder pain left.


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## Pkovo (Aug 22, 2012)

Sluker said:


> The pain sounds strange as with a grade three I did not have extreme pain when at rest.
> Are you sure you didn't break/bruise any ribs, what you are describing reminds me of that.


No not sure at all. In fact, if I was to guess, I would guess I did bruise ribs judging by the way I feel. The ortho said something to the effect that "you're all bruised up" but nothing more detailed. I think his wait a week or so and see where the pain is at approach is to weed out how much of it is just banged up pain.

My shoulder hurts really bad if I move it certain ways, but its kind of predictable. The worse pain I have is actually in my upper back between the shoulder blade and the spine. I get pain there with a deep breath, a sniff, real bad with a cough or sneeze. Getting out of bed is a trick, I kind of just slide off the side on my back without sitting up because sitting up gives me sharp pain. I've spent most of the last two nights in a recliner.

Historically I heal quick but I'm really bad at waiting. I went down hard, with all of my 200lbs pushing me into the ground so I probably just bruised the $hit out of everything in that area and I know I need to just wait and see how it progresses but I get so damn antsy.


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## Sluker (Jun 8, 2015)

I am no doctor but I would not delay getting a second opinion especially with back problems. 
I am kind of paranoid with ER diagnoses, when I broke my ribs I also punctured a lung, although I complained about shortness of breath they said I was fine, gave me pain killers and sent me home. Then at 3am I got a call from the doctor on staff who said I needed to come back in because they checked again and noticed I had a punctured lung.
Not fun.


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## JOHNRB (Aug 13, 2014)

Sounds like cracked ribs at the rear for sure, get them checked out sooner than later as Slucker said


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## Pkovo (Aug 22, 2012)

Thanks guys. I probably will get a second opinion. I'm not very trusting of doctors in general, but I have a good one in my office. Nice perk of my company..very old school. Made them give me my X-rays on disc so I could bring them in to him. The ER nurse looked at me like I was nuts asking for the X-rays. I guess most people don't. A few years back I had a stress fracture in my leg. It was missed by the X-ray tech but the doc at my office caught it. 

Although from what I know of bruised ribs, they don't really do anything for them anyway.


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## nzl62 (Jul 28, 2007)

Grade two ten days ago. About to go to physio but it's been getting better and better each day. Got reasonable motion. Had a bike holiday booked that leaves in 2 days so I have gone from def no to hmmm maybe if I stick to blue and green trails and have it taped
Will see what doc says but essentially it went from excruciating at time to now a week and half in where I haven't used the sling for about three days, can drive - hilux is auto luckily
And sleep pretty well in any position except on affected shoulder and on front.
Am I mad to even consider lightest double track forest riding after less than two weeks?
Pain has been very mild for 3/4 days and really only issue is the funny felling of pressure due to things not being in right place.
I know that if I ride and then crash I'll screw things up but flight paid for etc etc girlfriend going and she rides conservatively. Gotta be better than staying at home because it would drive me nuts to be there with all the other friends and not ride at all - would rather stay home!


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## Pkovo (Aug 22, 2012)

Well, day 8 for me and I'm certain I screwed up a rib or ribs. Deep breaths give mild pain. Blowing my nose med pain. Coughing serious pain. I had the misfortune of sneezing last night and it made me want to cry! Waiting to hear back from the doc, but from what I gather theres not much they can do for a rib. I just want to be sure its positioned right etc so itheals ok.

I found sleeping in bed makes it sore. I can only sleep on my back and it makes my pinky and ring finger and section of the palm beneath numb by morning. one day the numbness lasted half tbe day, but now it fades rather quickly. I find if I sleep in my recliner im more comfortable and get no numbness so thats my game llan for a while.

This whole thing is just such a hassle. If I had a trip planned, there is no way I could ride.


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## nzl62 (Jul 28, 2007)

Just back from physio. Strapped up and apparently only 6/10 crazy fro pushing ahead with my trip this week. Result. I know I won't be riding the tracks I would otherwise but better than working or moping about the house.
Feel for you guys I think I have got off really lightly. Physio did say that if I crash I will do it completely and I will be out for a god few months


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## digitalhippie13 (Nov 24, 2010)

Just thought I would add my tale of woe to the many others in this thread.

Had a relatively high speed MTB OTB October 25 resulting in class 5 AC Separation, left shoulder - barely a scratch on me (or bike!) otherwise. 

Underwent surgery October 30. Hamstring from leg used to reconstruct AC joint by Orthopedic surgeon specializing in knee and shoulder sports injuries.

I start rehab with physio later this week. Definitely keen to get into the hydrotherapy once the incisions heal.

Given the severity of the injury, it being on my dominant side and the physical nature of my work, I'm good with the decision to go with surgery. 

Obviously super early days but with each day since surgery there are improvements, obviously not without significant discomfort though as you'd expect at this stage. Time will tell.


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## Pkovo (Aug 22, 2012)

Good luck with the grade 5. It was confirmed much of what I am feeling is fractured or strained ribs. They said my breathing is fine. They didn't bother x-rating. Said treatment is the same whether strained or fractured. They also said I bruised/strained/tore a lot of e muscles in the rear of the shoulder. That's probably the bulk of my shoulder pain. They think the separation itself is a bit more minor. They still believe the way I hurt it will heal up nicely, so that's positive.

Recovery time is expected to be longer than initially expected. I was pretty bummed at that, but in the last few days (around day 12 or so) My range of motion has really gotten better. Still pain, but now at day 15 I can lift the arm straight up now under its own power and I'm able to do all of the PT each day. Ordered some soft armor so I'll feel a little more comfortable about riding before I'm supposed to. Probably just cruise some rail trails at first but something would be better than nothing.


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## gumbytex (May 9, 2012)

Grade 5 separation here, on September 17 2015. Had surgery on October 1, 2015. Today is November 11, 2015.

I was going down a barely hikeable section of trail (~-40%) and got off line, front wheel hit a bush and I went out over the bars and down, driving my left shoulder into the trail. I instantly knew something was really wrong, the bump and inability to use my left arm made it pretty obvious. Had to hike out by myself with my bike and backpack, wasn't very fun!

The ortho said if I had surgery relatively quickly, my own ligaments would regrow with the cadaver ligaments (he did the anatomic reconstruction) and create a strong joint. He said that if you wait awhile, like a snowboarder wanting to finish the season, the joint won't heal as well because your own ligaments won't regrow once they're in their chronic state.

Now, 6 weeks post op, I'm in PT. Shoulder got pretty stiff after surgery and ortho got me into PT sooner than anticipated. I can almost passively raise my arm 90 degrees to the front, and every visit I get more range of motion back. Still in a sling, my ortho wants me in it for 3 months (end of December). Sleeping is easiest propped up on the couch - I can sleep in my bed but I'm up every hour or so to shift positions.

I've been hiking a lot to keep active. Both PT and ortho say I'll be back to 100% when this is all said and done. After surgery my shoulder looks totally normal - no more bump - and aside from the pain and immobility there's no more of that disconcerting "disconnected" feeling that I had after the injury but before surgery.

I'm glad I had the surgery. One buddy just had the same injury, treated by the same doc, and 4 months later he's riding at 100% again. Another buddy had grade 3 separations on both shoulders, and had one operated on and the other not. He says he wishes he had surgery on both because his non-op shoulder just isn't the same, pushups etc. are sketchy.


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## digitalhippie13 (Nov 24, 2010)

Ok wee update..

Oct 25: MTB OTB, Class 5 AC Separation left shoulder

Oct 30: Surgery, used hamstring to reconstruct joint.

Nov 12: 2 weeks since surgery, increasing load of physio exercises. Can now get loose shirts and hoodie off and on - feels like quite an achievement! Here's a sped up video of the process 


__
http://instagr.am/p/99-LY2wvCh/

By the end of each day shoulder pain is quite intense, but on the upside every day there is more movement and the pain is generally less overall. I'm off the opiate based pain killers. The quality of sleep is improving too - down to just using my regular pillow vs sleeping propped up,

The plan is to keep hitting the physio pretty hard - not so much to rush the healing process and screw it up, but definitely to keep it progressing.

Can't imagine being back on a bike any time soon... apart from the indoor trainer. UGH.


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## CFH (Oct 27, 2015)

Boy oh boy... I feel like a lucky sob. Flew over the handlebars on a good drop Sunday and immediately went to the urgent care, something didnt feel right. Got the x rays done and doc said a level 2 separation... went to the ortho on Tuesday and got the same... level 2. Whats crazy is how I have full ROM and its barely hurting... Was feeling so good that I actually went for a nice little ride Wednesday night, only did 4 miles... didnt want to push my luck. So in all I got lucky I think and I know it could have been sooo much worse by reading this thread.


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## targnik (Jan 11, 2014)

New member to the club... not sure on grade... maybe a 1.5 - 2.0? The triage Dr said they may need to operate, but the Ortho came and looked at X-rays. Overhead him say they only operate on 100% separation. If I'm lying down shoulder doesn't really hurt just feels weird. But, if I move upper arm/shoulder 'HELLO!!' If I do accidentally move it I feel/hear clicking. I've been referred to the Fracture Clinic (told up to a week before I hear from them). Triage doc says 2 weeks off work/no using arm. So, am guessing at least a month off bike. Luckily I have a great physio, but Xmas hols are going to interfere with treatment. Would like to be able to say I did it on a 10 foot gap jump. No such luck, riding a new trail (berm) front tyre got a little close to top and the berm gave way!? Next thing I know, I'm hitting bottom of berm (which was like concrete!!).
After reading 2015 posts I'm hoping of a quicker than expected recovery. Once able, I'll be doing some running to maintain fitness. Local trails around here are dual use too. I maybe 'that guy' for a month or so. 

Happy trails!

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-=snifff!!=- What's that you say?


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## CFH (Oct 27, 2015)

CFH said:


> Boy oh boy... I feel like a lucky sob. Flew over the handlebars on a good drop Sunday and immediately went to the urgent care, something didnt feel right. Got the x rays done and doc said a level 2 separation... went to the ortho on Tuesday and got the same... level 2. Whats crazy is how I have full ROM and its barely hurting... Was feeling so good that I actually went for a nice little ride Wednesday night, only did 4 miles... didnt want to push my luck. So in all I got lucky I think and I know it could have been sooo much worse by reading this thread.
> 
> View attachment 1028355


Update... almost 2 weeks since the injury. Been on the bike every other day on the trails doing 10-12 miles at a time. This injury is weird... I dont feel any pain whats so ever while riding, but when I lay down to sleep its painful. Not taking any pain meds... just ice 2 times a day. I should be a 100% in 2 more weeks the way my recovery has been going.


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## targnik (Jan 11, 2014)

You are a lucky SOG!

Just had a look at mirror and there's a noticeable bump!!









Not much to look at... but, when compared to other shoulder!!

Trying to get dressed is a SOB! Ice + TV for me today...

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-=snifff!!=- What's that you say?


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## CFH (Oct 27, 2015)

Yeah man... getting dress sucked big time, I will admit that. But yours doesnt look too bad... but level 2 at least. Did you get any xrays?


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## targnik (Jan 11, 2014)

CFH said:


> Yeah man... getting dress sucked big time, I will admit that. But yours doesnt look too bad... but level 2 at least. Did you get any xrays?


Not given to me...

Just negotiating w/ boss via email on what constitutes 'light duties' and not using right arm...

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-=snifff!!=- What's that you say?


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## digitalhippie13 (Nov 24, 2010)

3 weeks since surgery on Class 5 injury:


Started driving car (manual transmission) again in this last week. Enough movement and strength in shoulder to change gears, not super comfortable but OK.

Rolled around on MTB for 5-10 minutes up and down driveway. Smallest bumps weren't comfortable, so while trail riding is a way off (probably January 2016) I'm going to start riding the MTB around town on sealed roads from now on, more fun than using the trainer.

Have started strengthening exercises in addition to ROM. Movement and strength is a long way down on my good shoulder arm - disheartening sometimes, but is improving each day.

Pain levels are still quite high, but that said I am hardly taking any pain relief medication now.

So all up, pretty happy with how things are going. Kinda feel like it's a bit of a danger zone for me now - where it would be easy to over do things due to the combination of frustration and feeling a little better.



digitalhippie13 said:


> Ok wee update..
> 
> Oct 25: MTB OTB, Class 5 AC Separation left shoulder
> 
> ...


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## Pkovo (Aug 22, 2012)

One day shy of 4 weeks on my grade 2 with fractured ribs....

Back to sleeping in bed this week rather than recliner. Can ride the bike on road and rail trails without discomfort. Sneezed yesterday, and although it's still quite painful, it wasn't nearly as horrible as it was in the beginning.

I get more pain out of my shoulder when I pull, like if I try to pull the front end of the bike up. I also get pain when I bring my arm behind me. I wanted to try surfing yesterday, but the paddling motion is still too painful.

Plan to ride 10 miles plus today. so far I've only done shorter rides so will see how it goes.


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## targnik (Jan 11, 2014)

Update: Grade 1.5-2.0

Sunday morning (day 3) and some ROM is returning ^^ see how it is once out of bed...

Update-to-update: 

Using range of motion causes prolonged suffering!! i.e. I'm pretty sore right now o_0
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-=snifff!!=- What's that you say?


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## Pkovo (Aug 22, 2012)

Pkovo said:


> One day shy of 4 weeks on my grade 2 with fractured ribs....
> 
> Back to sleeping in bed this week rather than recliner. Can ride the bike on road and rail trails without discomfort. Sneezed yesterday, and although it's still quite painful, it wasn't nearly as horrible as it was in the beginning.
> 
> ...


Rode 10 miles yesterday as planned. Felt so good, just kept going and ended up doing 30. All flat rail trail, but the riding position actually feels good.


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## targnik (Jan 11, 2014)

How's everyone's manualing technique going? Just a few days into recovery and I can see lifting the front end will be trickiest part of getting back on steed... which if riding gnarly trails is pretty important. 

-----------------------------------------------------------
-=snifff!!=- What's that you say?


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## spjones123 (Nov 15, 2014)

That manual motion of yanking something heavy in front is still the worst movement for my shoulder, now that I'm 95% better. I have an Outback, so I pick my bike up and slide it in back. That motion hurts more than riding my bike. Just a strange injury compared to everything else I've done. I can make it through most of my wife's Insanity videos, surf, lift heavier weights at the gym....but if I reach down to put on a shoe with my arm fully extended I get a little shot of pain. And none of my post recovery pain has ever been in the actual shoulder where the joint was damaged. It's always a dull ache up my Trapezius.

Which out of curiosity......what movements or strange everyday things still bother you guys now that you're more or less better?


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## Pkovo (Aug 22, 2012)

I believe I'm right at 5 weeks past my injury. The yanking/lifting is still the worst to me, but it continues to get better slowly. I also tend to get more pain with any motion where my hand is somewhat behind me. I'm nervous about trying surfing because when I simulate the paddle motion, I get pain in the whole portion of the stroke from when I would pull my hand out of the water until it goes back into the water, since that part of the stroke has my hand behind me. Also weird movements have caught me offguard. For example a smoke alarm went of yesterday. I jumped up to press the hush button instinctively with my injured arm, and that motion hurt.

My pain is mainly in the the head of my shoulder, and towards the rear portion. Not really where I visualize the separation is.


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## soulshaker (Sep 23, 2013)

5 months post-surgery for grade 5 AC sep. I found paddling my board to be good therapy. In fact, it seems to be the only therapy for getting back surfing. Like you, in the beginning I couldn't get my arm up high enough on the recovery part of the stroke but had no problem with the pull, other than being weak. Had to dog paddle at first with the left arm. A few sessions in it started to get better and now at times the stroke almost looks normal although it still hurts at that lifting the elbow spot. It also hurts to push to the sitting position and still can't push all the way to standing yet. Am going out in an hour or so (hoping the sun clears the clouds a bit) for my now regular 2 a week session. Am up to an hour out in the water mostly paddling alternated with 15-20 reps of sitting from prone. It doesn't hurt as much now. Hope to be back standing soon! Haven't found any exercises that replicate surfing and being out in the water really helps the soul.


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## digitalhippie13 (Nov 24, 2010)

About 4 1/2 weeks since surgery on grade 5 and pretty much any movement that includes extended reach is tough. A good example would be leaning over to wind down the car window on the passenger side from the drivers seat - almost impossible ATM and super painful.

I've been back on the MTB since last week, early days but gradually increasing intensity, moving from sealed roads to smooth paths. ATM with the shoulder I'm not able to lift/pull the front of the bike up at all, and absorbing large impacts is tough too.

That said I did several shuttle runs while working in the mountains on the weekend and loved being out on the bike. Definitely had to concentrate on staying relaxed and just riding vs protecting the shoulder, plus took it relatively easy of course. Main issue for me is building confidence in what the shoulder can do, while at the same time continuing to strengthen it up. In my case gotta be on the bike to make it happen in sync.


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## gumbytex (May 9, 2012)

I'm kind of amazed at how different the rehab protocols given by different doctors are! My doc has me in a sling for 12 weeks after an anatomic allograft reconstruction of a grade 5, not riding road until week 12, certainly not mountain biking before then. Other docs let people out of their slings at week 4-6 and allow biking again at that point. Blows me away how much variation there is!


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## targnik (Jan 11, 2014)

Can't imagine the pain associated with a grade 5... 

my 2-2.5 (75% separation) is pretty sore in the morning i.e. 10-12hrs w/o pain relief. Still struggling to feed myself (right hand - injury side) have to move mouth/head down to hand. Looking like a homeless man i.e. can't shave or not brave enough to try left handed (man slits own throat shaving!?) Still finding if I try and do anything particularly heavy with left arm, it will transfer to right side. Tried rolling on bike yesterday (asphalt) and handlebars felt crooked. Thinking full recovery is some weeks off yet... smooth trails in a couple weeks (hopefully), then some moderate single track after that... no rush to be bombing stuff yet. Just getting back out on bike will be nice. Martial Arts I'm thinking is done for the year. 

NB, 10 days post injury...

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-=snifff!!=- What's that you say?


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## digitalhippie13 (Nov 24, 2010)

gumbytex said:


> I'm kind of amazed at how different the rehab protocols given by different doctors are! My doc has me in a sling for 12 weeks after an anatomic allograft reconstruction of a grade 5, not riding road until week 12, certainly not mountain biking before then. Other docs let people out of their slings at week 4-6 and allow biking again at that point. Blows me away how much variation there is!


I would say it just depends on the individual injury and how it was repaired.

My AC joint grade 5 was reconstructed using a hamstring harvested from my leg - there was no graft etc. In my situation there was no benefit or need to immobilize the shoulder/arm in a sling following surgery. In fact you're encouraged to start moving the arm ASAP i.e. the next day, and stop wearing the sling altogether as soon as you can tolerate the discomfort, which for me was 1-2 weeks. From then on it's all about regaining movement and building strength especially during the first few months, and learning how the shoulder behaves. From all the options described by the surgeons this one seemed to be the one that best addressed the injury and my needs, lifestyle etc going forward. I'd probably describe it as brutal and effective.

I should say that while they OK'd smooth path riding ATM, neither the surgeon or physio recommended I go out trail riding just yet, but ya know sometimes you've got to find out where things are at, and I was relatively careful. The reason for their riding recommendation is that main risk in my case is crashing/bumping into something and fracturing the bones around where they were drilled to thread the hamstring - and crashing is obviously way more likely when you're shoulder isn't fully functional yet. The other risk is prematurely stretching the hamstring excessively which could lead to a sloppy shoulder later on.

For me the discomfort can still be intense in a searing kinda way (95% off all pain medication), but the trade off is each day the shoulder improves. Anyways that's what ya left with, on the outside at least!


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## targnik (Jan 11, 2014)

Sat on whip yesterday and pedaled around garage w/o any major pain (tight turns were meh)... Getting excited I'll be able to ride soon (even if it's only on flat stuff)

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-=snifff!!=- What's that you say?


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## targnik (Jan 11, 2014)

3 weeks post injury today...
Would say I've got 50-60% rom back... lacking strength at mo.
Have planned in my minds eye a midweek ride (next Wednesday) w/ kids - just paved stuff to dip the toes.

-----------------------------------------------------------
-=2011, 2015... 3-peat?=-


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## targnik (Jan 11, 2014)

10km ride not long ago... asphalt only w/ my 6 year old ^^ wish I was as hardy as him. He did an endo/scorpion... on the flat!? Don't know what he was trying to do ^^ couple of tears and he was off again. I would've been back in hospital >.<

Anyway, ride went fine. Hands took a wee bit to get used to weight/pressure again. Got adventurous and rode over a wooden carpark barrier (1/4 of a railway sleeper) shoulder not so keen on that... but, a little step down didn't faze at all!?

Planning another ride tomorrow with son again... this time on a little loop I do with the kids on hard packed trail. Will be a bit more challenging. Should be epic! If I come through unscathed o_0

-----------------------------------------------------------
No skool... like old skool!


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## Pkovo (Aug 22, 2012)

Stage 2 separation 10/25 with bruising and what turned out to be fractured ribs.

I've been riding single track again, for a few weeks. Each ride a little better. Last week I felt much better pulling the front end up, and even threw in some bunny hops. Was very happy with progression. Well, until today.

Today was my first attempt at surfing. Waves were about chest high. I really thought I was going to be relatively fine, but I was wrong. Everything hurt...paddling out, duck diving, popping up to my feet, really everything. The worst part was I couldn't paddle hard, so catching waves was very difficult. The whole session was essentially a wash. The shoulder got more achy as I went, and I even started feeling the ribs; even though they are in back, the pressure on the front of my rib cage made them hurt.

Pretty depressed with the whole thing. Hoping I just tried too soon, and in a few weeks it will be a lot better, but worried I may have damaged my shoulder in some other way. At least I can ride. Still haven't tried rear wheel hops or any trials you type moves, but XC riding has been great.

I did buy an armored vest though, in case I fell on the ribs. Gave me a sense of security (false perhaps) that helped me ride a bit harder. I also bought a fatbike about 1-2 wks after my crash thinking it would be a "softer" way to get back out there. Basically just an excuse to buy anger bike


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## targnik (Jan 11, 2014)

Woohoo!! First ride on dirt this afternoon ^^

Managed a wooden ramp and seesaw... wasn't going particularly quick (wasn't blazing when I injured shoulder either), only problem is up & overs i.e
up and over large roots. Small wheelies were fine as they're initiated by leaning back.

Think I'll do a solo (today's ride was with boy again) ride tomorrow... bit of asphalt, couple of good off road climbs then one more road climb home.

-----------------------------------------------------------
No skool... like old skool!


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## targnik (Jan 11, 2014)

Big ride this arvo... 2 hr 20 mins worth in 34 deg.c heat to boot!

-----------------------------------------------------------
No skool... like old skool!


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## spjones123 (Nov 15, 2014)

If it's any consolation surfing was pretty hard for me too. What really helped (not just surfing but everything about making my shoulder feel better) was slow progression in the pool....first time 5 minutes super slow, then 10 etc. after about a week and a half added some 75% sprints and on and on. Everyone's different but there was something about the swim motion that works both full range of motion and strength that really got me feeling better. Riding single track is fun, and it's great for mental health, but there's nothing about all that jarring and bouncing that's inherently good for a healing shoulder.

Long story short pool=crazy boring. But in my experience worth it for 4 weeks. Wish I would have started few weeks sooner.


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## targnik (Jan 11, 2014)

Shoulder been a lil sore post Monday ride...

So, I'm heading out again tonight... 

Tag along with the slow bunch on a group ride ^^ 

Then, it's beers n bangers!!

-----------------------------------------------------------
Ho, Ho, Ho... now you're broke!!


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## JOHNRB (Aug 13, 2014)

After about 4 months since a Grade 2 
Aches after riding, lifting the front wheel causes some pain on the trails, as does 3 foot + drops, puts a jar through the joint which causes pain, overall tho back riding and hoping i'm not doing more damage
Rock climbing is still out tho


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## targnik (Jan 11, 2014)

JOHNRB said:


> After about 4 months since a Grade 2
> Aches after riding, lifting the front wheel causes some pain on the trails, as does 3 foot + drops, puts a jar through the joint which causes pain, overall tho back riding and hoping i'm not doing more damage
> Rock climbing is still out tho


4 months!?

Holy, hand down the wide fronts and finding something missing... Batman!!

I'm going to need therapy if my AC takes that long to fully mend =(

________________________________________________
Ho, Ho, Ho!! And now you're broke...


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## targnik (Jan 11, 2014)

First really techy ride today... gnarly rock gardens for Africa!! Shoulder only squealed once, when I thought I was going to manual my front wheel on to the top of a rocky out crop... and instead I slammed into it and my shoulders/chest had to take the G-force. Icing it now >.<

-----------------------------------------------------------
Ho, Ho, Ho... now you're broke!!


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## SnoboardSteve (Jan 8, 2016)

*Arthrex Dog Bone experience?*

Considering the Arthrex Dog Bone procedure. zero85ZEN, any further recovery trajectory? Anyone else gone through it?

thanks!


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## Ricisan (Aug 30, 2006)

Each injury is different. After the surgeon, it is all up to you.
I treated my rehab like a job! I was getting paid after all.
I did my rehab as a circuit training. I made my 12 week goals in 9.
Take time to rest, then you have to put in the work of rehab.

R


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## soulshaker (Sep 23, 2013)

SnoboardSteve said:


> Considering the Arthrex Dog Bone procedure. zero85ZEN, any further recovery trajectory? Anyone else gone through it?
> 
> thanks!


5 and a half months post-surgery for Gr. 5 AC sep using the Arthrex fiber and button technology to get things back where they belong. Seems to have worked so far. At least no stretching or other failure of the materials. After 3 months, scarring in had stabilized the shoulder enough to be cleared for normal activity. Just finished PT and am at maybe 90% of previous range of motion and strength. Still exercising and stretching on my own per therapist's advice. I can mountain bike with no problems but surfing is coming more slowly. Have some pain still paddling and getting the elbow up high enough on the forward part of the stroke for my hand to clear the water. But is definitely improving and should be OK with continued effort. All in all, I'd have to rate it a success so far.


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## wtrskier (Jan 9, 2016)

Also glad to find this forum. I separated mine two weeks ago snowboarding. Finally saw an Ortho Sports Surgeon that treats the LA Kings who has me down as GR 2. I was surprised since the xrays look like GR 3. Anyway he recommends to rest shoulder for 4 more weeks with PT starting then and a follow up in 6 weeks. I can't keep still so starting my own PT after researching the web. I don't have much pain if I keep my movements ~75%. I do feel things moving around and will have pain with anything beyond that. Does anyone feel things moving around while doing PT? Has anyone tried shoulder braces?
Thanks!


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## digitalhippie13 (Nov 24, 2010)

Just thought I'd post a 10 week update, Grade 5 separation, AC joint reconstructed using hamstring.

Basically I'm super happy at this stage with how things are gone. The first six weeks were tough, but I really got stuck into rehab. ROM & strength have seriously really kicked on since then, and the level of background pain now is quite low. 

It's a relief in a way as both the physio and surgeon mentioned that what you have at 3-4 months recovery is pretty much what you'll have from that point on. Ealier on it was a bit like, damn I'm going to be stuck with this sh*t shoulder. Thankfully not the case.

I started back on the MTB at 4 weeks, and have slowly been getting back up to speed. I'm just at the point now where I can begin to ride aggressively, still a long way from pre-injury but pretty cool none the less. Critical thing in the short-mid term remains not to crash and re-injure shoulder.

Other cool things: I can now sleep on my side, injured shoulder down, which has really helped the quality of sleep. I've also been able to return to work in a fairly physical job. I can pretty much do most day to day things with that side of my body, which is also my dominant side. The surgeon encouraged a fairly aggressive approach to rehab, and touchwood that seems to have worked well for me.

Still working away on rehab exercises. Strength both away from my body and above shoulder height is going to take a while yet.


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## dbjohnso67 (May 17, 2014)

Grade 3 here 2 years ago this coming may.... I never had surgery.. Wore a shoulder brace for a few months though I still feel an annoying type of pain If I lay on that shoulder for more than an hour and I still feel things moving around though when riding I never notice anything other than a fear to not crash and then stick out my right arm to break my fall --- Ive trained myself to fall left now


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## zero85ZEN (Feb 11, 2015)

8 months since surgery and I'm feeling 100%! No limitations on anything I do. (I was actually riding the road again 6 weeks after surgery.)
I'm extremely happy I chose surgery and had the Arthrex Dog Bone procedure. No bump, totally normal shoulder and full range of motion and strength. I highly recommend you go through with it.



SnoboardSteve said:


> Considering the Arthrex Dog Bone procedure. zero85ZEN, any further recovery trajectory? Anyone else gone through it?
> 
> thanks!


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## targnik (Jan 11, 2014)

Been 2 months (almost to the day) since grade 3 separation... Had my first ride yesterday where I forgot about shoulder and just rode. Anytime I lift front wheel I get a twinge and also when weight is taken by arms on HB's i.e. quick deceleration etc. Seeing clinician this morning, final visit. 

-----------------------------------------------------------
#1 resolution... Ride it like I stole it!!


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## Pkovo (Aug 22, 2012)

targnik said:


> Been 2 months (almost to the day) since grade 3 separation... Had my first ride yesterday where I forgot about shoulder and just rode. Anytime I lift front wheel I get a twinge and also when weight is taken by arms on HB's i.e. quick deceleration etc. Seeing clinician this morning, final visit.
> 
> -----------------------------------------------------------
> #1 resolution... Ride it like I stole it!!


I'm almost to 3 months for a grade 2. I had that same thing when lifting, and now it's finally completely gone. Went surfing this past Sunday, and it was the first time the shoulder didn't really bother me paddling either.

I can still feel the rib injuries. Pressure of the front rib cage from laying on my board, gives mild pain to the rear rib cage where the injury was, but not bad at this point.


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## ClimberXC (Jul 31, 2015)

Its been 5 months since repairing a Grade 3 with the AC Tightrope procedure. Recovery has been more gradual than I expected. 95% range of motion and strength but still feel a bit sore at times and don't trust it in a fall yet. That may be psychological though. Don't feel it at all riding. 

Happy with the surgery route, still a small bump but nothing like the major bump and disconnected feeling I had before. 

The surgery itself was easy, or I should say both surgeries were easy as they had to go back in and repair the first one as the knot on the top button came undone. The most difficult part was fighting off frozen shoulder from being in a sling for an extended period of time.


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## Earchel (Jan 28, 2016)

Hey guys, 3 months ago I was in a motorcycle crash which gave me a grade 2 Ac seperation. I have the bump on my shoulder, with lots of popping.I have been getting back into the gym noticed a lot of pain in the joint so went back to the Ortho. He said I had weightlifter shoulder gave me a cortisone shot and said come back in a month if it's not better to discuss surgery. Does anyone know if I get the surgery which shaves the bone, will this help to reduce the bump? I hate having the bump, it's been really depressing.


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## heatstroke (Jul 1, 2003)

Try doing a bucket load of pushups. As the chest muscles tighten up it pulls the collar bone down. I had a grade 2+bump. Spent a year doing a fair bit of pushups. About 200 a day every other day. And the bump went away. 
your results may vary


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## Earchel (Jan 28, 2016)

Im really trying to decide wether or not to get this surgery to reconstruct my Ac joint. Going to the gym and strength training is something I don't want to live without. I am really wanting to get back into lifting heavy weights some day. It been almost 4 months now and still holds me back. It doesn't feel like it could take any kind of serious load. Like a 500lb deadlift, and benching 315. I can't imagine doing that with the way my shoulder is. Has anyone had success after the surgery with lifting heavy? My doctor told me I would have to stay out of the weight room for 6 months after the surgery to make sure it is fully healed before stressing it. Any advice on surgery or no surgery would be appreciated.


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## ClimberXC (Jul 31, 2015)

Earchel, I'm 6 months out from AC tightrope surgery and spend a lot of time strength training. My pre injury best bench was 315 (3 plates was enough). I'm working my way back carefully. I'm doing reps with 135 now. I'm going to be real patient with it. Especially with lifts that stress the joint. It feels stable but I hate the bump as well and don't want to risk it coming back. I do think I will get there though. 

The good news is that the dramatic atrophy I experienced after surgery (it was shocking) came back quickly after I got back into the gym. Every day it feels stronger and less of an issue. That was one issue I had before surgery, looking at how bad my shoulder looked just zapped my motivation to train.


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## brettex (Jul 29, 2014)

I had surgery last May to correct a grade 3 separation. Prior to my accident I worked out a lot, roughly 4-5 times a week. At first I contemplated surgery, I actually waited a month before I decided to have the surgery. I had a lot of pain and didn't see any improvement with in the month so I opted for the surgery. My main reason for the surgery was to eliminate the pain. I asked the Ortho specifically how long would it be before I would be able to work out heavy again. His answer was well it depends, like your Dr. said at least 6 month before I can start lifting. Its been nearly 9 months since my surgery and and I'm not 100% to where I was before the surgery. The Dr. told me 6-18 months as did my PT. Both said it would be a while. I can do pull ups again but for some reason lat pull downs are uncomfortable. Push ups still bother me some. I feel popping when I do certain activities and certain movements. I don't regret having the surgery one bit. The pain I felt was gone after surgery besides the pain that comes along with the surgery. It sucks a lot, I lost weight from not being able to hit the gym. I have altered my workouts to accomadate my shoulder. It's taken me longer to get back into the gym because I also broke my heel in my accident. I hope all goes well with what ever decision you make. Good luck.


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## targnik (Jan 11, 2014)

My martial arts master advises against getting surgery...

I've done pull ups, bench press, lateral raises, triceps ext. (seated/lying down), bicep curls... w/o too much issue. 

Of course the weight is down a bit (apart from chins) o_0

Holding the kick shields really aggravates the old AC... 

Will be 3 months since injury in 10 days. Thinking it'll be be good 6-8 months before I'm back to normal.

Know another fella, that did his a year ago. It's still giving him grief.

-----------------------------------------------------------
#1 resolution... Ride it like I stole it!!


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## ClimberXC (Jul 31, 2015)

Earchel, just noticed you say you have a grade 2 separation. Very surprised you were offered surgery for that. For Grade 3 it's a highly debated topic, but seemed pretty settled that "no surgery" was the route for Grade 1 and 2. 

If your just talking about the distal clavicle excision (shaving the end of the clavicle) I don't think that's really going to give you anymore stability in the joint. It will just deal with any impingement issues you have and make it look a bit better. 

There are several surgeries that are designed to address stability issues but they all are focused on reconnecting the clavicle to the coracoid. Grade 2 would imply you still have a connection there. 

If the bump is significant though it might be worth getting a second opinion on the grade. The docs sometimes get it wrong.


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## Earchel (Jan 28, 2016)

ClimberXC said:


> Earchel, just noticed you say you have a grade 2 separation. Very surprised you were offered surgery for that. For Grade 3 it's a highly debated topic, but seemed pretty settled that "no surgery" was the route for Grade 1 and 2.
> 
> If your just talking about the distal clavicle excision (shaving the end of the clavicle) I don't think that's really going to give you anymore stability in the joint. It will just deal with any impingement issues you have and make it look a bit better.
> 
> ...


Yes I was told that is a grade 2 but said it was as bad as a 2 could get. The doctor wants to shave off the end of the clavicle. I think if I was someone who didn't lift that would be fine. He did however say that it could leave my joint more unstable for weight lifting and if it creates and issue then he might have to do a tightrope surgery. The main reason I want to try and get it fixed is because I want to lift heavy again. It's been almost 4 months and I tried to set up to do a dip and didn't even try because I could feel my shoulder couldn't handle it. It is all just very confusing. I don't want to get the surgery and end up worse, but if surgery could give me a normal functioning shoulder it would be worth the 6-12 month waiting period to me. Thx for the responses guys, this has been hard to deal with on my own.


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## bboy_markus (Feb 15, 2016)

*Ac separation grade 1 or 2 ?*

Hi guys! I suffered a shoulder injury 7 weeks ago, falling on my right shoulder dancing. Went to MRI and Xray, doctors confirmed the acromioclavicular joint is normal, BUT I feel a bump on my shoulder much prominent than the left shoulder. I took an Xray for both shoulders to compare and I see a slight difference in spaces. I will upload pictures here to see. Also i still feel pain in my shoulder, i have full range of motion but not pain free.

left shoulder (normal) https://i64.tinypic.com/spg7yc.png

Right shoulder (injured)
https://i66.tinypic.com/svkl09.png


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## FL mtb (Mar 19, 2016)

See next post


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## FL mtb (Mar 19, 2016)

St. Patrick's Day 2016. Won't ever forget it! Headed out to the local off road park by myself after work, anticipating a fast run before a Guinness for the holiday. Beautiful Florida day! Put on my lightest biking shirt and went out on a fairly fast and level section and made it only 3/10 of a mile out before tires washed out coming out of a left berm. Never fell at such a speed on such a hard surface. Knew it was happening and turned the back of my shoulder to the clay and expected to roll right out of it like I had many times before. At impact I knew my left AC joint was cooked. Put my hand atop my shoulder and felt my collarbone jutting over the acromion. Called my wife, then called the orthopedist, before leaving the park. It was a ***** trying to put my bike on the rack one handed.

I went to urgent care to verify no fractures. Looks like a Grade 3 to me. Heading to the orthopedist in an hour or so.

I am a physical therapist and pretty much know how this is going to go down, but reading all of the stories here has lifted my spirits so much. The initial thought after falling was that I spoiled a great day to ride. The second thought, reinforced after looking at my deformed shoulder in the urgent care, was that I have irreparably changed the anatomy and biomechanics of my shoulder.

However, after seeing how you guys have willed yourself back to the activities you live for, I am much more upbeat. I especially am thrilled to read about returns to swimming and surfing. Thanks for posting your experiences.

A blurry iPhone pic, but you get the idea...


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## FL mtb (Mar 19, 2016)

First thing the orthopedist said after looking at the x-ray? "What a clean shoulder..." Seems I trashed a perfectly good shoulder. :-(

Off work and in the sling 2 weeks with no elevation past 90 degrees or shoulder height. He asked to see how high I could elevate my arm. Earlier this morning I could go just short of shoulder height, about 80 degrees, with some scapular elevation, or shoulder shrugging. In his office I went about 150 with a little better mechanics. It's improving daily.

But it needs rest for a little longer. I have ordered an off the shelf (off the internet!) acromioclavicular sling as he suggested. Should be here in 2 days. My daughter taped me up with Leukotape which really feels as though it has helped the stability. My two chief complaints at this point are the feeling of instability when I try to flex or abduct the shoulder, and the trapezius fatigue/tightening that I have felt when out walking a few miles. I have very little soreness there. I've turned down narcotics twice now, and I'm only using Ibuprofen and ice to manage discomfort.

I'll be back on a bike soon. Weight bearing lightly on that arm makes it feel better. I'll also be elevating to shoulder height in the pool soon.

Gotta get ready for a 27 mile ride in the woods in CT May 15th! Not missing Tour de Lyme!


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## FL mtb (Mar 19, 2016)

Couldn't wait. Took the bike out for 4.25 miles around the golf course in my neighborhood. A little sore moving my hand from my side to the bar and back. Otherwise, all good!


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## FL mtb (Mar 19, 2016)

And nearly 18 more today on multi use path...


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## FL mtb (Mar 19, 2016)

DAY 6

No riding today, so I went out for some parts to refresh my daughter's old Trek 820 Mountain Track. New wheelset, RD, cassette, and chain. about an hour in I shed the $3 sling. About another hour in, my new A/C brace arrived via FedEx. Goofed around another hour or so, and now I think I'm going to pay for it. I can feel swelling right at the a/c joint and it's as uncomfortable as it's been. I'm in the new brace, which I think I'm going to like, with ice on me and Motrin in me...


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## FL mtb (Mar 19, 2016)

Easily my best night of sleep last night. I've been sleeping on my back. I hadn't done a full night in the bed until last night. The couch has been more comfortable. I put my arm straight out to the side, which seemed to reduce the end of the clavicle. I was going to stay in this position only a few minutes, but wound up waking up a couple hours later. I then went on my right side, which has been uncomfortable for the injured shoulder, and woke up in that position. It was only minimally sore. I think taping my shoulder and the new brace have really helped. My wife put three strips of Kinesiotape (KT) tape, over the acromion last night, but I think Leukotape works better. It's a little less elastic. Little riding to get the blood flowing later!


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## targnik (Jan 11, 2014)

Had a wee tumble on my last ride - impacted rear of right shoulder (luckily on a rotten log i.e. semi soft landing)... have put my AC back 6-8 weeks =( going to quick on a night ride >.<

-----------------------------------------------------------
#1 resolution... Ride it like I stole it!!


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## davewhite (Feb 18, 2012)

I separated my shoulder (grade 3) a week ago snowboarding. This thread has been good for learning more about this. Planning on getting a second opinion soon, but right now I'm leaning towards no surgery. 

A couple questions though:

I've been taping the shoulder which makes it feel less creepy, but do you think it helps speed recovery or could reduce that bump if I stick with it?

Does that "creepy" my arms hanging by a thread, and the clavicle is poking out feeling ever go away? Not just get used to it, but go away?

and finally, how long should I keep using the sling?


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## FL mtb (Mar 19, 2016)

I'm doing the sling for two weeks. I got a specific acromioclavicular sling on the internet. Search Kenny Howard sling. I can get much more support than from a regular shoulder sling. The taping sure makes my shoulder feel better, but I don't know if there is any evidence showing it improves the deformity long term. There is less of that unstable feeling at one week post injury, but it doesn't take long out of the sling to tire the shoulder and get that sensation of instability with the collarbone poking up into the trapezius. Then I return to the sling and ice it. Rode 17.5 miles today, mostly flat path and about 2 miles of light trail, with just a couple twinges. Can't yet use the left arm to help lift the bike.


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## BrendonW (Mar 25, 2016)

This was a great Forum to visit to after such an injury. It all seems so tragic ... mine was caused fromover rotating on tabletop and landing hard on dominant right shoulder.
Not very much pain just discomfort and floppy arm. I went to the Emergency ward and discovered a 21 mm separation of CC joint (vs 8mm on good side). All the worries about what have I done and options of surgery.
MRI indicates grade 3+ with sprain to deltoid and a near full thickness tear to supraspinatus (a rotator cuff). The rest all good. 
That was on the 22 February .. So 4.5 weeks ago.
I have seen 5 physios and all seem to push towards PT. I went to the Public hospital orthopedic unit ... That was bad ... they had a model of the shoulder joint that was wrong.
So basic Timeline has been:
First week rest and sling
Second week rest and started pendulum swings and a little use
Third week basic ROM exercises
Fourth week. More whole body ROM exercises. Started a few light weights and theraband.
Overall I am lucky as I haven't experienced much Pain.
I already had a bit of scapula winging on that shoulder ... so I thing that makes it worse.
I try to set and hold the shoulder AC joint together from muscle setting. I sleep on back at night. In the end it may scar up ... at the moment I am just trying to keep things aligned under the false hope scar tissue may form.
I was in NZ when I did it and traveled around a little after the injury. Overall I have seen 5 physios. They all seem positive with my progress so far. Just light ROM. I have kept it taped most of the time as that keeps me aware of proprioception. Really having to work on scapula control and correct movement of it. and then strengthen all the muscles. Just take some time and plenty of conscious PT...


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## BrendonW (Mar 25, 2016)

Bad Side and good side xrays


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## FL mtb (Mar 19, 2016)

Day 8

Found out what it feels like to roll to the injured left side last night. I will call that pain. Woke the wife when I yelped. Kinda bummed to wake up to a stiff, sore shoulder this morning, and bummed again after removing the tape and taking a look in the mirror. The deformity isn't changing.

On the flip side, I got in the pool, primarily for maintenance, but found I could breast stroke a few laps without pain before fatigue set in, and I could weight bear enough on that arm to lift myself out of the pool. I also did some light buoyancy assisted shoulder range of motion. I won't be trying any freestyle for another week. It felt very good after the first pool session.

Up and down...


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## davewhite (Feb 18, 2012)

This thread is by a guy who taped his clavicle down for a while. The after picture looks like it may have helped
AC joint dislocation - Non-Wakeboarding Discussion


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## FL mtb (Mar 19, 2016)

Thanks for that link! That was encouraging to read, especially as his separation looks as though it was a bit worse than mine. I think I'll be using Hypafix under Leukotape for the next application. The Kinesiotape did not irritate my skin as much as Leukotape, but it is not quite as supportive.

The markings down the left side of my back are nearly identical to his abrasions.


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## davewhite (Feb 18, 2012)

Are you taping it like the video he linked to? Is there some better way?


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## FL mtb (Mar 19, 2016)

I'm not using nearly as extensive a tape job. Basically using three or four strips. I followed this link:

Conservative management of a type III acromioclavicular separation: a case report and 10-year follow-up

The 10 year x-ray looks encouraging, but the author calls the injury "an incomplete type III" separation.

I have my wife or daughter put an addition strip from front to back, scapula to pectoralis major, over the end of the collarbone. Taping definitely reduces the separation and the shoulder feels better. I need to be a bit more compliant as I spent several hours without the tape on today. I could have left it in place in the pool. The best reduction occurs with the sling.

Just got back from 17.8 road bike miles. The shoulder felt good, whether on the hoods or in the drops. Got one twinge when my right foot slipped off the pedal as I attempted to clip in.


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## stoplight (Mar 8, 2009)

curious what you shoulder guys have to say..

Prior history, left shoulder rotator cuff repair, 2008, right shoulder, orthopod gave the nod for same repair 2012...have not had it done.

Jan 21 missed a 5ft jump and partially landed on my right shoulder..pain was instant and severe, hard to describe as the entire shoulder area hurt. Next day could only raise my arm from my side or front about 10". Based on past shoulder injuries this one did not feel like the rotator cuff. I figured an Acromioclavicular Joint Sprain grade II. Rested it for a couple weeks then began a series of ROM and week four began light strength training and got back on the bike both road and MTB though less aggressive on the MTB. Now into week 8 and am now curious if I DX it correctly. 
Of course I lost some strength due to the down time but....I noticed when doing bicep curls its painful to completely supinate my hand and then complete the motion. My tendency is not fully supinate the hand. Pouring water from the coffee pot into the coffee maker is quite painful and have to support the pot with my left hand. Doing shoulder raises with any kind of weight with the hand supinated is pretty tough, with the hand pronated much easier. Sleeping can be sketchy..it woke me up every night until just recently but have adjusted my sleep position, more on my back to take pressure off the joint. What feels odd...the fatigue I feel in the deltoid..like vacuuming or holding the 2 stroke blower..it tires quickly and on occasion when attempting to push something away from my body the shoulder feels like, for lack of a better term, wants to unhinge, not sure how to describe it...but the unhinge sensation is felt broadly across the shoulder including the deltoid and is not specific to the distal end of the clavicle which is the pinpoint area of the "sharp, piercing" pain most often felt. 


thoughts????


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## FL mtb (Mar 19, 2016)

Two things come to mind:
1) The condition of the long head of the biceps tendon, considered your fifth rotator cuff tendon, given your issue with supination and elbow flexion. Inflamed or injured post fall? Remember, too, that it connects to the labrum at the top of the glenoid.
2) The extent of that pre-existing rotator cuff tear.
An MRI would go a long way to help pinpoint the issue. Good luck with your latest recovery!


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## FL mtb (Mar 19, 2016)

Just got back from a cruise. Where better to recover? I continue to tape the shoulder daily.
Day 11 - ran without sling on a treadmill without issue
Day 12 - discontinued to sling (available for anybody who wants to try it in the first couple weeks after injury!)
Day 13 - snorkeling - no overhead strokes yet
Day 14 - resuming flexion and abduction past 90 degrees - essentially have full ROM
Running and biking are no problem. Haven't tried freestyle swimming yet.

I saw a kid on one of the cruise outings who clearly had a separated shoulder. Turns out he is a 16 year old from the UK who separated his shoulder snowboarding in February in the Alps. He was issued a clavicle splint, but used it little. No taping. He states he has full function now. He said he just started sleeping on his injured side, which is still uncomfortable for me ay Day 17. He showed me his x-ray, which looked very much like mine. When I have no tape on my shoulder, our deformities look identical. He has elected to have surgery in a couple months "to get rid of the lump." It was nice to talk to somebody with a nearly identical injury.


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## FL mtb (Mar 19, 2016)

I'm remembering now that I'm not the first in my immediate family to have an A/C separation. A few years ago, my son was skateboarding with friends and had a fall. He has had the "bump" at the A/C joint since. I'm guessing his is a Grade 2 separation.


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## FL mtb (Mar 19, 2016)

Yesterday was Day 18 and my first day back at work. I had to remove the Kinesiotape because of blistering. Shoulder felt good, but by the last client at 6 PM, it was fatigued and I rested when I got home. I'd like to get the tape back on soon as I really feel it will help with the final clavicle position and the extent of the deformity.


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## davewhite (Feb 18, 2012)

I'm on day 21 and it does feel quite a bit better. Not sure I can stick with the taping though it's pretty rough on my skin, we'll see.


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## FL mtb (Mar 19, 2016)

Glad you're feeling better. Really thinking I'm glad I didn't jump into any surgery, but at less than 3 weeks, it is awfully early...


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## davewhite (Feb 18, 2012)

One thing that I wonder about, and I'm no expert on anatomy or the mechanics of the shoulder/AC Joint, but if the clavicle was down where it was originally but no longer attached, is there more likelihood of them bumping into each other when you raise your arm up by your ear?


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## FL mtb (Mar 19, 2016)

Valid concern, I think. I'm hoping for enough scarring to stabilize the joint without creating too much AC degeneration down the road. That scenario is one of the arguments against the surgery. However, the collarbone can be shortened at the time of the surgery or later if problems arise.


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## FL mtb (Mar 19, 2016)

Up to 5 miles running at Day 20. Still haven't gone to the trail or tried freestyle swimming yet.


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## stoplight (Mar 8, 2009)

FL mtb said:


> Two things come to mind:
> 1) The condition of the long head of the biceps tendon, considered your fifth rotator cuff tendon, given your issue with supination and elbow flexion. Inflamed or injured post fall? Remember, too, that it connects to the labrum at the top of the glenoid.
> 2) The extent of that pre-existing rotator cuff tear.
> An MRI would go a long way to help pinpoint the issue. Good luck with your latest recovery!


You pretty much nailed it.

saw my trusted orthopod today...xrays taken and of course he manipulated the shoulder. He ruled out further damage to the rotator cuff, DX was bicep and grade II AC sprain. Said I was lucky I did not tear the bicep totally as apparently its not that hard to do, another couple weeks and should be good to go.


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## FL mtb (Mar 19, 2016)

Glad it'll be a quick recovery!

You gave a pretty detailed description of your issue, which made it easier to guess. If you'd completely torn the long head of the biceps, you'd have had a ball of muscle just above the front of your elbow. That's another condition the orthopedist probably wouldn't repair unless you were a high level competetive athlete.


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## FL mtb (Mar 19, 2016)

Day 21 - 3 weeks
Bit achey today. Maybe from last night's 5 miles. Changed the daughter's oil and could feel twinges here and there. Had the wife apply 2 strips of Kinesiotape. At the very least, it reminds me to use good posture. Might try the trail this weekend...


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## targnik (Jan 11, 2014)

5 months in and thing still gives me grief from time to time... very rarely do I notice it while riding.

Did take a wee tumble a couple of weeks ago that aggravated it some, but I don't think did and extra damage.

I can do palm up chins and don't feel a thing (225lbs) but, try and do 1 press up (handlebar width) and it grinds and groans!?

-----------------------------------------------------------
#1 resolution... Ride it like I stole it!!


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## FL mtb (Mar 19, 2016)

One month:

I can run - did 6 miles on the road yesterday.
I can bike - did 12 miles in the woods today without a problem, though I did thump a tree with that shoulder on a tight left turn.
I can do pull ups and push ups with a little soreness right at the AC joint. I can do 5# standing flexion and abduction.
I feel the joint most at rest. I am able to sleep for short periods on the injured side.
Haven't been back in the water yet.
I mowed the lawn and raked the front yard after my ride today without difficulty.
I guess I'm happily surprised with where I am one month into a three month recovery.


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## davewhite (Feb 18, 2012)

FL mtb, does it seem like the taping has helped keep the clavicle down?


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## FL mtb (Mar 19, 2016)

I haven't taped it for several days now, mainly due to irritation. The shoulder does feel ok without it now, too, in terms of stability. However, the deformity hasn't changed in the last couple weeks. I will use the tape when I return to the pool.


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## CHUM (Aug 30, 2004)

here's mine - happened of course 1 day after I register for Grinduro :madmax:

grade 3 AC separation - no surgery needed for now

invisible wheel eating hole got me...blargh

















look foward to reading through this thread


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## FL mtb (Mar 19, 2016)

Wow! Look at that gap. How's it feeling? Are you able to lift your arm at all? Is this affecting your work?

I'm 6 weeks (and 2 hours!) after injuring mine. Seems like a lifetime ago. Still a bit sore at times. I'm running as much as 6.5 miles, biking a couple hrs on the road and an hour in the woods. I did swim freestyle about 10 minutes several days ago, and it felt clunky; not really smooth at all, and definitely lacking some power when pulling with that left arm. I still haven't taped it again, but I will say again that it really helped decrease the feeling of instability early on. Doing 10# dumbbell and theraband strengthening. Signed up for a sprint triathlon in September, so that swim needs to improve!

Keep updating! Good luck, brother!


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## stoplight (Mar 8, 2009)

Completed my first two full p90x workouts, chest and back, shoulders and biceps, since F'ing the shoulder up 3 months ago. From not being able to lift my arm 10" to doing dumbbell shoulder presses with 25lbs,shoulder is still not 100%, maybe 80% and still having mild discomfort doing any exercise palm up and still wakes me up though not as often. The good news my rides are pain free...


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## FL mtb (Mar 19, 2016)

Sounds like good progress. Can take awhile for things to heal and all of the inflammation to resolve, eh?

Do you have that step deformity at the end of your collarbone? I don't remember you mentioning any. I know you said Grade 2...


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## stoplight (Mar 8, 2009)

FL mtb said:


> Sounds like good progress. Can take awhile for things to heal and all of the inflammation to resolve, eh?
> 
> Do you have that step deformity at the end of your collarbone? I don't remember you mentioning any. I know you said Grade 2...


was noticeable in the beginning, not to much now unless one knows where to look.

serious grinding and popping with light weight straight arm dumbbell raises, 10lbs..sounds like it should hurt more then it does 
and yes..taking a while..but my age, 60, I am sure is working against me. In fact though unrelated, I would say my healing, strength and endurance is down probably 10-15% from age 55..at some point we start aging in dog years..


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## FL mtb (Mar 19, 2016)

Sixty?! Inspiring man! I'd like to think I'm decades away, but I'm really right behind ya! Going for a run...


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## CHUM (Aug 30, 2004)

FL mtb said:


> Wow! Look at that gap. How's it feeling? Are you able to lift your arm at all? Is this affecting your work?
> 
> I'm 6 weeks (and 2 hours!) after injuring mine. Seems like a lifetime ago. Still a bit sore at times. I'm running as much as 6.5 miles, biking a couple hrs on the road and an hour in the woods. I did swim freestyle about 10 minutes several days ago, and it felt clunky; not really smooth at all, and definitely lacking some power when pulling with that left arm. I still haven't taped it again, but I will say again that it really helped decrease the feeling of instability early on. Doing 10# dumbbell and theraband strengthening. Signed up for a sprint triathlon in September, so that swim needs to improve!
> 
> Keep updating! Good luck, brother!


can't lift arm yet - but it's getting better. been 3 days and off of the Norco now...and back to work on Monday.

great to hear your recovery is motoring along nicely


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## FL mtb (Mar 19, 2016)

Rode 50 miles on the road Saturday. Cycling is not an issue. Got in the pool today with the goal of freestyling 10 minutes. I did complete the 10 minutes, but the first couple of minutes felt awful. I wanted to sign up from a trimming of the end of the clavicle immediately! But after a couple minutes, it really felt at least 90%. I'm sure my mechanics need some work, but I can see swimming without difficulty soon. Seven weeks tomorrow.


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## FL mtb (Mar 19, 2016)

Wow! As bad as those first couple of minutes felt swimming Wednesday night, my shoulder nearly feels 100% today (Friday). I am 7 weeks and one day and I finally feel over this. Might surf tomorrow...


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## Tt31978 (Jun 5, 2016)

Thank you so much every one that responded to this thread!! I had a very small wipe out that gave me a bad type 3 separation in my left shoulder this past memorial day. I thought for sure my riding days were over! A google search popped this up so I had to join and say thanks. I'm only 6 days into recovery I know I have a long road ahead but I'm comforted by the others with the same injury that still ride.


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## FL mtb (Mar 19, 2016)

Well, finally made it back into the Gulf. Tropical Storm Colin kicked up some waves and I went to a somewhat protected spot that turn 12 ft at the buoy into waist high waves. No trouble paddling, duck diving, popping up. Still not 3 months post-Grade 3 and really nothing I can't do.


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## CHUM (Aug 30, 2004)

I'm at 6 weeks today with my grade 3. First 9 days hurt like hell...then I got a lot of range of motion back quickly after that

Started road riding at 2 weeks - could do it, but it was a mistake. It simply aggravated it and made it hard to sleep so i stayed off the bike until this week.

I tried a push up - that was dumb. Treading water hurts as well.

Currently my range of motion is ~99% and I'm at 75% strength, so things are going well 

The only thing that really bugs me now is my scapula muscles spasm. I hope that stops at some point


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## DinoRidge (Aug 29, 2007)

I'll be at 4 weeks tomorrow with a grade 3. I started road riding at day 10 immediately after talking to a bike mechanic who never stopped riding! Riding went well except for neck stiffness. I think I solved the neck stiffness by maintaining better posture both on the bike and off.

I read about the wakeboarder who taped his grade 3 back down, and no longer has a bump. I'm curious if anyone else has had any luck taping, as the medical community has only provided the usual 'bump or scar' scenario. I realize I may be a little late in starting (I started taping at day 24) compared to the wakeboarder, but I was told that scar tissue will continue to form for months after the injury. So, I am hoping...

My taping experience:
Monday 13 June: I taped like the wakeboarder's link shows, with a firm elastic tape around my bicep and tricep, which formed a two-inch-long blister after less than a day. 

Tuesday 14 June: Really had my wife stretch kinesiotape tight as she applied pieces chest-to-back and neck-to-delt. No tape around the blistered bicep/tricep. An hour later I felt pain like I had when I first injured myself, even with the pain meds leftover from the ER trip. The bump was visibly smaller though! 

Wed 15 June: Woke to no pain, but the pain came back (though less severe) once out of bed for an hour. Rode the bike with the tape still on, and felt more confidence than ever with the shoulder. After riding in the heat the tape loosened, and I removed the tape in the evening. The bump came back to apparent full height, which is in line with the wakeboarders early taping. Taped up Wed night, aiming to find a tolerable pain level that has an effect on the bump. I've found that the 'hold your arm like a teacup' advice of the wakeboarder is key for the neck-to-delt tape; the more 'teacup', the more tension when you put your arm at your side. I had two chest-to-back pieces, one neck-to-delt piece. Pain was mild.

Thur 16 June: This morning. Very mild pain. Less tension in the tape helped, as well as not taping over the very distal part of the clavicle.

I'm trying to take a picture of the lump every day to objectively measure progress. Once I get some measurements of lump displacement I'll post them.

Anyone else taping?


An


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## L84Beer (Jun 24, 2015)

I'm a little over a year out from my Grade 3 separation, and I feel like I've gotten to 90-95% of where I was pre-crash. I've been at this level for 6 (give or take) months. About the only thing I don't care to do, which may be more psychological than anything else, is lift heavy objects with my elbow extended (i.e. lifting and carrying with my arm to my side). I will caveat that I did not do much more PT than to simply manage swelling, pain and ROM in the 1st 4 weeks. Maybe I'd be better off with some focused strength building around the injury.....dunno, but I don't have much time and I'd rather be with my family and ridding or skiing 

As for taping, I tried that for the 1st 4 weeks and the only thing I got from it was tape burns. I think the only thing it could possibly do is allow scar tissue to assist in holding down the clavicle, but scar tissue isn't ligaments.

I have resigned that my crash was preparation for retirement, where I will become a pirate. I now have the perch for a parrot!

My thoughts/advice:
1) If you are thinking surgery, force the issue early on. DON'T wait. There is a part of me (albeit slowly fading into a distant memory) that wishes I just insisted on the surgery in the first two weeks. Re-injury complication risks, and potential for surgical risks for what is most likely only a cosmetic trade caused me to forego the surgery. A very good and highly reputable orthopedic friend that I ride and ski with thinks I made the best choice.

2) Don't be a puss with the recovery. As the pain allows and you are comfortable, get back at living your life. I probably could have gotten more engaged in life at an earlier point, but I held a silly notion that rest would allow me to heal faster.

3) Lots of icing and Advil as needed, to manage pain and swelling in the early days/weeks are the best path to regaining ROM and your life back.

4) by the 4 to 6 month mark, you've probably recovered as far as you're going to. The scar tissue holds things together and will eventually allow you to rest on the injured side with reasonable comfort.

5) Accept your "scar", be it a lump or a remnant scar from surgery. The lump will make you self couscous, and it freaks people out the first time they see it and/or feel it. I'll be honest, I still get freaked out by feeling the lump.

6) The non-surgical route means that putting stuff on your shoulder (e.g. skis, shoulder straps, and the like) is going to be uncomfortable and sometimes hurts, like when your skis come crashing down on the end of the clavicle.

7) The shoulder will likely always have some moderate amount of instability. I notice this most when I am playing cornhole, and I have to make a rotation of my arm to adjust how my shoulder sits so I can make a consistent throw of the bag.

Good luck and healthy healing to those recovering from their new or old separation injuries!


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## targnik (Jan 11, 2014)

I'm 8 months post separation... sleeping on the injured side (my preferred sleeping side) is still somewhat uncomfortable. I can do chins (have since week 8-9) and modified press ups (last month or so) where my hands need to be a little wider and hands splayed out to the side some.

I've fallen on same side a couple of times... One was only 4-5 weeks post injury, my forearm took brunt i.e. naturally altered my impact point to protect shoulder. Other was right upper side/lower rear of shoulder where I slammed into a rotten stump (luckily it was rotten!). Neither caused any issue for my AC. 

It's still clunky for the most part. But, the strength work makes a difference for mind. If structures around it are strong they will assist it in the future, when I'll undoubtedly fall again.

Fingers X'd it won't be in the top of shoulder (where/how I injured mine).

-----------------------------------------------------------
Damage: 14' Kona Process 134, 12' Transition Bandit 29er


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## tolleyalways (Jun 16, 2016)

Joining this former because of this wonderful thread. BMXer and Cat 1 road racer, dabble in CX and MTB when I find the time.

Anyway, got a grade 5 after a kid wrecked me out in the final turn of a sprint. About 11 days out, full ROM back, strength is OK, with overhead strength compromised.

I plan on detailing my recovery over the next few weeks.


I have some questions though! 
The modified Weaver-Dunn method using allograft, etc has been suggested to me. The doc fixes a lot of cyclists, and worked on Lance's collarbone. I've had my labrum done on my other arm, 3 ACL surgeries, and 4 menicus surgeries. BMX is a brutal thing. I've read about the other option such as the Dog Bone, Tightrope, Hook Plate, etc and this seems to be tried and true. 

My main question, as is for most people who love riding, is how long is recovery? Primarily concerned about salvaging the end of my season. I need to know how long until I'm even casually riding road bikes. I plan on hitting rehab incredibly hard, with cryotherapy, hyperbaric, and laser treats thrown in. So people that had a similar repair, how long was it until you were at least on a road bike? Earliest I've been quoted is 8 weeks/two months. I'll post again later with pictures/video of the wreck. 31MPH with a 15ft dive into the asphalt. Almost snapped my neck, so I am fortunate!


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## targnik (Jan 11, 2014)

Mmm... mine was grade 3, so take what I say with a pinch of salt ^^ I could get back on bike one week later - just rolling on flat no pedaling. It did feel weird though. 3-4 weeks and I was riding in pavement. The natural position of hand on handlebars and sitting upright wasn't painful i.e. joint being at waist height could take the weight. At 4-5 weeks I was riding (timidly) some of my normal trails. 6-8 I was almost up to full speed but still cautious. Now I don't even worry about it. I might feel it after a particularly gnarly ride ^^ but it doesn't last. I'm probably at 90% of where I was pre accident.

-----------------------------------------------------------
Damage: 14' Kona Process 134, 12' Transition Bandit 29er


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## stoplight (Mar 8, 2009)

just a quick chime in. AC shoulder sprain grade II, and bicep sprain late Jan. Took at least to the end of April, mid May before I could rotate a 25lb dumbbell up to shoulder press position, hesitate then begin press movement. Prior to the fall was doing 35lb raises. Now mid June have to think about the curling movement before doing otherwise I hedge on the right side. Just about ready to move to 30lb dumbbells..that should be interesting. On occasion during normal movement throughout the day the shoulder will pop followed by a stabbing pain I feel in my gut, mommy!! Calling 90-95% recovered.....ride strong on my road bike and have dialed it back a couple notches on the mountain bike.


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## patski (Dec 12, 2005)

DinoRidge said:


> I read about the wakeboarder who taped his grade 3 back down, Anyone else taping? An


I "picked up" a grade 3+ five years ago, never heard the wakeboarder tip. I had good range the day after the biff and was slowly cruising on my road bike in a week. Within 6 weeks I was back riding my MTB on almost everything, only problem I had was sleeping. My Ortho was gob smacked at my initial range and how fast pain went away, he said, "don't do surgery unless it starts bothering you because it will be ugly."

I say "grade 3+" because when I broke my wrist a different Ortho said, "Wow! That's surely a 5."

Wish I knew about the taping because it gives people the chills, my wife made me turn the light out for years... 

This is from this morning.


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## FL mtb (Mar 19, 2016)

Wow! That is an impressive step deformity!

I'm 3 months and 3 days today. Last couple of swims have been very comfortable. I can bike on road and off road without difficulty. I've been up in the tree in the backyard trimming, hanging, climbing, as always. I can surf without a problem.

There is clearly still an instability there, but it doesn't limit me or cause me pain.

The biggest adjustment has been psychological. I've adjusted to the deformity, in part thanks to this thread!


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## tolleyalways (Jun 16, 2016)

digitalhippie13 said:


> Just thought I'd post a 10 week update, Grade 5 separation, AC joint reconstructed using hamstring.
> 
> Basically I'm super happy at this stage with how things are gone. The first six weeks were tough, but I really got stuck into rehab. ROM & strength have seriously really kicked on since then, and the level of background pain now is quite low.
> 
> ...


What surgery did you have done? Going in for mine on Wednesday. Desperately trying to get back to road riding in two months. Having bouts of anxiety right now thinking about recovery.
Oddly enough my grade 5 is feeling pretty normal. Logged 120 easyish miles this weekend. I have two huge races first week of October that I'm trying to get ready for.


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## DHFREERIDER (Aug 2, 2015)

Crashed Friday. Last run of the day, last feature that I had hit all day long, landed wrong off the cliff not bringing the whip just enough back, hit left hand, shoulder, hip. I went in to PT on Monday and Tuesday. Saw doctor on Weds. The Xrays suggest I've got a stage I or II AC sprain or tear with a possibble labrum SLAP tear. Will have MRI in three weeks because just got corotzone shot. Was training for going to second trip to Whistler. Still plan to ride ALine and Dirt Merchant but thinking twice now about even attempting Crabapple. If I ride and don't crash, will my throwing around a demo 8 on jumps and off drops turn this potential stage two separatino into a stage three???? PT and Doc know my plans and never said I couldn't go ride. I've got KT Tape and a Shock Doc shoulder brace to hold things in place. Do you all think I will be ok? Thanks, and thanks for starting and contributing to this thread. The comments have helped me deal with this situation.


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## DHFREERIDER (Aug 2, 2015)

Oh, meant to say going to ride Whistler this Sunday for about a week of riding daily. Wish me luck, or please offer whatever cautionary advice you think is warranted or best advice for riding downhill jumplines with a stage I-II AC sprain or tear. Thanks!


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## stoplight (Mar 8, 2009)

DHFREERIDER said:


> Oh, meant to say going to ride Whistler this Sunday for about a week of riding daily. Wish me luck, or please offer whatever cautionary advice you think is warranted or best advice for riding downhill jumplines with a stage I-II AC sprain or tear. Thanks!


ah to be young again....getting back on my bike a week after my AC grade II was the last think on my mind..lol


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## DHFREERIDER (Aug 2, 2015)

I'm 45 years old, but thanks. I don't plan to ever grow up.


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## stoplight (Mar 8, 2009)

your body might have other ideas..I thought the same when I was your age  enjoy your time at Whistler!!


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## DHFREERIDER (Aug 2, 2015)

Thanks man, yeah, the grey hair is already starting. And I'm already getting my perspective in line with the possibility that I may not be able to ride like I want or ride at all this time. Going to be going on more hikes with my wife and boys, for sure.


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## M320 (Mar 22, 2013)

6 hours post crash. I'm 32 years old. 6'4 280#. Currently Still on vacation. Have to make appointment to meet with the orthopedic surgeon and get his/her opinion. I have no idea what to expect. But this post is helping some. Guess I will find out in a few days or so. Any and all thoughts / comments/ advise are more then welcome. Thanks all.


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## ride the biscuit (Jun 4, 2009)

DHFREERIDER said:


> Crashed Friday. Last run of the day, last feature that I had hit all day long, landed wrong off the cliff not bringing the whip just enough back...


well, i was gonna contribute how i hurt mine, but I'll just quote you because it went down pretty similarly...bike park a week ago. 34yo, prior shoulder dislocation and surgical repair so i must have been predisposed

I got the initial DX for grade 1 or 2, but its gotta be a 2 since my deformity is more consistent with pics of 2s and 3s

I had to go on a work trip this week and the pain didnt dog me too too badly. I tried to keep it in the sling as much as possible. Will be starting ROM at PT this afternoon aside from just easy movements in the hotel room while on the road this week.

I had some wierd tendon/nerve pain at the elbow where the tricep connects to the underside of the elbow that I assume will heal up as I get ROM back

Planning on taking it a bit easy with PT in the first few weeks. I dont think 2 weeks is long enough for atrophy to be a huge issue but want to move it enough to get blood in and prevent unnecessary trigger points from forming


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## ride the biscuit (Jun 4, 2009)

one question - 
so is there any verdict on taping?


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## stoplight (Mar 8, 2009)

final update......from Grade II and bicep strain from Late Jan. Age makes a difference so preface it with age 60. Last week did full bottom up shoulder dumbbell presses with 30lbs, pause and push from shoulder and no issues. Today finally,.....did 35lb dumbbell curls and no strain on the bicep during the up motion, had previously lost, with hand supinated, full curl extension. Close grip lat pull downs can be done without any pain or shoulder clicking. Calling it recovered!!! the bicep strain was the more troublesome concern and took much longer to regain full ROM and strength on the right side. My wheels shall not leave the ground on purpose from this moment on ..


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## DHFREERIDER (Aug 2, 2015)

Listen up, I've got some good news. If you have not heard of Prolotherapy, check it out. I had some Prolotherapy done and could move my shoulder the next day without pain. Was able to ride A-Line and Dirt Merchant and my usual lines but not able to or confident enough to more than mini-whips. Technical sections were a little painful, but drops and gaps ok. The shoulder is plenty sore again now after two days of riding like that, but it feels like it is getting better and stronger. Dr. Dawn out in Whistler was really positive and encouraging and saying prolotherapy is all about healing the joints and ligons and muscles and that it works. Super encouraging. Doing the hot cold hydro therapy shower thing, too, and taking vitamins, protein, and some other natural meds she prescribed. She just targeted the nerve centers mainly in the shoulder but says there is prolotherapy involving white blood cell injections and stem cell injections too. Supposedly pros are into this and some folks do it as standard practice now for upkeep of those joints that go bad with age anyways.


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## cloudyknight (Jul 17, 2016)

Mine's a bit different than most here because I tore my CC but my AC was fine. I spent a lot of time reading this thread in the past few weeks, so I thought I'd add my story.

I was in a xc race on a fast easy course. I made 4th wheel into the woods and moved up to 3rd then 2nd. I was just closing in on the leader when I crashed. There was a massive log to hop over at the bottom of a downhill. I cleared it clean about 7 times before the race so I thought I knew what I was doing. It's always overconfidence that gets me. I must have been going a lot faster than I realized. The front wheel was over but I didn't push forward to lift the back wheel in time and went over the bars. I thought I was going to be fine when I was flying through the air. I did my usual dive roll and jumped up right back on the bike.

Something felt really wrong in my shoulder and after the next few corners I realized I wasn't going to ride it out and bailed out of the trail and rode back to the car. I told the race director what happened. He stretched his shirt to show me a scar from a surgery he had to fix his clavicle that he shattered going over that same log. He said he passed out when he did his and thought I was just sore.

I went to the doctor the next day to find a fracture at the distal third of my clavicle. My shoulder had the bump like it was separated but the end of my collarbone was still attached to my AC joint. It didn't look like it was going back in place so I got surgery 8 days later. 

They thought it would take 2 hours at most to plate the pieces of my bone back together, but every time they tried to put a screw in, my collarbone would pop back up. I had ruptured my CC ligaments in the crash as well. My AC ligament was fine. They drilled a hole in my clavicle down to my coracoid base and dropped in a flip button with sutures as my new CC ligaments. The other end of the button is flush with my plate. 6 screws went into the plate. The operation ended up taking 3 hours and 20 minutes.

I'm now 5 weeks out from the operation. I've had very little pain and no nerve damage apart from the numb skin on top of the plate. I would have been out of my sling free to use my arm after a few days if it was only the fracture. Since it was also a ligament repair I'm only doing light passive motion with that arm and still in the sling most of the time.

The recovery is long but I think the surgery was the best choice for my situation. I start PT in 8 days. My doctor says it will be stronger than it was once it heals up but I don't know what happens if I hit it again. I'm sitting inside this summer watching Cavendish win 4 stages of the tour with both of his surgically repaired shoulders. It gives me hope that I can get back to my form.


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## DHFREERIDER (Aug 2, 2015)

Supplements I've been told to take to help with AC / Labrum healing: 
JointSoothe TM (Tumeric/B3/Zinc/Selenium/Copper/Manganese/Glucosamine/MSM),
Wobenzym N, NeoCell's Super Collagen+C, Osteo BiFlex Glucosamine/Chondroitin, MSM, Boswellia, Hyaluronic Acid, Ultimate Omega and especially EPA, as well as usual multivitamin. Also taking GNC Advanced Whey Protein.

What supplements are you taking that help? 

Also, anyone tried acupuncture?


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## FL mtb (Mar 19, 2016)

cloudyknight said:


> I'm sitting inside this summer watching Cavendish win 4 stages of the tour with both of his surgically repaired shoulders. It gives me hope that I can get back to my form.


I keep looking at shoulders as I watch the TDF. I see many bumps and narrow shoulders! I wondered how many of these guys opt for the surgery.
Mark Cavendish ends season after undergoing shoulder surgery - Cycling Weekly


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## DHFREERIDER (Aug 2, 2015)

A couple days over five weeks now. Been stretching, mostly resting shoulder, and doing electro stimulation of the shoulder to relax muscles and deal with pain in front of shoudler. After four days of that, have been starting physio training with light band tension rehab work, doing shoulder shrugs, and girl pushups but not all the way down to the ground. Can drive with hurt arm now, using steering wheel to keep flexibility and using the turns as a light workout. Takinig extra Amino Acids to help as well as protein. Have started a supplement with three types of glucosamine, too. Starting to feel positive and can see how I will be able to make it back to riding with strength again. 

Funny, I Facebook messaged Tom Van Steenbergen, not because I know him, but because I admire his riding and know he recently had a big shoudler injury. He was nice enough to message me back, saying he had a stage 3 AC tear but is now back to riding full out with strength again. He just said really do the physio therapy and stick with it. That was awesome to hear. And know I'll be coming back strong. 

I guess my question now would be, do I do physio every day, multiple times a day, or do I skip days by doing physio, then resting, then doing pysio. I know with lifting weights, you need to take a day between. But this light band physio, while I can feel it, it feels more like cardio workout than weight lifting. I guess the lesson with all of this is to listen to the body, do what feels good, and go slower than you normally would with working out, stay patient, be positive.


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## ride the biscuit (Jun 4, 2009)

DHFREERIDER said:


> I guess my question now would be, do I do physio every day, multiple times a day, or do I skip days by doing physio, then resting, then doing pysio. I know with lifting weights, you need to take a day between. But this light band physio, while I can feel it, it feels more like cardio workout than weight lifting. I guess the lesson with all of this is to listen to the body, do what feels good, and go slower than you normally would with working out, stay patient, be positive.


I had a dislocation and then surgical repair on the same shoulder I recently separated, so I've spent a lot of time rehabbing shoulders. It can be very easy to overdo it, and you'll know it. I've overdone it in the past doing something that feels fine in the gym or trail but then an insane amount of soreness sets in that can turn into a real setback.

Stay away from heavy push and pull exercises for a while and when you do start with such a small weight, 5 or 10 lbs max, you dont think its doing anything at all. Wait a day or two and increase if you dont have pain. Use common sense, but I will say it is difficult for me to follow my own advice. Its still pretty easy for me to overdo it on an injured shoulder.

A lot of the pain is from muscle knots, so its all about trigger point muscle therapy - Lacrosse ball works best at home but a knowledgeable physical therapist is the best. Hot water really helps, too.


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## DHFREERIDER (Aug 2, 2015)

So I'm scheduled for an MRI with Arthrography injection of dye for my shoulder next week. Anyone had arthrography? Sounds painful for days. Worth it?


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## RTM (Sep 17, 2005)

DHFREERIDER said:


> do I do physio every day, multiple times a day, or do I skip days by doing physio, then resting, then doing pysio.


every case is different. general rule, if it hurts don't do it. but you really should consult with your Dr. and therapist.



DHFREERIDER said:


> So I'm scheduled for an MRI with Arthrography. Sounds painful for days. Worth it?


I've had both types. Indirect and direct, both painless. For a grade 1/2 the MRI is probably to detect any small tear they may not have seen on the xray. the catch is, even if they see a tear, its possible they won't do anything about it anyway. if you have insurance and don't mind the out of pocket you may like to know what's going on. But really, a slight tear...no tear...even a full tear...usually ends up being the same game plan. you may be inclined to skip it. but again, I'm just a guy on the internet. definitely ask your Dr.


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## stoplight (Mar 8, 2009)

*I guess my question now would be, do I do physio every day, multiple times a day, or do I skip days by doing physio, then resting, then doing pysio. I know with lifting weights, you need to take a day between. But this light band physio, while I can feel it, it feels more like cardio workout than weight lifting. I guess the lesson with all of this is to listen to the body, do what feels good, and go slower than you normally would with working out, stay patient, be positive. *

What ride the biscuit said....I concur. start slow, range of motion stuff, should not over work shoulders but unfortunately when you do you will not know at the time...but the next day or few days later you will get a reminder who the boss is.

I started with simple wall climbs and no weight ROM exercises. Eventually added weight slowly and cautiously.....


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## RTM (Sep 17, 2005)

Now I've got a question. Grade 3, first doc recommended surgery, second felt pretty strongly against. I'm going to skip surgery for now, knowing I may need to revisit some day.

Question for anyone who skipped surgery...how is your shoulder after you fall on it again?


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## DHFREERIDER (Aug 2, 2015)

MRI shows I have a stage 1 AC strain and small Slap lesion and labral tear but that the main source of my pain has been that I actually fractured my shoulder. Initial XRays didn't show it, but MRI showed subacute fracture of the greater tubrosity of shoulder with 2.5 centimeter x 2 centimeter fragment and right where rotator cuff is anchored, and thank goodness it is still anchored, but that thing pulling is causing the pain, and thank goodness all the riding I did at Whistler didn't displace the fracture. Since it is still nondisplaced and showing signs of healing, no surgery needed. If you have shoulder pain from falling on outstretched arm, this kind of fracture is common. I won't be able to really ride for months, but I will be able to come back strong. I should have taken an intro Judo lesson and learned how to fall long ago. Oh, and arthrogram didn't hurt, but being in the MRI machine was really annoying.


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## FL mtb (Mar 19, 2016)

Wow! Good thing you had the MRI!

I'm 5 months today and had a minor incident road riding that makes me think not having surgery was the right choice. I was making a really low speed 90° turn and my tires washed out on dry concrete. I've been wondering how this would feel. No problem. Bounced up and rode on. I wonder if a repair would have failed with that minor fall. Haven't yet heard of someone trashing a repair.


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## Fritobandito (Aug 24, 2009)

I had a pretty good fall about 3 months ago and landed directly on my left side. I hopped back up quickly, but realized something was wrong shortly after. I thought I either broke my collarbone or separated my shoulder, so I went to get some x rays. The doctor said the x rays looked fine and he said it was just a contusion. I had a hard time lifting my arm above my head for a few weeks after that. 

The following month I noticed my collarbone was raised higher on that side. It wasn't noticeable visibly that much, but it was easy to feel compared to the other side. I had a physical scheduled that month and asked the doctor to take a look at the x rays again and we looked at them and they were completely normal. I asked about the bump and he said it might have been a subluxation of the shoulder. He thought I might have popped it out and back in really quick. He said they could do an MRI to find out what exactly happened, but it wouldn't change the outcome and I was almost pain free and my ROM was back by that point. 

I was having a hard time understanding how the x ray could be completely normal looking, yet I have this bump on my shoulder, which was never there before. Has anyone experienced anything like this before? I just rode Whistler for 5 days and had no pain or issues, but the x ray is still confusing me.


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## dirtrider76 (Sep 19, 2012)

I got a stage 2-3 AC separation yesterday. OTB rolled out but hit my right shoulder blade as I rolled. Thought I dislocated it but I have full ROM except up. Dr. did some resistance tests and said although its stretched real bad and might be torn some its not fully torn off. I've got the lump but collar bone moves with shoulder not separate.


I saw the tape thing but I googled last night and there are shoulder braces for these injuries to hold them tight. Dr. gave me a sling to use but it doesn't really hold my arm up much. If I prop my elbow on the arm of a chair the shoulder comes up to the collar bone and it feels normal. Has anyone tried one of these braces?


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## M320 (Mar 22, 2013)

dirtrider76 said:


> I got a stage 2-3 AC separation yesterday. OTB rolled out but hit my right shoulder blade as I rolled. Thought I dislocated it but I have full ROM except up. Dr. did some resistance tests and said although its stretched real bad and might be torn some its not fully torn off. I've got the lump but collar bone moves with shoulder not separate.
> 
> I saw the tape thing but I googled last night and there are shoulder braces for these injuries to hold them tight. Dr. gave me a sling to use but it doesn't really hold my arm up much. If I prop my elbow on the arm of a chair the shoulder comes up to the collar bone and it feels normal. Has anyone tried one of these braces?


The bump is due to the collar bone no longer being held down. The only way to get that back down would be sugary. I hear you on elbow pressure feels / looks normal , but in fact you are then moving the shoulder up to the new location of the collar bone. Welcome to the bump club.


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## dirtrider76 (Sep 19, 2012)

Yeah I know but the bump follows the shoulder. The Dr. gently pulled down on my arm and the collar bone follows which is why he thinks it isn't severed completely. The only pain I have is at the end of the collar bone if I try to put my elbow above my shoulder.


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## RTM (Sep 17, 2005)

Fritobandito said:


> I had a pretty good fall about 3 months ago and landed directly on my left side. I hopped back up quickly, but realized something was wrong shortly after. I thought I either broke my collarbone or separated my shoulder, so I went to get some x rays. The doctor said the x rays looked fine and he said it was just a contusion. I had a hard time lifting my arm above my head for a few weeks after that.
> 
> The following month I noticed my collarbone was raised higher on that side. It wasn't noticeable visibly that much, but it was easy to feel compared to the other side. I had a physical scheduled that month and asked the doctor to take a look at the x rays again and we looked at them and they were completely normal. I asked about the bump and he said it might have been a subluxation of the shoulder. He thought I might have popped it out and back in really quick. He said they could do an MRI to find out what exactly happened, but it wouldn't change the outcome and I was almost pain free and my ROM was back by that point.
> 
> I was having a hard time understanding how the x ray could be completely normal looking, yet I have this bump on my shoulder, which was never there before. Has anyone experienced anything like this before? I just rode Whistler for 5 days and had no pain or issues, but the x ray is still confusing me.


I wouldn't worry about it. If you had a bad separation you would definitely see that damn bump. May just be swelling or a minor separation. Either way same approach. Rest until it feels better then forget it ever happened.

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## Cherry660 (Aug 22, 2016)

i joined the shoulder lump club 4 weeks ago. Sharp turn, bike skid, shoulder impact to Tarmac ouch! 
not sure of the grade- ortho said to leave it, start physio and review in 6 weeks which made me think it was a grade 3 but then I received a copy of the letter send to my gp which stated it is displaced over 100% so I'm not sure.

ROM is not too bad now reaching across my body is difficult and up above my head still hurts. Very little strength in the arm and pain when I forget and over do something. 
Iv been going to the gym the last few days to use whatt bike and cross trainer to try and get back some cardio fitness after 3 weeks of doing very little, a massive culture shock as I had been training hard for a half marathon in a few weeks time. Not much pain when doing the workout but aching in the joint after. 

I tried to drive today but it was a no go- driving not to bad but trying to park and really pull at the steering wheel brought tears to my eyes! So will leave it until next week and try again.

Few questions when I rotate the shoulder it grinds and I can feel the collar bone moving over the shoulder bones which feels weird does this get any better as it heals? I'm worried about arthritis in the joint the way the bones are running over each other.
Also I have grinding At the opposite end of my collar bone where it is attached to the chest as if that too is moving out of place- no pain just a weird sensation. 
Muscles around my shoulder blade also seem to contract and spasm making my shoulder blade stick out which is uncomfortable anybody else experience this and have ideas on how to lessen it? 

I am undecided on surgery route at present. My shoulder is improving but 4 weeks on there are still many everyday tasks I cannot do- hang washing out, iron, tie my daughters hair up silly little things that I have taken for granted. 
From a shallow cosmetic point of view I also hate the bump and feel very lob sided with my arm hanging lower that the other. I am very aware of the bump when wearing vest etc and hate the thought of never wearing anything strapless again due to the look of my shoulders... But I'm not sure if its worth the surgery and extra down time...... Lumpy shoulders suck!


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## dirtrider76 (Sep 19, 2012)

2 days post injury. I'm off pain meds and started ROM rehab. Shoulder has full 90degree ROM self powered every direction. Once my arm gets straight out from my side it gets tight but I was told elbow no higher than shoulder self powered. One of my stretchs for ROM is spider crawls with my hand up and down the wall. With my hand powering my arm it has full ROM already.

After ROM rehab today I was able to take a shower and put on a t-shirt with no issue's. I just did my 2nd ROM rehab for today and its better than before. I just picked up a coffee pot with no discomfort.

Shoulder lump is about half the size it was Sunday but my shoulder blade is still funky feeling. Only pain is at the end of my clavicle but that is going away fast.


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## dirtrider76 (Sep 19, 2012)

1 week post crash.

Full ROM, full use of arm for normal tasks UNDER 10lbs(Dr. advised limit). Putting on a shirt, washing my hair, wiping my butt you know those little things fine. Got on the trainer last Wednesday and have been doing structured training. In riding position I feel normal but I'm sure jumping/hopping stuff would bother it. My lump is there but if I push there it will go down but when let go I can feel it pull tight on my shoulder. 


Sleep was a issue and was bothering my back. I normally sleep on my injured side. Sleeping on my back was ok for a bit then the front of my shoulder would tighten up. Sleeping on the non injured side it felt as if my shoulder would roll forward and the muscles would tighten up. Finally tried sleeping on my stomach with my arm off the bed but shoulder supported by the bed. PERFECT, the support keeps the shoulder from tightening in front and with a pillow under my arm it didn't just hang.


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## FL mtb (Mar 19, 2016)

I used the Kenny Howard or AC separation sling from about Day 5 to Day 13. It did provide some comfort. I don't think the brace made a difference in the deformity. I'm now 5 1/2 months post-injury. I can feel the distal end of the clavicle is remodeling. There is instability there, but I rarely think about it with daily activities or recreational activities. I'm swimming up to 30 minutes a session. I was out in some decent surf from TD 9 in the Gulf for an hour and a half last night without any issue. 

Cherry660: If you are really bummed about the lump, consider the surgery. If you're talking about going strapless, though, the scar does become a bit of an issue. Discuss the issue with the surgeon. He may close the incision differently for you. You might even have a plastics guy close the wound. The spasm definitely decreases as you recover and strengthen the surrounding musculature. The pain you feel with some of the extreme motions will resolve, too. As you described, reaching across the front of the shoulder and fully overhead, as well as behind my back, were particularly uncomfortable for awhile.

Keep your head up as you're only a month in and likely to make lots of progress in the next month or two!


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## Cherry660 (Aug 22, 2016)

Been back to fracture clinic today for 6 week review and have been referred to shoulder specialist.
Rom is better but joint is still very unstable. I tried to road ride this week but could not cope well with even small bumps in the road and the vibration. Back to the stationary bike for a bit longer!


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## dirtrider76 (Sep 19, 2012)

I had my 2nd recheck Wednesday, Doctor is allowing me to return to work on Monday which is 3 weeks since injury. ROM is great except for reaching across to my other shoulder. That pulls tight once I get my hand to my shoulder, other side I can reach all the way around and touch my shoulder blade. Shoulder is stable and I just have to watch certain movements and do my rehab to help strengthen my shoulder more. I was told my AC is now full of scar tissue and the lump may still get smaller but will likely not go away. 

I'll try and update in a few weeks and hope everyone heals up fast.


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## RockinRoller (Sep 14, 2016)

Man one of the worst things to do after an AC separation is jump back on the bike too soon and setback your short term or overall recovery. The weaker muscles will not react nice to jolts and quick muscle contractions coming from road bumps; let alone trails.

After the 1st week of the body healing naturally- stretching and massage therapy will help remove the internal scaring, help ROM, and prepare for light strengthening with just body weight. Slow and methodical movements to retrain the body to move with this new shoulder mechanics. Move onto elastic bands then weights- the body will let you know.

I got my AC separation 9/5 and opted for no surgery and have picked up Yoga - helps stretch and strengthen.


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## gingus (Sep 27, 2004)

RockinRoller said:


> Man one of the worst things to do after an AC separation is jump back on the bike too soon and setback your short term or overall recovery. The weaker muscles will not react nice to jolts and quick muscle contractions coming from road bumps; let alone trails.
> 
> After the 1st week of the body healing naturally- stretching and massage therapy will help remove the internal scaring, help ROM, and prepare for light strengthening with just body weight. Slow and methodical movements to retrain the body to move with this new shoulder mechanics. Move onto elastic bands then weights- the body will let you know.
> 
> I got my AC separation 9/5 and opted for no surgery and have picked up Yoga - helps stretch and strengthen.


Plus one to this, don't over do it to early and get worse long term results.

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## SikeMo (Mar 17, 2013)

How long are you guys waiting to get back on the mountain bike? I'm 4 weeks into a grade 3 and feel like I still have at least another 4 weeks to go. I have decent range of motion, but still cannot reach over my head or behind my back. PT starts this week, for me.


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## M320 (Mar 22, 2013)

SikeMo said:


> How long are you guys waiting to get back on the mountain bike? I'm 4 weeks into a grade 3 and feel like I still have at least another 4 weeks to go. I have decent range of motion, but still cannot reach over my head or behind my back. PT starts this week, for me.


Grade III here.I was back on the road bike 3 weeks, mountain bike week four. I'm on week 9 now. Still sore at times, hurts if I pull up hard for a rock or jump. Drop off and small bumps are fine. Doc says do what ever I want within my pain threshold. Just do not fall on it. (have clipped a few trees OUCH). all in all. I only used the sling for the first week and only a few hours at a time. No pain killers, just IB prof. Based on other reviews I forced myself to keep it moving and deal with the pain early, that way I did not loose much ROM. Still cant sleep on that side and it will still hurt at random times, but pain is what you make of it. I like riding my bike more. Best of luck on speedy recovery


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## SikeMo (Mar 17, 2013)

It's amazing how much orthopedic recommendations vary in these scenarios. I was told 6-8 week recovery and don't lift anything over 5 pounds for the first 4 weeks. I wouldn't even think of getting on a bike at this point.


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## SCtriton (Mar 29, 2015)

My experience was very similar to the posts after my G3 separation in March 2015. I had good ROM after week 1 and was able to do pull ups/pushups, paddling, etc. by week 8 trying to get back to normal ASAP. I decided on surgery in late May because the annoying pain from the clavicle digging into my shoulder on every paddle stroke and instability when duck diving large waves. 

That is when things went south. I got staph in my shoulder and spent 3 months trying to kill it in order to salvage the surgery that ultimately failed. So, not only did I lose the CC/AC joint repairs, I had much more scar tissue and muscle loss particularly in my deltoid area that was concave (i.e. a divot) by September. My right shoulder (deltoid, trap, etc.) was a shrunken mess from its pre injury form.

What helped me recover was getting a PT that was hands on: pulling, twisting, deep tissue messaging, etc. all the muscles, bones, ligaments, etc. in my shoulder area for 50 minutes followed by 10 minutes of heat therapy and a brief review on new home exercises. Some of these sessions were very painful but I could feel the improvement the next day. She warned against doing anything strenuous until the shoulder mechanics were fixed in order to avoid further injury to another area particularly the rotator cuff. I started PT in September, went once a week and was at full strength by December 2015: paddling, running, biking, weight lifting, etc. 

Now a year later, I am stronger than I was before the injury. I continue to lift weights because it feels good in the shoulder. I hadn’t been on a bench press in over 20 yrs but now go a couple times a week. I still have stiffness from the scar tissue and I don’t think this will ever go away although my PT said it takes about 2-3 years to eliminate. The bump is barely noticeable and both shoulders are nearly identical. 

I highly recommend getting a PT that knows what they are doing. Don’t waste money on these PT shops that want to sign you up for several months so you can waste your time and money doing exercises in their shop that can be done at home. You absolutely need the hands on PT if you want to accelerate the healing process in your shoulder.


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## SikeMo (Mar 17, 2013)

Thanks for that. Just had my first PT session today and it was as you described, with the addition of electrical stimulation. I will be going twice a week for six weeks. They've given me several ROM exercises to start with but said to lay off as soon as I feel any pain. Fortunately my insurance covers it.


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## krjr13 (May 2, 2010)

I dislocated,separated and tore my labrum in my shoulder 6 weeks ago in a crash. I am now 2 weeks post surgery and went to pt twice. I was going to ask other cyclists how long they waited with similar injury but there is obviously a wide range previously given for other injuries. But how much pain is everyone dealing with once back on the bike? And I'm guessing the torn labrum with the separation is why I feel I'm so much further behind then everyone else because I'll be in a sling for 2 more weeks. Thanks for any insight and everyone heal up!


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## abrooks (Feb 1, 2015)

Broke mine 3 weeks ago. Broke at the end collarbone so not enough to for a screw to get any purchase. Have just started physio, it's dam sore. 



I'm not able to drive so can't work, I'm bored sat at home.. 
Just wan't to know how long will it be before I can get back on my bike, bearing in mind winter is on it's way. Which usually means wet and muddy in the UK. I'm kinda leaning to heading to the gym once the doctor gives the go-ahead and leaving getting back on the bike in spring as I'm worried about breaking it again.
I know I have to get back on at some point..


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## dirtrider76 (Sep 19, 2012)

Tomorrow is 8 weeks since my AC separation. I'm doing PT and only issue I had was they think my pectoral muscle was damaged when I fell. I have 2 weeks home rehab and go back to get it checked to see that its improving. As long as it is I'm done with having to go to PT and can do normal stuff at home. My goal was to ride park before the end of the year. Planning on riding the 30th which is the last day before they close for the season.

As far as riding goes I'm trail riding now. Wednesday I did a few hops over logs with no issue. It felt pretty odd at first but it got better fast.


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## targnik (Jan 11, 2014)

This time next month and it'll be 1 year since my grade 3...

Shoulder still clunks when I do press ups, unless I splay hands out to the side and take a slightly wider stance.

Shoulder doesn't affect my riding/confidence.

The confidence thing took 5-6 months, maybe... 

I've since taken the odd tumble on same shoulder and it's held up.

I am still conscious when in similar riding situations that caused the original injury.

My Brain won't easily forget the events that occurred 11 months ago.

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## gooseberry1 (Mar 16, 2016)

Just did this and hope it will not be affecting my bike set up.


















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## abrooks (Feb 1, 2015)

It's been 5 weeks now since my accident. I returned to work Thursday, as my mental health was starting to wane . I have been having physio for the last 2 weeks and have to return to the fracture clinic this coming Wednesday. I'm still in pain and by the end of the day it is unbearable. 








The way I feel at the moment, It'll be a while before I'm back on my bike. Those of you who didn't have surgery how long was it before you were able to do some sort of exercise?


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## gooseberry1 (Mar 16, 2016)

abrooks said:


> It's been 5 weeks now since my accident. I returned to work Thursday, as my mental health was starting to wane . I have been having physio for the last 2 weeks and have to return to the fracture clinic this coming Wednesday. I'm still in pain and by the end of the day it is unbearable.
> View attachment 1100149
> 
> 
> The way I feel at the moment, It'll be a while before I'm back on my bike. Those of you who didn't have surgery how long was it before you were able to do some sort of exercise?


That one kinda looks like it should need surgery just saying you might want another opinion. My break is a 50/50 chance for surgery if it stays together.

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## bogeydog (Apr 13, 2015)

Mine was between a grade 2 and 3. 3 weeks and I was 80. 5 weeks all Ok. 

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## FL mtb (Mar 19, 2016)

Those fracture/separations look a lot more painful! Gooseberry's fragment looks less displaced and more likely to heal. Can't believe how many new members there are every time I log in here!


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## DudeDowne (Jun 18, 2012)

It's been 1 week since my fall. Grade 4 separation, surgery in 3 days. What should I expect for the first week? Thanks for any input.

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## matt.s67 (Nov 4, 2016)

Just thought I'd chime in since this thread has been very helpful to me.

9 days ago on 11/3/16, I went over the bars at Bent Creek in Asheville, NC. I was wearing a helmet (thank God) and had a concussion, lost short term memory and was totally out of it...until I ate a rice krispie treat (no joke). Here's a video...notice I stop breathing for 12 seconds after the crash. The crash is right around the 1 minute mark...girlfriend found me shortly afterwards gasping for air with my eyes rolled into the back of my head. For anyone who followed my other thread, we still never found my iPhone.






Anyways, we made it back to FL the next day, and for the first 2-3 days, I couldn't use my left arm at all and had to keep it in a sling. Day 4, I went to my physical therapist to show him the X-ray and have him apply some KT tape to strap down the clavicle and stabilize the joint, which helped a ton. Around day 5, I started to progress rapidly and gain back range of motion. Rode the stationary bike for 40 minutes and it felt really good to get some good blood flowing. The next day, I bought some Rocktape and really taped the **** out of the joint, following the pattern in this video:






Day 7, I was able to ride my bike around the block without any pain (it only hurts getting on and off) but didn't want to push it.

Day 9, yesterday, I felt so good and had back so much range of motion that I rode my bike 5 miles on pavement and did 30 minutes on the Airdyne (think of a bike with elliptical handles). Shoulder still feels unstable during certain movements, but I have back 75% of my range of motion.

I had an MRI yesterday, but haven't received results yet.

I've been taking Cissus Quadrangularis which has helped immensely with joint pain in the past. 2400mg Cissus, 800mg ibuprofen, 2-3 fish oil capsules and 3g curcumin 3x a day since day 1. Ice 4-5 times per day for 15-20 minutes.

For the record, I separated my other AC joint back in 2009 when jumping over a 6 foot wall on an obstacle course. My legs went over the wall, but my arm didn't. I have a slight bump on the right shoulder, which healed 100% without any surgery. I'm an avid weightlifter and have full functionality in that arm. I always wondered why I had more range of motion when vertical pressing on the previously injured side...maybe I just evened myself out?


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## matt.s67 (Nov 4, 2016)

13 days in, MRI results indicate my scapula is also fractured (non displaced). Can't see an ortho until next week so I'm just staying the course with ice/ibuprofen and light exercise when I can. Rode my bike for 1.5 hours this weekend on smooth dirt paths / grass etc with no pain, and managed to do a leg workout at the gym. Still not stable enough to do anything with my arms but I'm not in a rush.


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## DudeDowne (Jun 18, 2012)

Thanks guys for the updates....it's been 1 day since surgery and it hurts like a mofo. Hopefully I can ride my trainer next week. 

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## dirtrider76 (Sep 19, 2012)

DudeDowne said:


> Thanks guys for the updates....it's been 1 day since surgery and it hurts like a mofo. Hopefully I can ride my trainer next week.
> 
> Sent from my SAMSUNG-SM-G890A using Tapatalk


I had a friend setup my bike in the trainer for me. Did some easy spinning to keep from being bored and keep blood moving. About a week later I was doing my ROM stretches on the trainer while I rode.


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## rocbike (Nov 17, 2016)

I sustained a grade 5 separation in August and had reconstruction surgery 2 weeks after the injury. I can tell you that for the first 4 to 5 weeks I was useless; unable to utilize the arm at all and too afraid to even go hiking. I started PT about 2 weeks after surgery. By week 8 I tried to do light mountain biking, making sure not to fall and to walk all of the challenging and technical stuff. I felt good that day but for the next almost week after that I was very sore and in a lot of pain. I think it may have set me back in my PT a little too. The phys. therapist yelled at me and when I saw the doctor 9 weeks after surgery he told me not to get on the bike. So now I'm heeding his warning and will ask him again about it in January when I see him again. Luckily I'm well enough to hike now and the strength in my arm has improved significantly. I feel like I can do light riding now, at 12 weeks out and I might cheat, still thinking about it.


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## DudeDowne (Jun 18, 2012)

rocbike said:


> I sustained a grade 5 separation in August and had reconstruction surgery 2 weeks after the injury. I can tell you that for the first 4 to 5 weeks I was useless; unable to utilize the arm at all and too afraid to even go hiking. I started PT about 2 weeks after surgery. By week 8 I tried to do light mountain biking, making sure not to fall and to walk all of the challenging and technical stuff. I felt good that day but for the next almost week after that I was very sore and in a lot of pain. I think it may have set me back in my PT a little too. The phys. therapist yelled at me and when I saw the doctor 9 weeks after surgery he told me not to get on the bike. So now I'm heeding his warning and will ask him again about it in January when I see him again. Luckily I'm well enough to hike now and the strength in my arm has improved significantly. I feel like I can do light riding now, at 12 weeks out and I might cheat, still thinking about it.


Good luck with the recovery. After the surgery doc said I had a grade 5 due to the tissue damage that didn't show up on x-ray. I certainly over estimated my recovery, like you stated I am useless. I will heed your story and not push it. Thanks for sharing your story.

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## Jackietrentlynch (Nov 19, 2016)

*Grade 5 separation and Lockdown surgery*

I was excited to find this forum, and I hope you will accept my horse as my bike! I suffered a grade 5 separation 4 years ago and was told that unless I was a major league baseball player I should not have surgery. Thinking that I had no other option, I continued to compete, train ex-race horses, jump and fall off of horses with this injury - sometimes with my arm strapped to my chest to get the job done!

After four years of great pain I finally got a second opinion. This doctor said he had never seen x-rays as bad as mine, and couldn't believe I had gone this long in that kind of pain. I am scheduled for lockdown surgery the day before Thanksgiving, and I feel like I'm going to get my life back! Any tips to get through the recovery period would be greatly appreciated!

Wish I could figure out how to post my X-rays!


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## DudeDowne (Jun 18, 2012)

Jackietrentlynch said:


> I was excited to find this forum, and I hope you will accept my horse as my bike! I suffered a grade 5 separation 4 years ago and was told that unless I was a major league baseball player I should not have surgery. Thinking that I had no other option, I continued to compete, train ex-race horses, jump and fall off of horses with this injury - sometimes with my arm strapped to my chest to get the job done!
> 
> After four years of great pain I finally got a second opinion. This doctor said he had never seen x-rays as bad as mine, and couldn't believe I had gone this long in that kind of pain. I am scheduled for lockdown surgery the day before Thanksgiving, and I feel like I'm going to get my life back! Any tips to get through the recovery period would be greatly appreciated!
> 
> Wish I could figure out how to post my X-rays!


Wow...good luck. I am in day 5 from surgery and finally feel somewhat human. Lessons I have learned: Make sure you have some sort of support system for the first few days. Setup your recovery area with a comfy couch, small pillows, TV, books etc. I can't sleep lying down yet so I spend much time there. Take pain killers and force yourself to eat something in the first days. I didn't eat for a couple of days and it really sucked. I now eat rice oatmeal stuff like that so the side effects from the oxy are tolerable and I sleep longer.

Not sure how much this helps, but it is getting better every day.

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## FL mtb (Mar 19, 2016)

matt.s67 said:


> 13 days in, MRI results indicate my scapula is also fractured (non displaced). Can't see an ortho until next week so I'm just staying the course with ice/ibuprofen and light exercise when I can. Rode my bike for 1.5 hours this weekend on smooth dirt paths / grass etc with no pain, and managed to do a leg workout at the gym. Still not stable enough to do anything with my arms but I'm not in a rush.


Watched your video. Looked like such an innocuous stretch of trail, but in an instant your life changed. Glad you're recovering. Curious to hear how you think the taping works out. Do you think your first separation was a Grade II?


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## matt.s67 (Nov 4, 2016)

FL mtb said:


> Watched your video. Looked like such an innocuous stretch of trail, but in an instant your life changed. Glad you're recovering. Curious to hear how you think the taping works out. Do you think your first separation was a Grade II?


I know right? I'm still not sure exactly what happened, whether I pulled back on the bars with uneven pressure, or if the rear wheel popped forward on the lip of the jump...or maybe both.

Rocktape is awesome. Every time I remove it prior to re taping, my shoulder feels way less stable than it does with it. My physical therapist feels that it's going to be a substantial factor in my healing process.

Weird thing, the X ray looks like a grade 2 or 3, but the MRI states it's only a grade 1. Perhaps that's why I'm recovering so quickly.

Anyhow, my real main concern is that I may have a torn labrum as the pain from my AC joint area has dissipated and I now only feel pain coming from inside the shoulder socket, and my shoulder still feels unstable. Meeting with an ortho next Wednesday so we'll see what he says. MRI apparently didn't find any type of labral tear, but from what I hear an MRI isnt the best way to detect it.


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## LemonDrops (Oct 11, 2016)

I seperated mine 4th degree about 11 years ago. i'd say it's 98-99% back to normal and forget it happened except when I see the scar or dragging fingernails across the top there is some slight numbness/tingling, I imagine from nerve damage from the surgery. I had surgery about 3 weeks after the accident. I can't believe Jackietrently had 5th degree and gone 4 years witho surgery, that is crazy.:skep:

One thing I would suggest anyone who suffers this injury/surgery to push their doctors/insurance company for is one of these.







https://www.activeforever.com/airca...id=A24789+01&gclid=CIWF0r2uwNACFUg2gQodlz0MQg

It beats holding an ice pack on your shoulder and does a much better job. You have to wear a sling anyway, and this is a sling and ice pack in one.


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## gooseberry1 (Mar 16, 2016)

LemonDrops said:


> I seperated mine 4th degree about 11 years ago. i'd say it's 98-99% back to normal and forget it happened except when I see the scar or dragging fingernails across the top there is some slight numbness/tingling, I imagine from nerve damage from the surgery. I had surgery about 3 weeks after the accident. I can't believe Jackietrently had 5th degree and gone 4 years witho surgery, that is crazy.:skep:
> 
> One thing I would suggest anyone who suffers this injury/surgery to push their doctors/insurance company for is one of these.
> 
> ...


I second this and love my coldrush unit. I will never use a ice pack again. Btw I'm back to normal for the most part and plan on riding next week

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## dirtrider76 (Sep 19, 2012)

They had something like that at my PT to ice my shoulder. It was pretty awesome and really nice for after my PT.


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## matt.s67 (Nov 4, 2016)

I've been pain free for about 2 weeks and can say I'm now 100% healed with zero limitations 2 months following my injury. I can lift weights as heavy as I want with no pain, I'm sleeping on my left side again...I don't even think about it anymore.

Weight training, although painful at first, helped a ton. I had to push through a lot of stuff and do what I could without aggravating it, and it would be very sore afterwards, but the following day I would have noticeably less pain and more range of motion.


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## DudeDowne (Jun 18, 2012)

matt.s67 said:


> I've been pain free for about 2 weeks and can say I'm now 100% healed with zero limitations 2 months following my injury. I can lift weights as heavy as I want with no pain, I'm sleeping on my left side again...I don't even think about it anymore.
> 
> Weight training, although painful at first, helped a ton. I had to push through a lot of stuff and do what I could without aggravating it, and it would be very sore afterwards, but the following day I would have noticeably less pain and more range of motion.


Great job and glad to hear! Keep the progress updates coming. Very helpful to hear sucess stories.

I just got clearance to get rid of the cradle. For me it has been 8 weeks since crash and 6 weeks since surgery (grade 5). I can't lift my arm above chest high yet, but will be starting PT next week. Still some dull pain but getting better.

On a related note, I started an indoor training plan with Trainer Road since I won't be able to ride trails for at least another 3 months. It has been great to have a structured plan to motivate me and focus on fitness. Something I have never really taken seriously. I am still planning on making the Pisgah Enduro first week of June.

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## dirtrider76 (Sep 19, 2012)

I'm at 6 months since my AC separation and torn Pectoral muscle. Life is pretty much normal again. It gets bothered if I sleep on it wrong or if I yank on my arm a lot or push something down a lot. Unless I move it certain way I don't really notice the lump but when it does stick out its way out there.


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## rossy (Mar 3, 2017)

I have a sneeky suspicion I have a seperated AC, so last week I went into hospital after a otb crash, took xrays but they said nothing wrong with my collar bone or shoulder just possible sprain, but now im home and the swelling has gone, I can see and feel that the collar bone sits way higher where it meets my shoulder then my other side. Still hurts quite bad especially in certain positions I guess I should see the Dr haha.


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## giantfox (Aug 13, 2012)

update:
I am 4.5 years down the line from a grade 3 separation - no surgery.

shoulder is good, works fine


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## throet (Oct 8, 2016)

I suffered a Grade 5 separation, torn pectoral muscles, and a sternocavicular dislocation from a crash in June 2013. Because I had surgery within 2 weeks of the injury, the surgeon was able to do it without any grafting. He used a tightrope device that simply reattaches the clavicle and let's the soft-tissue scarring hold everything together permanently. I was skeptical at first, but I was back in the bike in 6 months and was back playing racquet sports after a year with no ill effects (same side as surgery). Six years later, my chest muscles still sag, presumably from the upper pectoral tears, but I've regained most of my strength. The only other problem I have is the clavicle popping out at the sternocavicular joint, but apparently there is very little that can be done for that. It's only noticeable with arm extended out and wide rotations of the shoulder.


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## Jadw (Mar 31, 2017)

I'm a cat 1 roadie and xc mountain biker that suffered a grade 3 on my left shoulder in March 2015 going over the bars on a long downhill after my new elbow armour slowly cut off the circulation to my hands and I had a braking 'malfunction' a few corners from the bottom of the trail. Doh.

My shoulder bump was big, but my recovery was very fast and I had full range of movement within 4 weeks, and was back riding on the road around the 3 week mark. I had no pain with day to day activities though on the road bike I'd get pins and needles in my hand after about an hour of riding. I realised this was because I had the tendency to shrug and tense the shoulder and lock it in to the trap in order to get some stability. Another problem I realised early on is that the separation made my left arm about 1 inch functionally longer than my right when reaching for the bars. This would mean that when I was putting the hammer down on the road bike that I would tend to push off the left side pushing that hip back and the other hip forward.

The shoulder however was definitely functional and pain free so I upped my training volume for a stage race mid last year and was faster and stronger than I've ever been, however developed bad pelvic nerve pain on the right side that has forced me off the bike ever since. After a lot of futile core work, scans revealed a hip labral tear and gluteal nerve impingement on the right hip that had turned my glute med to fat.

It took quite a bit of detective work to discover that the AC separation was the main cause. I've only recognised in hindsight the importance of trying to keep both clavicles level in day to day activities (and how my AC separation made this almost impossible). For me, my brain would keep both shoulders level (even though the left now had a big drop) and this meant my clavicles developed an angle downwards to the right. This strengthened some muscles, weakened others, and kinked my spine, and eventually the scoliosis at the base of the spine started bringing my right hip upwards, rotated forward, and a decent training load entailed the hip and SI joint copped the full brunt of all my asymmetries. 

My AC surgery in 3 weeks will use a Lockdown artificial ligament, then I'll have hip arthoscopy a few months after that. I'm hoping after fixing the AC my spine can remember what being straight feels like and help my pelvis heal.

Maybe I was prone to a malalignment problem (left footed, right handed) but I think if you're very sporty and young and have a grade 3 and the decision given to you by medical professionals for surgery is 'does my shoulder work without pain...' you should also seriously think about the downstream effects in the kinetic chain, or at the very least monitor them really closely.


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## DudeDowne (Jun 18, 2012)

Jadw said:


> I'm a cat 1 roadie and xc mountain biker that suffered a grade 3 on my left shoulder in March 2015 going over the bars on a long downhill after my new elbow armour slowly cut off the circulation to my hands and I had a braking 'malfunction' a few corners from the bottom of the trail. Doh.
> 
> My shoulder bump was big, but my recovery was very fast and I had full range of movement within 4 weeks, and was back riding on the road around the 3 week mark. I had no pain with day to day activities though on the road bike I'd get pins and needles in my hand after about an hour of riding. I realised this was because I had the tendency to shrug and tense the shoulder and lock it in to the trap in order to get some stability. Another problem I realised early on is that the separation made my left arm about 1 inch functionally longer than my right when reaching for the bars. This would mean that when I was putting the hammer down on the road bike that I would tend to push off the left side pushing that hip back and the other hip forward.
> 
> ...


Jadw,

Thanks for posting. I had a grade 5 separation in November and had surgery to repair left shoulder using donor ligaments. I was able to start indoor training in December and cleared for strength training in March. I still have a large bump and my clavicles are not symmetrical. My hope is continued strength training will reduce the imbalance.

However I now have nagging right knee pain. In researching this it seems I found that glute med strengthening/activation may help. I found that performing glute exrcisines my right side is very limited compared to my left. I suspect that this imbalance is due to my left shoulder as well. I hope surgery is not required and PT can fix this.

Good luck on your surgery and recovery.

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## zaxmalloy (Jun 23, 2014)

Boy this thread has been a wealth of information and positivity.

I was hit by a car going about 45 mph (the car not me) about 7 weeks ago, which took out the car windshield. I manned-up (aka was an idiot) for a few days and finally went to the doctor - discovering I had multiple fractures on my left ankle (for which I have had surgery for a screw) and a grade 3 shoulder separation on my left side. I had to go to two separate doctors and it's interesting that neither really takes the other injury into account - e.g. using crutches with a separated shoulder...hurts.

The ankle was worse off and the focal point because I had to have it surgically repaired. The shoulder seemed to heal faster with ice and rest and the shoulder doc 'released' me 4 weeks after the crash because I had full range of emotion and just some soreness now and again. Weirdly enough once the ankle really started to improve a couple of weeks ago the shoulder got worse - not chronic pain but random spasms and soreness that would come and go. And it didn't get better. How could it go backwards?

So I started PT on the shoulder and my therapist says what I'm experiencing isn't unusual - especially for someone with multiple injuries as the body can really only focus on so much repair/pain at once. Now that the ankle is much better, I'm just feeling the shoulder more - at least that's her contention. 

She also said the deltoid muscle has been over-compensating for the AC joint leading to spasms and discomfort as the AC joint has not been used. Muscle relaxers for the ankle taken multiple times a day probably did'n't help the situation (taken before bed is not a problem since the shoulder isn't moving anyway.) 

She gave me some basic exercises but warned me this might get a little more painful before it gets better - but it should get better and quickly but it will still take some time to get it 100%. She did not see a reason to return to the doctor to have the shoulder re-evaluated

I get the ankle air cast off for good (with any luck) next week and hope to get back on the bike asap - since pedaling is actually good for getting range of motion back in the ankle...assuming you avoid cars. I am wondering if my shoulder will be able to take it - the leaning over, the gripping...but guess we'll see...


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## Spec44 (Aug 17, 2013)

I was pretty comfortable on the bike until I tried to pull the front wheel up for bunny hops, woop-de-doos, logovers, etc.

Every once in a while a bump or drop would catch me off guard and cause a bit of a wince, but it only lasted for a second.


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## jacksonlui (Aug 15, 2015)

Wow. Reading this thread makes me wonder why im still biking. Mine still hurts after a few months after casing a jump with my shoulder. It didn't help that i clipped my handlebar on an extended tree going 25 and reinjured it. Now I'm concerned about range of motion later on in life. 

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## bogeydog (Apr 13, 2015)

jacksonlui said:


> Wow. Reading this thread makes me wonder why im still biking. Mine still hurts after a few months after casing a jump with my shoulder. It didn't help that i clipped my handlebar on an extended tree going 25 and reinjured it. Now I'm concerned about range of motion later on in life.
> 
> Sent from my SM-G930V using Tapatalk


It can be repaired. Mine will be this fall.

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## dirtrider76 (Sep 19, 2012)

I've fallen on mine again since being separated. Its sore for a few days then back to normal.


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## LyncStar (Feb 16, 2006)

I had a fourth or fifth degree sep, ten years ago at 39. Its right as rain today. Just get it taken care of.


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## DinoRidge (Aug 29, 2007)

jacksonlui said:


> Wow. Reading this thread makes me wonder why im still biking. Mine still hurts after a few months after casing a jump with my shoulder. It didn't help that i clipped my handlebar on an extended tree going 25 and reinjured it. Now I'm concerned about range of motion later on in life.
> 
> Sent from my SM-G930V using Tapatalk


I'm about a year from a grade 3, just did a rocky mtb race on a rigid bike yesterday with no problems from the shoulder. It did take a while for the pain to fade though, but I credit religious physical therapy for my recovery. In particular, I still occasionally do the range of motion exercises. Also, my injury-causing crash, aside from rider error, was caused by my seat popping me otb. I have a dropper now. Love the dropper!


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## xtruder (Jun 16, 2017)

Another member to the club with, albeit different, story.

I woke up this morning and in the shower mirror I noticed my left shoulder bone protruding slightly out of my body. A quick google session and I found correct medical term and by the looks of it I have level 3 ac joint separation. I haven’t fell or experienced any trauma to my left side ever! Nor I remember feeling pain in my left shoulder or having any immobility issues ever!

After reading a few pages of this thread I started testing the symptoms. Did some pushups, pullups, chin-ups – nothing unusual. Not to mention sleeping on either side – no difference at all. However, after doing some slower shoulder rotations and elevations (to compare both shoulders) I felt some clicking in the left shoulder. Did “hindu” pushup and felt the clicking, but no pain. Does this mean I separated it a while back and already recovered from it?

I started doing calisthenics recently and wonder if I should stop it and do correct recovery? Will the lump get worse? I’ve scheduled appointment with my doctor, but do wonder about your opinion.


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## matt.s67 (Nov 4, 2016)

xtruder said:


> Another member to the club with, albeit different, story.
> 
> I woke up this morning and in the shower mirror I noticed my left shoulder bone protruding slightly out of my body. A quick google session and I found correct medical term and by the looks of it I have level 3 ac joint separation. I haven't fell or experienced any trauma to my left side ever! Nor I remember feeling pain in my left shoulder or having any immobility issues ever!
> 
> ...


You can't diagnose yourself as having a grade 3 separation by looking in a mirror and googling. If you had a grade 3, or even a grade 1, you would have known it - you'd experience a LOT of pain and not be able to move your entire arm for awhile. It's not just something you wake up with one day. If you never had any pain or trauma to your shoulder, I'm not sure why you think the AC ligaments are completely severed.


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## jacksonlui (Aug 15, 2015)

Google says mine is a grade 3.14159. Wonder what the co-pay is with this obamacare

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## throet (Oct 8, 2016)

xtruder said:


> Another member to the club with, albeit different, story.
> 
> I woke up this morning and in the shower mirror I noticed my left shoulder bone protruding slightly out of my body. A quick google session and I found correct medical term and by the looks of it I have level 3 ac joint separation. I haven't fell or experienced any trauma to my left side ever! Nor I remember feeling pain in my left shoulder or having any immobility issues ever!
> 
> ...


If the bump has been there and you're just noticing it, then it is either a birth defect or related to an old injury. I doubt there is anything you can or should do at this point, especially since it doesn't seem to be hindering you in any meaningful way. I've separated both of mine, and never had the first one treated. It's fine now. The other one was a Grade 5 and required surgical repair. It's fine too except for the same popping or clicking that you describe, which I don't worry about.


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## Spec44 (Aug 17, 2013)

matt.s67 said:


> You can't diagnose yourself as having a grade 3 separation by looking in a mirror and googling. If you had a grade 3, or even a grade 1, you would have known it - you'd experience a LOT of pain and not be able to move your entire arm for awhile. It's not just something you wake up with one day. If you never had any pain or trauma to your shoulder, I'm not sure why you think the AC ligaments are completely severed.


This x2


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## bachman1961 (Oct 9, 2013)

I don't recall what I had but the Dr said no surgery needed... was happy with that. 

Eighteen or more years ago I was showing a friend around on our bikes up behind the Broadmoor and coming down Chutes from Goldcamp at a good rate of downhill momentum, I spotted the Brady Bunch coming up the flat entry area. I moved over well early but my tire found a square-edged rut and bike and I were launched to the ground at impressive velocity. 
I was winded and although I got right up, my arm was completely dead and numb. I had to lift my right arm and lay it and hand on the handle bars to guide the bike back to the the car.

It finally came back to haunt me with some minor pain and some range of motion issues here in the past year or so but thankfully nothing of consequence. Back then I was 38.


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## Losvar (Mar 21, 2016)

Disregard, I'm bad at forums.


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## Rocko99 (Jul 27, 2017)

xtruder said:


> Another member to the club with, albeit different, story.
> 
> I woke up this morning and in the shower mirror I noticed my left shoulder bone protruding slightly out of my body. A quick google session and I found correct medical term and by the looks of it I have level 3 ac joint separation. I haven't fell or experienced any trauma to my left side ever! Nor I remember feeling pain in my left shoulder or having any immobility issues ever!
> 
> ...





matt.s67 said:


> You can't diagnose yourself as having a grade 3 separation by looking in a mirror and googling. If you had a grade 3, or even a grade 1, you would have known it - you'd experience a LOT of pain and not be able to move your entire arm for awhile. It's not just something you wake up with one day. If you never had any pain or trauma to your shoulder, I'm not sure why you think the AC ligaments are completely severed.


This is not true. I did not crash, have an accident or fall at all. I do a lot of weight lifting and woke up one morning with a somewhat sore shoulder. Collar bone bump on right side, took an x-ray, II-III separated shoulder. The doctor didn't believe I didn't fall. Going to ortho in 2 weeks.

BTW, x-ray techs are not the best at diagnosing these. They look for fractures, breaks, and something way out of wack. My x-ray report said normal shoulder when you can clearly see the clavicle sitting above the acromium. An MRI is needed to see the ligament damage, x-rays won't show anything. Go to your doc if you have one and stop doing push-ups, bench, overhead press, etc.


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## savoi (Jul 16, 2017)

*Grade V*

I had this injury in a hiking accident 7/15/17, the ER doc said grade II, yesterday on 7/26/17 the Ortho surgeon said Grade V. I really don't want to have to go through the surgery, but feel it's the best thing to do overall.

Even after making the decision still having nagging thoughts. Having surgery and 4 weeks in an immobilizer is nothing to laugh about.

I've attached two photos, hopefully they come through. The red on my shoulder is from having my shoulder taped and I may have ripped it off too vigorously.

It's hard to get a straight answer, the surgeon said it's up to me, and this guy is a high ranking ortho sports medicine guy.

Good luck with whatever you are doing, things can work out.


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## Chicane32 (Jul 12, 2015)

I had a grade 3 separation on my shoulder from a snow boarding accident in 2002 at 27 years old. I caught an edge and hit hard. The Dr at that time told me grade 3 was the worst. He told me surgery wasn't necessary and it was only for cosmetic looks due to the bone sticking up. My shoulder was completely immobilized for 8 weeks in a sling. When I removed the sling I had no muscle and after rehab and weights, I have 100% motion and never had any issues with my shoulder. Surgery wasn't needed for me. It's interesting to here the different recovery times and opinions from other Dr's. Fast forward to 2016, on my MTN bike I cut a side wall on a steep run and dislocated the same shoulder, but luckily popped it back in socket. The Dr told be it's completely unrelated to my first injury, but I will need surgery due to a torn Labrum. Three months later I washed out the front going somewhat fast and dislocated it again. It was only out of socket for about 3 hrs until the ER Dr. drove put it back in place. Drove myself to the ER after the Ranger picked me up and took me back to my truck. Pain was only 12 out of 10. I waited about 4 1/2 months to get back on the bike and my shoulder feels as good as it did before surgery. Fun times.


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## throet (Oct 8, 2016)

savoi said:


> I really don't want to have to go through the surgery, but feel it's the best thing to do overall.
> 
> Even after making the decision still having nagging thoughts. Having surgery and 4 weeks in an immobilizer is nothing to laugh about.
> 
> It's hard to get a straight answer, the surgeon said it's up to me, and this guy is a high ranking ortho sports medicine guy.


Both the pic and xray look very similar to what I had, also diagnosed as Grade 5. I had surgery around 2 weeks after the accident after getting opinions from 2 ortho surgeons. One wanted to do a graft to reconstruct the joint. The other recommended a simpler approach involving a tightrope device that essentially just ties the clavicle back down to the shoulder blade allowing scar tissue to form. I opted for the second approach and haven't had any issues. This happened when I was 55 but I recovered nicely. I was back mountain biking after 4-5 months and eventually resumed playing racquetball and squash with that arm with no issues. I've had no regrets, although I really can't say how things would have turned out without the surgery. Feel free to PM me if you have any specific questions.


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## Skorp (Jul 20, 2009)

Had my first shoulder separation 3 weeks ago. 
I have not had MRI, is this important to help me recover and choose right training? 

I work on a vessel in a foreign country, it would be a hassle to get to any hospital but something i could do if its important. 
If its no problem to do it in 4weeks, then i can do it at home.

EDIT: When reading and looking more in this thread, i see that i have mixed up things. I had a dislocated shoulder, not AC separation.


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## Losvar (Mar 21, 2016)

Skorp said:


> Had my first shoulder separation 3 weeks ago.
> I have not had MRI, is this important to help me recover and choose right training?
> 
> I work on a vessel in a foreign country, it would be a hassle to get to any hospital but something i could do if its important.
> ...


Can be a good idea to see a doctor and get an MRI, I had issues with my shoulder for about 7 years after dislocating it. Tore some ligaments and after having it dislocated a few more times it didn't sit right in the socket any more. Had to get surgery, and now it's stronger than my "healthy" shoulder, just a tiny bit less mobility after srugery.


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## Rocko99 (Jul 27, 2017)

savoi said:


> I had this injury in a hiking accident 7/15/17, the ER doc said grade II, yesterday on 7/26/17 the Ortho surgeon said Grade V. I really don't want to have to go through the surgery, but feel it's the best thing to do overall.
> 
> Even after making the decision still having nagging thoughts. Having surgery and 4 weeks in an immobilizer is nothing to laugh about.
> 
> ...


I am no doctor, but having looked at many xrays of separated shoulders, I would say that is a IV to V.

Ask your primary doctor for a second opinion from another ortho. This is common when contemplating surgery.

That being said, if it's IV-V you should get surgery. With a III-V you have no ligaments holding your clavicle in place-not good.


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## throet (Oct 8, 2016)

Rocko99 said:


> With a V you have no tendons holding your clavicle in place-not good.


It's actually the absence of attached ligaments that distinguish a Grade V. There are normally 3 that create the AC joint on that end of the clavicle. When all 3 are severed it is either grade III or V depending on degree of separation. A grade IV is different, involving a different type of displacement.


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## Rocko99 (Jul 27, 2017)

throet said:


> It's actually the absence of attached ligaments that distinguish a Grade V. There are normally 3 that create the AC joint on that end of the clavicle. When all 3 are severed it is either grade III or V depending on degree of separation. A grade IV is different, involving a different type of displacement.


I was mistaken. Thanks for the info.


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## pedromayall (Jun 12, 2013)

Losvar said:


> Can be a good idea to see a doctor and get an MRI, I had issues with my shoulder for about 7 years after dislocating it. Tore some ligaments and after having it dislocated a few more times it didn't sit right in the socket any more. Had to get surgery, and now it's stronger than my "healthy" shoulder, just a tiny bit less mobility after srugery.


 I think too you should see a shoulder specialist as soon as possible. I dislocated my left shoulder for the first time 2 years ago and it only got worse. I took too long to treat it proper, so ended up having to do a major reconstruction surgery. I lost time and suffered pain uncessessarily. For now, keep your arm as still as possible and go see a doctor when you can. If he says you should operate, do it quickly.


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## savoi (Jul 16, 2017)

Rocko99 said:


> I am no doctor, but having looked at many xrays of separated shoulders, I would say that is a IV to V.
> 
> Ask your primary doctor for a second opinion from another ortho. This is common when contemplating surgery.
> 
> That being said, if it's IV-V you should get surgery. With a III-V you have no ligaments holding your clavicle in place-not good.


Rocco,

Agree with you, but no time left for a second opinion unless I can get it Monday. My surgery is scheduled for Tuesday morning. I have wrung my hands over this and feel it is right for me. Thanks for your reply


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## Losvar (Mar 21, 2016)

pedromayall said:


> I think too you should see a shoulder specialist as soon as possible. I dislocated my left shoulder for the first time 2 years ago and it only got worse. I took too long to treat it proper, so ended up having to do a major reconstruction surgery. I lost time and suffered pain uncessessarily. For now, keep your arm as still as possible and go see a doctor when you can. If he says you should operate, do it quickly.


So much this!


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## Rocko99 (Jul 27, 2017)

Did anyone get numbness or tingling in their hands or fingers on the side that was separated?


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## iabra (Aug 20, 2017)

*AC Separation - Grade 2*

Got a grade 2.5 AC Separation on my right (dominant) shoulder 12 days ago after hitting the pavement at 30mph... This bruiser also came with 1) coracoclavicular tear (ac joint in tact though but I have a big bump that accompanies ac separations), 2) SLAP tear (superior labrum) as per the MRI (see below), 3) Edema extending on my clavicle into my trapezius muscle. Also sprained my left wrist and left ribs but I assume that will go within the next 2-4 weeks...

Dr says to wait 4 weeks for swelling to subside and start physical therapy - revisit pain after PT sequence. My questions are the below:

1) Does the CC tear merge back together over time or is surgery the only way for it to fuse back?
2) I have my normal range of motion minus having to move much slower and weaker strength. However, I cant raise my arm in front of me above waist height - not sure if its the CC tear or SLAP tear so for those with AC grade 3, did you have limited range of motion similar to mine?

Thanks in advance.


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## jacksonlui (Aug 15, 2015)

I couldn't raise my arm above my waist for a few weeks let alone take off my shirt. Its been a year and it only hurts a little at certain angles. Hindsight, i should've done some exercises to speed up recovery. 

Sent from my SM-G930V using Tapatalk


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## dirtrider76 (Sep 19, 2012)

jacksonlui said:


> I couldn't raise my arm above my waist for a few weeks let alone take off my shirt. Its been a year and it only hurts a little at certain angles. Hindsight, i should've done some exercises to speed up recovery.
> 
> Sent from my SM-G930V using Tapatalk


Rehab helped a ton! Part of the rehab is strenghtening the muscles to help locate your shoulder and part is to retrain your shoulder to work right minus the AC. I have full ROM 1 year later(almost to the day actually). No pain but its more mobile than my other shoulder still. A few motions I was told I'd never be able to do I can do no problem. I was back to work as a auto tech in under 4 weeks from injury with a grade 3 separation and pectoral tear. I did rehab from day one and 6 weeks after I returned to work.


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## jacksonlui (Aug 15, 2015)

What type of exercises did you have to do?

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## bad andy (Feb 21, 2006)

I joined this club last sunday. 

Diagnosis by: parking lot diag from fellow rider/Dr., ER doc, and Ortho 1 day later: Grade 2 ac separation. Bummed I did this entering the best part of the season for riding, weather-wise - but content knowing how bad things could have been. Anxious to make some progress so we'll see...


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## iabra (Aug 20, 2017)

Fell on same spot but on right side. Did you have a swollen rhomboid/Traps for couple of weeks? I have edema in my Traps and when I put my back against the wall, my injured side touches well before. It's been 3 weeks since injury - ROM is 80prcnt but my arm gets tired at end of day and I get more swollen behind my right scapula.


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## iabra (Aug 20, 2017)

matt.s67 said:


> View attachment 1105017
> 
> 
> View attachment 1105018
> ...


Fell on same spot but on right side. Did you have a swollen rhomboid/Traps for couple of weeks? I have edema in my Traps and when I put my back against the wall, my injured side touches well before. It's been 3 weeks since injury - ROM is 80prcnt but my arm gets tired at end of day and I get more swollen behind my right scapula.


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## tubbnation (Jul 6, 2015)

... I broke my ankle and separated my shoulder while screwing around on some jumps back in June (2017).

At the time, the ER PA said injury was between Grades 2 and 3. I saw an ortho about a week later, and he said the same thing, and also indicated that I would get back 95% functionality through non-surgical treatment. This clown, who worked on Carolina Hurricanes hockey players, didn't even ask me to take off my shirt to look at it. Appt lasted all of 5mins.

Between weeks 6 & 7, I saw another shoulder specialist (for a 2nd opinion), who happens to be known as the "King of Shoulders" in the Raleigh area, and he said that maybe it was a Grade 2-3 at the time but since has become closer to a Grade 5. Being how active my lifestyle is, he said that I would never be happy with it (non-surgically treating it).

His procedure uses zero hardware. He debrides old scar tissue, shaves the end of the clavicle, and secures the collarbone with Fiberwire. He also puts your blood into a centrifuge to get the plasma. He then puts the plasma back into the ligament areas to stimulate healing/growth. He's been doing this procedure for 10yrs and has had 100% success.

To the day, I'm currently 7wks out from the surgery.

At the 4wk appt., I was given another 4wks to ween myself out of the sling. The goal at 8wks is to be able to extend my arm out and raise it above my head. I'm pretty close to doing this now. * side note; he said, _there's nothing you can do at this point that would damage my work, but if you aggressively rehab, you're not going to be able to accelerate the progress - moreover, you're going to be sore as hell and wished you hadn't been aggressive with it. This is going to take time, and progress will be slow-going._ Damn, if he wasn't right!!!

So, I see the doc in a week, and provided he's happy with my efforts, he will instruct me to start some formal pt.

Even though I have lots more time to rehab this thing, I am much happier now with how the shoulder and body feels (and looks) compared to where I was at 7wks with the non-surgical treatment.

Now, all this being said, there's no sugar-coating - the surgery/recovery hurt like a *****. I've broken many bones and have had plenty of surgeries but this shoulder crap blows big-time! Also, rehab ain't no joke... (and I would still do it all over again!)

Btw, I got 2 screws in the ankle I busted, which, coincidentally, was the same ankle I got 2 screws in when I was a kid.


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## Chicane32 (Jul 12, 2015)

^^^ Just curious how a grade 2-3 gets worse, by moving it? My grade 3 was immobilized in a retaining sling for 8 weeks and I was told no surgery was needed. After 8 weeks I had no muscle left and had to do extensive rehab and weights to build the muscle back up. Other then the clavicle being lifted up, I've never had an issue and have always had 100% motion. Yes the constant pain while wearing the sling was not fun. Heel quick!


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## tubbnation (Jul 6, 2015)

Chicane32 said:


> ^^^ Just curious how a grade 2-3 gets worse, by moving it?


Thanks! I don't know - the second doc just said that it looks worse than a Grade 2-3.

Personally speaking, I don't think the severity increased that much, if at all, between the first and second diagnosis.


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## savoi (Jul 16, 2017)

Woodchips,

That is an interesting surgery/procedure you had. I had a grade 4/5 and had open ACJ reconstruction surgery with graft. My surgeon told me my ligaments were too shredded to do much with but was able to bring some together. His clinic does do PRP but he never mentioned this as an option. 

At 6 weeks and out of the sling I have developed frozen shoulder which is delaying my recovery.

Hope to hear more about how you are doing down the road and have a speedy recovery!


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## Chicane32 (Jul 12, 2015)

savoi said:


> Woodchips,
> 
> That is an interesting surgery/procedure you had. I had a grade 4/5 and had open ACJ reconstruction surgery with graft. My surgeon told me my ligaments were too shredded to do much with but was able to bring some together. His clinic does do PRP but he never mentioned this as an option.
> 
> ...


I hear that. I've had full and about half frozen shoulders on both sides at different times. What started getting them moving for me was laying down on the bed, hold a broom stick with both hands and start lifting up. Your good arm will help your bad shoulder move. A little at a time and it will progress.


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## savoi (Jul 16, 2017)

Good to hear Chicane - I am doing that kind of work with a broom stick as you suggested and it seems to be helping. Externally rotating the arm while at my side is almost nil.

I guess it's jut a little bump in the road compared to what I've been through the last 8 weeks.

Thanks for responding!


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## dirtrider76 (Sep 19, 2012)

Chicane32 said:


> ^^^ Just curious how a grade 2-3 gets worse, by moving it? My grade 3 was immobilized in a retaining sling for 8 weeks and I was told no surgery was needed. After 8 weeks I had no muscle left and had to do extensive rehab and weights to build the muscle back up. Other then the clavicle being lifted up, I've never had an issue and have always had 100% motion. Yes the constant pain while wearing the sling was not fun. Heel quick!


My grade 3 I was back at work in under a month as a auto tech. The day I went in the ER I asked what I could start doing right away. ROM stretches and working my hand/forearm to keep things moving. Went back 2 week later and was told more things I could do. I never stopped using it just used my sling to hold it from sagging down.

2 days after I went back to work I went to rehab. At this point I was doing everything I did before just felt a bit loose. 6 weeks later with rehab once a week I was released stronger than I was before. I hardly even notice my right shoulder is separated besides for the lump which has gotten smaller.

Currently dealing with my left shoulder have a grade 1 again. Clipped a tree pretty fast, thank god it was just a clip. Effing grade 1 hurts worst than tearing the damned thing off but I'm haven't given it any down time just not riding for a bit. Still working though!


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## tubbnation (Jul 6, 2015)

savoi said:


> Woodchips,
> 
> That is an interesting surgery/procedure you had. I had a grade 4/5 and had open ACJ reconstruction surgery with graft. My surgeon told me my ligaments were too shredded to do much with but was able to bring some together. His clinic does do PRP but he never mentioned this as an option.
> 
> ...


Thanks! I'll update as the healing progresses.

I'm sorry to hear about your frozen shoulder. I was in the sling for 4wks and I was thankful to get out of it when I did because I could tell my body wanted out of it.

Take care!


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## Steveboxy (Sep 20, 2017)

*Grade 4 surgery or not?*







I fell on my right shoulder 10 days ago. Went to ER, was x rayed. Been back to hospital today to be told it is a grade 4 separation. I've had it taped by my wife, who is a physio. I have a decent amount of movement, next to no pain. I've only taken 2 paracetamol today about 12 hours ago. I'm still undecided on whether to go under the knife?? Do I try and go down the physio route?? Or under the knife??


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## tubbnation (Jul 6, 2015)

Steveboxy said:


> View attachment 1158672
> I fell on my right shoulder 10 days ago. Went to ER, was x rayed. Been back to hospital today to be told it is a grade 4 separation. I've had it taped by my wife, who is a physio. I have a decent amount of movement, next to no pain. I've only taken 2 paracetamol today about 12 hours ago. I'm still undecided on whether to go under the knife?? Do I try and go down the physio route?? Or under the knife??


A Grade 4 injury is a severe or significant displacement of the clavicle in the posterior direction - and is most often treated surgically.

Did the doctor actually indicate that the clavicle was significantly displaced in the posterior direction? With a standard xray, it can sometimes be indistinguishable from a Grade 3 until 3D imagery is looked at.

In any case, just by looking at your xray, I would, personally, get it surgically treated.

You indicate a decent amount of movement and next to no pain. I was in the same boat but I didn't like how clunky my shoulder girdle felt. Sometimes there was rubbing and clicking, and I didn't like being asymmetrical, and the thought of the kinetic chain impact an injury, such as this, can have on other parts of the body, if left untreated surgically. Also, a big clavicle bump was not helping matters.

I got a 2nd opinion and was told a severe Grade 3 or low Grade 5. In any case, he agreed with me to get it surgically treated due to how active my lifestyle is. He basically said I wouldn't be happy otherwise (if left untreated surgically). I'm currently a little over 7wks out from my surgery, and I feel much better than I did prior to surgery. Also, my shoulder contour (and symmetry) has been reestablished.

So, maybe first talked to your ortho and get some more details regarding your injury, and if you feel at all that you should get a 2nd opinion, do it, and do it relatively soon. Search for a doctor that specializes in shoulders and does kickass work.

If you decide you want surgery, it's usually best to have it sooner than later. Best results are usually had inside the 6-7wk window from date of injury.

If you do decide to wait things out (16wks +) to see how you feel, you could always have the surgery then if you're not happy with it. PT is a must either way. Fyi, I waited... until 7wks, and then decided to have the surgery. There was a possibility it might feel better (without surgery) but I didn't want to wait 16wks, and then decide I wanted surgery to then go through many more weeks of rehab.

I hope there's some info here that helps.

Take care!


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## Steveboxy (Sep 20, 2017)

Hi Woodchips,

Thank you for your reply. Being in the UK, picking a choosing surgeons is not always a viable option. I will look at a second opinion, unfortunately the Otho and Dr left the ball in my park as to whether I should go down the surgery route. I am not getting the clicking/ rubbing feeling. I may give it a week to see where I'm at.


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## tubbnation (Jul 6, 2015)

Steveboxy said:


> Hi Woodchips,
> 
> Thank you for your reply. Being in the UK, picking a choosing surgeons is not always a viable option. I will look at a second opinion, unfortunately the Otho and Dr left the ball in my park as to whether I should go down the surgery route. I am not getting the clicking/ rubbing feeling. I may give it a week to see where I'm at.


You're welcome ...

I have my suspicion about this being a Grade 4. Typically, these are surgically repaired but your doctors are not pushing for surgery - which is interesting. Also, you seem to be feeling fairly good while I imagine a Grade 4 would feel pretty crappy, right?!

As you are feeling good, maybe ride it out for another few weeks - time is on your side for now. Keep having your wife tape your clavicle down in hopes the scar tissue will eventually hold it down without the tape. I've seen a few cases where results have been good, and this has been with Grade 3's. It usually takes weeks of religious taping but it can work.


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## savoi (Jul 16, 2017)

Steveboxy said:


> View attachment 1158672
> I fell on my right shoulder 10 days ago. Went to ER, was x rayed. Been back to hospital today to be told it is a grade 4 separation. I've had it taped by my wife, who is a physio. I have a decent amount of movement, next to no pain. I've only taken 2 paracetamol today about 12 hours ago. I'm still undecided on whether to go under the knife?? Do I try and go down the physio route?? Or under the knife??


I had a Grade 4/5 separation with clavicle posteriorly and superiorly more than 200% of its diameter.

I was doing well in PT and ahead of schedule. The surgeon left it up to me whether I wanted to have surgery which I didn't understand exactly because from what I read - it is recommended to have it done with grades 4,5 and 6. There are however people who have sustained a grade 4 or 5 and opted out of surgery.

Looking back I can see why it was left up to me, but would have liked to have more guidance in making the decision. Any surgery comes with it's risk and recovery time and if you choose to have it - it's set up so you can really only blame 'you' in most cases.

In the end I chose surgery because I'm 65 and didn't want to run the risk of needing to have the surgery later on when I was much older. I am also very active and wanted my shoulder to function right and look normal as well.

It is not an easy surgery and recovery as I also have the additional feature of a frozen shoulder after 6 weeks in the sling 24/7.

Make sure you find a good sports ortho who specializes in shoulder surgery.

Good luck with your decision!


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## tubbnation (Jul 6, 2015)

I'm not a doctor, but I play one on mtbr forums...

In general, regarding Grade 3's, I don't think surgeons push to operate because results are basically a coin-toss.

In other words, surgical treatment results are about the same as non-surgical treatment results. Why push for surgery when the outcome will more or less be the same as a non-surgical result.

I believe better surgical results increase when you're referring to doctors who specialize in shoulders, and moreso, specifically, in AC separations. 

Typically, Grades 4-6 are operated on because patients are in some discomfort or pain, and/or do not have a good prognosis treating the injury non-surgically.

Now, while it's atypical not to operate on Grades 4-6, I can understand doctors not pushing for surgery if the patient seems to be doing well, and the prognosis seems good.

Having surgery is risky stuff. If it can be avoided, it should be. 

Also, recovery sucks (i.e., painful) - with this open operation, I left the operating room with a fanny pack of morphine attached that supplied a catheter drip on the nerve that supplied shoulder pain to the brain (for 3-days). On top of this I also was taking 10mg of Oxy every 3-4hrs. After initial recovery, then I was faced with all muscle content in my arm, shoulder and left chest and back reduced to nothing from being in a sling for 4wks. Now, almost 8wks from surgery, I'm working on ROM. This, at times, can be excruciatingly painful because all your muscles are gone.

I still have a long way to go... but you get the idea...

Nonetheless, in my case, from day one since the injury occurred, in thinking about whether or not to have surgery, I kept asking myself, "are you happy with how you feel?", "do you think treating this injury non-surgically will result in a better outcome than a surgical treatment?" and if leaning towards surgery, "can you find someone skilled and experienced enough to your satisfaction to operate on you?".

When I determined I was leaning to towards surgical treatment, I researched doctors nationally. I was prepared to go across country if need be, but, fortunately, I was satisfied in choosing a doctor locally. Note - my doctor, who specializes in shoulders, and runs the Shoulder Center through Duke Hospital, has had 100% success in 10yrs of performing the procedure he did on me.

Thus far, I am happy with my decision ... and in the end this is what it is all about, right?!

Fyi, I'm 50, and was active as hell on wheels before the crash.


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## savoi (Jul 16, 2017)

woodchips said:


> I'm not a doctor, but I play one on mtbr forums...
> 
> I believe better surgical results increase when you're referring to doctors who specialize in shoulders, and moreso, specifically, in AC separations.


Woodchips,

I wish I could have read your post before I had surgery! I found a knee and shoulder specialist, but maybe I should have looked deeper. Although the surgery seems to have turned out well up to this point the injury and having to have surgery really bothers me.

I have great concern about the procedure failing and this has got me fairly depressed, even though the surgeon feels quite confident about the work he did. The mind is strange, at least my mind is.

I went in to the procedure thinking my ligaments would be repaired (which they were the best he could do but they were really shredded), i.e. sewn back together arthroscopically and found out the day of the surgery with this grade of dislocation it could not be done. It was a simple yet disturbing miscommunication which I take responsibility for.

I knew to look for a specialist and found a well recognized shoulder and knee specialist, but did not think of looking for one who specifically specializes in AC Joint repair and reconstruction. Even now when I search they don't seem to be jumping off the computer screen.

I had a AC reconstruction with graft and FiberWire was used as well for clavicle reduction.

Now it's just doing the rehab and doing the best I can.


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## tubbnation (Jul 6, 2015)

savoi said:


> Woodchips,
> 
> I wish I could have read your post before I had surgery! I found a knee and shoulder specialist, but maybe I should have looked deeper. Although the surgery seems to have turned out well up to this point the injury and having to have surgery really bothers me.
> 
> ...


The mind is very powerful, and I know it's difficult, but try not to focus on the past. Think positively moving forward.

You said that the surgery has gone well up to this point, and that the surgeon feels confident in the work he did - take stock in this. Frozen shoulders happen, it's not necessarily an indicator of "bad work" or that the prognosis going forward is not good. It's just another obstacle, at this point, that you need to work through.

Stay strong!

Btw, if I hadn't found my local doctor, another doctor I would have consulted with is Peter Millett MD | Shoulder Specialist, Knee, Elbow & Sports Medicine).


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## savoi (Jul 16, 2017)

woodchips said:


> Frozen shoulders happen, it's not necessarily an indicator of "bad work" or that the prognosis going forward is not good. It's just another obstacle, at this point, that you need to work through.
> 
> Stay strong!
> 
> [/URL]).


Thanks for the encouragement Woodchips - I know you're right...and didn't mean to imply the frozen shoulder was any fault of the surgeons in any way.


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## tubbnation (Jul 6, 2015)

savoi said:


> Thanks for the encouragement Woodchips - I know you're right...and didn't mean to imply the frozen shoulder was any fault of the surgeons in any way.


You're most welcome, savoi!


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## Steveboxy (Sep 20, 2017)

Quick update

So, it's 3 weeks since my accident. I am off daily painkillers, one every now and then. I've got 90% movement in my arm. I rode my bike for the first time today, did some local easy off road trails. Felt a bit stiff at first then I relaxed, all was good. Started on the weights tonight. Laying on my back doing an imaginary clock. Hurts between 3 and 6. 

I'm glad I didn't have surgery as I'm making good progress.


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## ibiskid (Jan 24, 2012)

3 years from my grade 3/4 separation. No surgery. I have 100% strength and ROM. Most important thing to do immediately is tape the bone down so scar tissue forms and bone stays down as low as possible.And I have the best shoulder brace to wear for first 3 weeks!

This forum helped me a lot back then


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## jonas_24112 (May 16, 2016)

I crashed Sunday and suffered AC separation on a back country ride. Rode/walked out 6 miles or so. Visited the ortho Monday morning, he x-rayed the shoulder and diagnosed me with grade 4 separation. He wanted to go ahead and schedule surgery with the plate and hook and use a ligament from my leg for reconstruction. I told him I needed time to digest it, study it and talk to my wife. He prescribed no pain medication or any means of isolating movement in the shoulder- no K-Tape or even a sling. He only scheduled for me to come back in a week to talk to him again. I have to say I was not impressed and decide on a second opinion. I will not have surgery in my local hospital if I have a choice. 

I talked to a friend who is a pro mountain biker with many sports injuries and has been living with a grade 3 AC separation for years with no problems. He suggested I get a second opinion from his regular ortho doc who is a highly rated shoulder specialist, is a mountain biker and has over 29 years of experience. I have an appointment with him next week. 

I'm not suffering from a lot of pain and have a good bit of movement and no clunkiness that I can feel. My clavicle is a little bit higher from the shoulder falling down, but not anything that bothers me aesthetically. Maybe 1/2" or so. It definitely went down since the initial injury. 

I'm guessing isolation from a sling and/or K-Tape can only be beneficial at this point, at least for my own comfort anyway. I'll keep taking 800 mg ibuprofren for the next few days at least and wait it out till the 2nd opinion.


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## dirtrider76 (Sep 19, 2012)

My grade 3 was a bit over a year ago, no real issues now besides for the lump. I did not have surgery. Keeping up on your fitness helps them as the muscles locate it now without the AC. Good call on the 2nd opinion, something seems off there. Wouldn't be a bad idea to sling it till then if its not usable. The first week mine was mostly useless but got better fast.


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## jonas_24112 (May 16, 2016)

Update- I am currently 10 days post AC separation. You can see my first post a couple posts up. Since the injury, I have not had much pain, just discomfort. I have good strength and rotation, but a little soreness and stiffness, so I have been taking it very easy. Took ibuprofren 800mg 3X/Day for 7 days, then have been taking it just at night since.

Visited a 2nd orthopedist with my x-rays and records this morning for second opinion. This guy was recommended to me by another MTB'er. I could tell right away that his practice was much larger and more modern, which made me feel better. He said it was definitely a grade 3 with a good amount of separation, but considering how I have fared with pain, strength, ROM and collarbone stability that surgery is really my choice. However, his bias is to not do surgery. Most people do well without, unless they have a profession that requires the joint intact- powerlifting, baseball pitcher, etc.

Easy decision on my part. I will take it easy for another 4 weeks- no lifting or pulling, then do a followup. I can stationary cycle or ride a Greenway, but don't fall on it again. 
After that, most likely home exercises for strength and stretching.

Should I ever decide to do surgery, he does the button hole surgery with cadaver ligaments, which seems much less barbaric than what was originally given to me as an option.

So, I think maybe instead of that new bike I've been wanting, I may buy me a good interactive trainer for the winter and do some extra training until spring.

See my xray below:


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## tubbnation (Jul 6, 2015)

Update:

It's been less than 4mos since my ACJ reconstruction surgery (for what my doc called a low grade 5 or a severe grade 3 injury) - the surgery (at 7wks after date of injury) did not involve any hardware, just FiberWire, and my plasma enriched blood. Also, the end of my clavicle was reduced.

I've had eight 1hr PT sessions thus far that sometimes included the need for dry needling, and have just a handful of sessions to complete before I am done.

I have most of my ROM back (95+%), and have been strength training for about 2wks.

I went for my first bike ride yesterday - cruised around my neighborhood for about 1/2hr. Popped some wheelies, and hopped some small rocks. Felt good.

My shoulder is feeling better and better everyday, and prognosis is excellent. 

In my case, the non-surgical route was not proving to be satisfactory, and, at this point, am much happier having had the surgery!


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## jacksonlui (Aug 15, 2015)

Was there predominant PT exercise that you did?

Sent from my SM-G930V using Tapatalk


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## savoi (Jul 16, 2017)

woodchips said:


> Update:
> 
> It's been less than 4mos since my ACJ reconstruction surgery (for what my doc called a low grade 5 or a severe grade 3 injury) - the surgery (at 7wks after date of injury) did not involve any hardware, just FiberWire, and my plasma enriched blood. Also, the end of my clavicle was reduced.
> 
> ...


Good to hear Woodie! Wonder why more surgeons don't use your doctors technique? Do you know how the FiberWire was used in your surgery? Keep up the good work and thanks for all your comments on here, they have been very helpful to me.

This is a good thread, hope it continues.

savoi


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## iabra (Aug 20, 2017)

iabra said:


> Fell on same spot but on right side. Did you have a swollen rhomboid/Traps for couple of weeks? I have edema in my Traps and when I put my back against the wall, my injured side touches well before. It's been 3 weeks since injury - ROM is 80prcnt but my arm gets tired at end of day and I get more swollen behind my right scapula.


So I ended up having a grade 5 separation with SLAP tear (after they compared my R shoulder to my L). Had shoulder reconstruction with allograft (donor) and SLAP tar surgery simultaneously on Nov 15. First night was decent as my entire arm was numb, all other nights im taking painkillers. It seems like each day I can do slightly more than before so, so far so good. Will post additional updates as I go on. Feel free to message for questions.


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## tubbnation (Jul 6, 2015)

jacksonlui said:


> Was there predominant PT exercise that you did?


Sorry, for the delayed response; there were many exercises the therapist outlined along the way and I didn't feel that any one exercise was predominant.



savoi said:


> Good to hear Woodie! Wonder why more surgeons don't use your doctors technique? Do you know how the FiberWire was used in your surgery? Keep up the good work and thanks for all your comments on here, they have been very helpful to me.


Unfortunately, I'm not going to be much help describing how the FiberWire was used ... doc said it was an "over and under" technique.

Thanks, savoi!


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## humptybump (Sep 17, 2015)

Hey all. This seems to be 'the' thread for AC injuries amongst cyclists. I don't really consider myself a mountain biker but I own an MTB and ride a fat bike in the winter, sustained my injury on a CX bike so hopefully that's close enough to avoid any anti-roadie sentiment. 

Injuried my AC sliding out on a corner in late August. (mis)diagnosed at hosipital as grade 2, treated conservatively with a sling for a few weeks. Started physiotherapy in 2nd week and have been at it ever since. At week 12 with a lot of shoulder instability still present new x-rays ordered and diagnosis changed to grade 3. The x-rays don't look that bad, but the function is bad with the scapula winging and the shoulder sliding easily forward/downward leading to the appearance of the clavicle sticking out behind the shoulder, the motion is primarily in the horizontal plane relative to other structures in the shoulder. 

Pain has been minimal throughout, probably because everything was completely severed from the beginning.

I'm closing in on 15 weeks now and things overall are not really getting better. I'm getting stronger from the physio but that is leading to unwanted muscle in my shoulders and on my back on the affected side. My scapula is winging and the physio exercises I'm doing for it don't seem to be helping although wearing a figure of eight brace does seem to help and my sports med doc has me wearing that full time. I've been prohibited from outdoor riding.

Right now I am just incredibly frustrated with this injury that has no end in sight. I'm tired of wearing braces and doing daily physio for months on end and not being able to get back to where I need to be, which is on my bike.

I feel like the doctors and in general the information out there about this injury and expected recovery time is just full of ****. Yes in 8-12 weeks I was dressing myself and going about my daily life (this was true even at four weeks) but having to wear a brace full time and not having the function and performance back is not what I consider a recovery. And the business about just living with a bump seems to completely understate the problem. A bump is one thing but having a clavicle slide back and forth behind your shoulder is another. Sorry but I'm really pissed about the stupid and just wrong expectations that get set, it seems irresponsible to me that the profession shouldn't be as completely up front about the negative potential outcomes with conservative treatment as they are about the negative potential outcomes from surgery (which BTW I am still desperate to avoid).

I would LOVE to hear from others that have (hopefully) had success with conservative non-surgical treatment of grade 3 ac separations and whose injuries were still very unstable after 3-4 months with lots of horizontal movement of the clavicle. There are a couple people in this thread that did have unstable grade 3s that weren't operated on but they never followed up as far as I can tell. I'm desperate to hear some positive stories because right now it just seems hopeless.


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## M320 (Mar 22, 2013)

I would LOVE to hear from others that have (hopefully) had success with conservative non-surgical treatment of grade 3 ac separations and whose injuries were still very unstable after 3-4 months with lots of horizontal movement of the clavicle. There are a couple people in this thread that did have unstable grade 3s that weren't operated on but they never followed up as far as I can tell. I'm desperate to hear some positive stories because right now it just seems hopeless.[/QUOTE]










Major grade 3 for me on July 4th 2016. I went my own approach after MRI , doctors advice and talking with different people. I decided not to have surgery and to rehab on my own. No pain meds from the start (just IB for the swelling) Ditched the sling after about 10 days. Asked the doc when I could ride again and he said if you can deal with the pain just don't fall on it. So after three weeks I was back on the road bike for easy rides. No PT "per say" just every day life and some light weights at home. After about 6 months I started to stop thinking about it all the time, only when lifting heavy things or hits on the mountain bike would I be reminded by the discomfort that something was going on. After about a year I started not to feel discomfort when on my Rides and doing heavy lifting. I still to this day have some movement and some popping now and again but I don't think about it at all 90% of the time. And please don't think I'm trying to come across as some tough guy that doesn't feel pain. It hurt. In fact it was the worst pain I have ever felt in my life, the night after it happened. But I decided to let it heal on its own and I'm glad I did. Not worth the risk of infection and time away from everyday life for me to risk the surgery. Also chances are it could happen again anyway. So all I can say is hang in there and trust yourself. Only you know how you are progressing. But know that it will never be the same as it was before , you will still have some movement and discomfort at times but only you can decide if that is going to limit you. Best of luck on you recovery. (This site helped me a lot, so I try post back updates for others as well . Cheers )


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## humptybump (Sep 17, 2015)

> Major grade 3 for me on July 4th 2016. I went my own approach after MRI , doctors advice and talking with different people. I decided not to have surgery and to rehab on my own. No pain meds from the start (just IB for the swelling) Ditched the sling after about 10 days. Asked the doc when I could ride again and he said if you can deal with the pain just don't fall on it. So after three weeks I was back on the road bike for easy rides. No PT "per say" just every day life and some light weights at home. After about 6 months I started to stop thinking about it all the time, only when lifting heavy things or hits on the mountain bike would I be reminded by the discomfort that something was going on. After about a year I started not to feel discomfort when on my Rides and doing heavy lifting. I still to this day have some movement and some popping now and again but I don't think about it at all 90% of the time. And please don't think I'm trying to come across as some tough guy that doesn't feel pain. It hurt. In fact it was the worst pain I have ever felt in my life, the night after it happened. But I decided to let it heal on its own and I'm glad I did. Not worth the risk of infection and time away from everyday life for me to risk the surgery. Also chances are it could happen again anyway. So all I can say is hang in there and trust yourself. Only you know how you are progressing. But know that it will never be the same as it was before , you will still have some movement and discomfort at times but only you can decide if that is going to limit you. Best of luck on you recovery. (This site helped me a lot, so I try post back updates for others as well . Cheers )


Thanks so much for that, so glad to hear about this working out for you and also that you're still getting movement but that overall you're not being limited. This gives me some hope!


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## savoi (Jul 16, 2017)

You're right Humpty, very limited information for anything to do with this injury except the anecdotal from places like this. One thing is for sure, if PT doesn't produce satisfactory results there is the surgery which is a ***** from the recovery standpoint. I don't need to tell you, if you go that way - find the best surgeon you can. Good luck to you and hope the PT can be adjusted to address the issue you are having right now.


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## FL mtb (Mar 19, 2016)

Finally getting around to posting some photos of what my shoulder can look like with good posture and when I let it get sloppy. I had a Grade III separation 03/17/2016. I can do anything with my R arm. My main activities are surfing and training for sprint triathlons, and I have no issue paddling or swimming. You can tell which photo is which...

...If they were there. Guess I can't use photobucket anymore. Anyway, if I put my scapula in it's normal position, the distal end of the clavicle reduces, next to the acromion. If I'm slouching, the acromion drops away from the end of the collarbone and the lump appears.


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## savoi (Jul 16, 2017)

FL mtb said:


> Finally getting around to posting some photos of what my shoulder can look like with good posture and when I let it get sloppy. I had a Grade III separation 03/17/2016. I can do anything with my R arm. My main activities are surfing and training for sprint triathlons, and I have no issue paddling or swimming. You can tell which photo is which...


That's amazing, keep that good posture!


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## humptybump (Sep 17, 2015)

savoi said:


> You're right Humpty, very limited information for anything to do with this injury except the anecdotal from places like this. One thing is for sure, if PT doesn't produce satisfactory results there is the surgery which is a ***** from the recovery standpoint. I don't need to tell you, if you go that way - find the best surgeon you can. Good luck to you and hope the PT can be adjusted to address the issue you are having right now.


Thought I'd give a little update on my AC separation.

First, I had a bit of a breakthrough in physio with some deep massage techniques which freed up my shoulder and allow me to put my hands on my hips again. I followed up with a full hr massage therapist appointment after that since it had such a dramatic effect on that weird range of motion that seems specific to hands on hips. So just throwing it out there that after prolonged physio some of the muscles can get tight and may start restricting motion in weird ways that can be addressed through massage. My injured shoulder is more heavily muscled than my good one at this point.

With respect to scapular winging things have not improved, actually ever so slowly it's getting worse and I've been noticing a very gradual increase in pain as the months go by.

I did have a consultation with a surgeon a week ago. I have to admit I was kind of hoping that he'd look at it and say suck it up, the instability is not really abnormal for the injury and you don't need surgery. That is not what he said. Basically he confirmed what my sport med doctor said, which is that the instability isn't usual and is characteristic of failed conservative management and that I'm a candidate for surgery at this point. Obviously it's up to me whether I want to go that route or not.

Because a surgery would take out the entire next cycling season if I go that route I will plan it for this coming September. I see the surgeon again in June and we will assess where things are at with the shoulder and make a decision then whether to book a surgery for the fall. This gives me lots of time to continue to work on the shoulder and it's a relief to have a plan of action in place.

The surgery would be an arthroscopic procedure to reconstruct a replacement for the CC ligament with donor/cadaver tissue as well as remove the last 1cm or so of the clavicle. The recovery period is very long, with an extended period immobilized in a sling as one of the common ways this surgery fails is for the reconstruction to give out and the clavicle to pop up again requiring another surgery. He did say I'd be able to ride an indoor trainer sitting upright with no hands on bars, or on a recumbent exercise bike, very quickly after surgery - a week or two - but I'd be in that mode for ~3-4 months.

Anyway for now I'm just sticking with indoor training and lamenting that my fat bike isn't leaving the basement this winter. 

I plan on trying taping again for outdoor riding this summer. I'd taped during the first couple months of recovery but found over time that it irritated my skin, but that was wearing tape several days at a time. What I plan to try is taping only for my rides and then removing the tape right after.


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## savoi (Jul 16, 2017)

Sounds as though you are going to do the surgery, I didn't wait to see if PT would help. It was just too wrong for me. Still happy I did it although it is so slow to come back from. Good luck in whatever you do!


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## giantfox (Aug 13, 2012)

hi

I'm just popping in with an update.
5.5 years after my grade3 separation and there are no issues (no surgery)
Sure it pops and klicks etc.

But it works just fine


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## wreckingrob (Aug 24, 2007)

giantfox said:


> hi
> 
> I'm just popping in with an update.
> 5.5 years after my grade3 separation and there are no issues (no surgery)
> ...


Ditto. Started lifting weights, which has helped a lot. Dead lifts, bench, no problem...


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## sturge (Feb 22, 2009)

Had my first Grade 3 three weeks ago. Went OTB and bounced on CT perma-frost. No surgery required...rehab only. I've got 'the bump' and it had some good color after a couple of days. It was pretty touchy the first week or so and I did my share of ibuprofen. Tough to get dressed, shower, can't carry anything, or sleep on that side, etc. After 2 weeks it was feeling better and I started mellow rehab exercises.

Week 3 I've stepped up the exercises as hard as I dare and it has gained mobility in the last week. It's going so well I decided to brave a 'moderate' night ride last night to test it out. I did about 10 miles without any problems. I took it easy and did the first mile or so on fire roads. As I gained confidence, I dipped into some of the more technical singletrack loops and before I was done I was able to ride almost everything but much less aggressively than normal. 

Great to be on the way back!


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## scotts25 (Mar 9, 2018)

Wanted to share a little bit of hope with a success story going without surgery. I am very active and am in the gym 5 days a week. I am 37 years old and still play hockey, mountain bike, and am on a SWAT team. Last May I suffered a 3/5 AC seperation. I opted on the wait and see option, but I could not put on a shirt or wash my hair without terrible pain. I could not even lift the sheets of my body without pain when getting out of bed. The doctors said it could go either way and insurance was not an issue. I never really took it easy and whatever I could take I would do at the gym. At about 8 weeks I was able to do many things at the gym, albeit lighter weights. Dips and bench were out of the question but shoulder press and pull ups came back quick. Things really slowed down after that. They progressed, but not at the rate they did for the first 8 weeks. Over the next 3 months my strength came back a lot, but the first sets of bench hurt a lot and then I would be fine for the rest of chest day. Incline bench came back the quickest. Believe it or not my shoulder would ache regularly when driving, or shaving, or doing everyday things, but if I worked out chest or shoulders I would be OK for at least 2-3 days. Dips were still out of the question. 

Then out of nowhere, at about the 7 month mark, if really stopped hurting. I would still notice it here and there, but I could even bench press 95 lb dumbbells with almost no discomfort. At about 8 months I could even do dips but I still feel that a bit. I can sleep on it with not issues and really only lossy about 5% strength and only in some excersizes. I still have the huge lump and it's obvious it is not connected, but I have no issues doing Anything I used to do. 

Side note, from compensating while trying to maintain, I may have inflamed arthritis in my neck, but that may have happened anyways. 

Good luck to everyone with thier decisions, but if you can live with the lump, this is something that can be overcome on its own. I only missed 1 day of work., but 3 months of SWAT.


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## gski801 (Mar 21, 2018)

This thread was useful to me so I thought I would put my story up quick. I crashed in a crit race in August of 2014 that left me with a grade 5 separation on my right shoulder, all ligaments gone. I saw four different docs in the SLC area for an eval, 3 wanted to do nothing. One took one look at me trying to take my t shirt off and said, you're going to want to have that fixed.

Three weeks later surgery, it was starting to feel a lot better by the time of the surgery which made me start to question the decision a little. I went thought with it and have no regrets. Doc completely reconstructed the AC ligaments with a donor hamstring tendon. 

Surgery took almost four hours. Two keys for recovery post op for me, one I had a nerve block. My right arm was paralyzed for almost 48 hours after surgery. It was a little nerve racking but feeling and movement came back in full exactly when they said it would. The second key was an ice machine that pumps cold water around the shoulder. I used it all the time, even while I slept. 

With these two things I was able to completely avoid using any painkillers. After a week I went back to work in a sling, no real pain. I took the arm out of the sling a few times a day and just walked my hand around a desk or table to move it a bit. 

Three weeks after surgery I started PT. I went twice a week, but did additional exercises as prescribed everyday. I was cleared from PT the week before Thanksgiving. 

I did wear a hardshell brace on that shoulder during the next year for riding and skiing. More just to make sure I was thinking about it than actual protection. 

It took almost 8 months for full strength to come around and almost two years for the size the muscles in the injured area to look normal again. 

Today, my shoulder is as strong as ever and very stable, no clicking or cracking noises. I have no problem suggesting surgery but do understand that everyone of these injuries is different. Today I also try to ride in such a way as to (hopefully) never have this happen again.


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## jonas_24112 (May 16, 2016)

5 months post grade 3+ AC separation. No surgery, no PT. Never had any loss of range of motion. Just ibuprofren and light duty to not further hurt the shoulder. 

I have a bump. I'm not 100% what I was, but not less than 95% I would say. A little cracking and popping every now and then and maybe a little sore after a few hours of heavy hitting repetitive motion (i.e. chopping roots or digging with a mattock or trail tool). I can still feel that one shoulder is different from the other, but rarely think of it. 

I was riding paved trails and Zwift the week after injury and single track again within 6 weeks. 

I think these injuries are different between individuals. My decision to not have surgery was mostly based on the fact that there is no time limit. If it ever loses stability or changes, I can then opt for the surgery. And who knows, maybe then there will be better technology with less invasive options and shorter recoveries.


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## YDrx (Apr 19, 2018)

Hi all, on April 8 2017 (29 years old) I made a nasty fall on a trail with the mtb. Result, grade III AC separation.

The emergence room doctor told me I would not need surgery, only a little bump will remain. They gave me a sling and sent me home. I already felt: this ain’t right. Whenever I wanted to tie my shoe lace, the clavicle would pop out of its socket. The days after I was doing a lot of google searching and found this forum and started reading.

14 days later I had an appointment with an ortho surgeon: he operated me immediately (next day) with a single tightrope and stitched the AC ligament.

I knew from the start of the injury that I am not the person who can deal with a loose clavicle as I am a very active individual (regular gym, mtb, running) I guess that is a personal decision.

Now, one year later I am fully healed and going to the gym since January. Heck, I can sleep on the shoulder  I would like to encourage you all to do the surgery, the results are fantastic!! sidenote: I did let it heal from april 23rd until January 2018, did nothing in the meantime.

I wrote this text, because I was very depressed during the time of the injury and first month post-op and want to share that with you. I hope some of you can benefit from this!

Greetings


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## pacing08 (Jan 15, 2008)

I separated my shoulder badly 5-6 years ago if I recall correctly. It was a grade 5. It was a dumb accident and I was stubborn riding without insurance at the time:nono:. I didn't even see a doctor at the time and did a lot of research and diagnosed myself (of course I would not advise this nor would I be dumb to take the chance and diagnose myself again)with a separated shoulder. Also from reading forums, I learned there were a quite a few people who actually chose not to do surgery and they turned out fine.

Years later, I saw an orthopedist for a different mtb injury and I was curious about my shoulder. He had it x-rayed and confirmed it was a separated shoulder and told me that it is a grade 5 and he would have recommended surgery at the time. Since it has been years since the injury and there is no pain and have full rotation, he did not recommend doing surgery.

My shoulder is fine but definitely not 100%. Can't really explain how it feels, but you would be able to tell it's not quite right.There is no pain and is fully rotational. I can lay on it, run, shadow box, and lift weights, etc. Pull ups are hard on the shoulder and I lift very light for shoulder workouts.There is a permanent bump.

There are those who choose not to do surgery even with bad separations. There is always a risk with complications from surgery even if it is routine. If I had insurance at the time, I don't know if I would choose surgery or not. My feeling is that my shoulder will get worse with age and will eventually need surgery. The older you are the more complications there can be from surgery and healing time would take much longer. But who knows, maybe I will never need surgery even at an older age.

If you don't have insurance, take it easy on the bike. If you can't take it easy and are easily tempted to ride aggressively, don't bike at all. See you all on the trails:cornut:.


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## BB3 (Jun 24, 2017)

I went over the bars a week ago with a grade III AC separation. I work in Philly and went to UPenn, right out the gate said no surgery.(after viewing the X-ray) 
Hoping it heeals like many others here! Getting better every day, first couple days very limited now ROM is improving
I'm not in great shape and not a great rider. Will take it easy when I return still have trouble with steeper downgrades which is how I got injured. 
Thanks for all of the stories is very helpful!


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## dcr1 (Nov 3, 2017)

I am six week past a grade 3 and did a mountain bike ride today. I took it easy. The worst part is pulling up on the bars to clear roots, etc, It is hard to replicate that moment despite lots of rehab on the shoulder. I did not elect for surgery. The orthopedic did not recommend it, but said he could do it 6 months or a year later if there were lingering issues. I found some of the comments about inability to do bench press and dips interesting. I have the same issue. I am glad to hear people did get strength back after 8 months. My one concern is the greater susceptibility of the collar bone to future injuries. I am looking at some of the shirts with some padding in the shoulder. It is a set-back, but at 55 every injury is a set-back.


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## sturge (Feb 22, 2009)

BB3 and dcr1 I can relate. I'm 58 and all is well since my grade 3 late Jan 2018 (see post #1108). I've been riding 3X/week since mid March and also did a fair amount of spring skiing thru end of April. I'm pretty much all the way back regarding how aggressive I can ride but my shoulder will never be what it used to be. It's not really limiting me and I have no pain...just feels different from a properly attached shoulder!


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## BB3 (Jun 24, 2017)

*padded shirts*

. I am looking at some of the shirts with some padding in the shoulder. It is a set-back, but at 55 every injury is a set-back.[/QUOTE]

I purchased a padded football shirt, has shoulder, rib and middle of back protection. Not sure of fit although meant to be snug- can't get my arm through maybe in a couple weeks. I saw a rugby shirt that looked good but i don't think they had my size.
Any others wearing padded shirts just to protect the shoulder?


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## BB3 (Jun 24, 2017)

Good to hear that Sturge! Can't wait to get back on the bike. I hope it only takes a couple months although that feels like forever!
I feel like a slug not doing much without being able to ride...


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## tubbnation (Jul 6, 2015)

Check out the Pro-X Compression Shirt by G-Form. Maybe it's something you (and or others) will like...

It was exactly what I was looking for once I was cleared to ride after my ac joint surgery. I wear it every time I ride a trail (3/4x weekly), and now have been wearing it for several months. Still holding up strong...


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## sturge (Feb 22, 2009)

Padded gear is nice but after years of testing and careful analysis of previous incidents, my data indicates the most effective strategy to combat future injury is....DON'T CRASH! 

Example...Rain from Sat night made our Sun morning ride a bit slick with dampness on rocks, roots, etc. Even though it was not super slick I did a number of 'go arounds' on some of the more advanced obstacles I typically hit...that's called 'experience'!


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## BB3 (Jun 24, 2017)

*nice option*



woodchips said:


> Check out the Pro-X Compression Shirt by G-Form. Maybe it's something you (and or others) will like...
> 
> It was exactly what I was looking for once I was cleared to ride after my ac joint surgery. I wear it every time I ride a trail (3/4x weekly), and now have been wearing it for several months. Still holding up strong...


Looks like a nice option thanks


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## BB3 (Jun 24, 2017)

Experience helps a ton!
I'm pretty sure my fall occurred from poor experience or not thinking about what I was doing. Pretty sure I was not in a good position to descend and over I went!


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## dirtrider76 (Sep 19, 2012)

dcr1 said:


> I am six week past a grade 3 and did a mountain bike ride today. I took it easy. The worst part is pulling up on the bars to clear roots, etc, It is hard to replicate that moment despite lots of rehab on the shoulder. I did not elect for surgery. The orthopedic did not recommend it, but said he could do it 6 months or a year later if there were lingering issues. I found some of the comments about inability to do bench press and dips interesting. I have the same issue. I am glad to hear people did get strength back after 8 months. My one concern is the greater susceptibility of the collar bone to future injuries. I am looking at some of the shirts with some padding in the shoulder. It is a set-back, but at 55 every injury is a set-back.


2 years post grd3 and torn pectoral muscles. I explained in detail what I do to my PT and he tailored my program around that. 6 weeks post injury I was riding bike park again. He had me doing things like resistance band rows seated using handlebars at home and rows in the gym specifically to do that motion. Break down the motion that isn't good to its basic movement and work on that. I really don't notice my shoulder now but the first few months I was aware of it at all times.


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## BB3 (Jun 24, 2017)

dirtrider76 said:


> 2 years post grd3 and torn pectoral muscles. I explained in detail what I do to my PT and he tailored my program around that. 6 weeks post injury I was riding bike park again. He had me doing things like resistance band rows seated using handlebars at home and rows in the gym specifically to do that motion. Break down the motion that isn't good to its basic movement and work on that. I really don't notice my shoulder now but the first few months I was aware of it at all times.


What's the average time post injury people are doing PT or stretches at home? Any good YouTube vids to share?


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## dirtrider76 (Sep 19, 2012)

I did every day for like 3 months from my injury, I stretch every day still. I plan on starting to do some again here soon as my right shoulder is a bit rolled forward and it helps my posture a lot(I have tech neck from work).


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## BB3 (Jun 24, 2017)

What Do you do for the rolled shoulder?


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## joel.dunsdon (Jul 23, 2018)

I've got to say, this is about the most comprehensive ac separation thread on the internet. Thanks to everyone that's taken part so far, a real wealth of information here.
So, my contribution....























A grade 4 I picked up 25 days ago. 
Like many of you I did a lot of reading, everything I could find on pub med and shoulder Doc. Much of the studies (Beitzel being one of the most reliable) suggest conservative treatment for grade 3, and surgery for anything above. Their conclusion was that in grades 4/5 conservative treatment only had a 20% success rate, where as surgical had an over 70% success rate, higher still if surgery was performed in the acute phase.

So my question is; *Why am I having to battle for surgery*! I have seen a Doctor who recommended conservative treatment, then a physio, then a surgeon, all suggesting the same thing. "Try physio for 6 months, then consider surgery if you don't like the results".

My issue is, if physio has an 80% chance of not working, then why blow 6 months just to have surgery and start my recovery process all over again?

Have any of you guys been in a similar position?


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## tubbnation (Jul 6, 2015)

^^^ Have you researched a shoulder specialist you want to have work on you? I bet one look, and he would say you need to get it operated on.

This is what I did. I researched, found one, and told him I was an extreme athlete. He told me that I would not be happy leaving the injury untreated surgically. Bam, scheduled surgery right then and there.


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## joel.dunsdon (Jul 23, 2018)

woodchips said:


> ^^^ Have you researched a shoulder specialist you want to have work on you? I bet one look, and he would say you need to get it operated on.


Thanks for the reply mate.

I'm in the UK so doing my best to get fixed up through the NHS.
So far i've seen a doctor and a surgeon, both of them trying to take me down the "give it 6 months" road. Seeing the shoulder specialist Monday, apparently he is on point, so i'm hoping he'll be my guy 

I want to be prepared so i've spent an hour trying to find out which procedure has the best success rate. There's so much conflicting info out there. Which method got you shredding again?


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## tubbnation (Jul 6, 2015)

Good to hear, man - I hope he's the guy for you, and takes care of ya!

Using just FiberWire (no hardware), my doc utilizes his own securing technique to keep the clavicle in its proper place. Unfortunately, I don't have any details regarding his method, and I haven't seen his technique anywhere on the web. In any case, he impressed upon me that no matter what I did to my shoulder going forward, there's no way I could "undo" his work.

Other than that, he removed scar tissue and put my blood into a centrifuge to use platelet-rich plasma in the shredded ligament areas to promote healing. He also shaved a little off the end of the clavicle to hopefully delay arthritis as long as possible.


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## joel.dunsdon (Jul 23, 2018)

woodchips said:


> Using just FiberWire (no hardware), my doc utilizes his own securing technique to keep the clavicle in its proper place. Unfortunately, I don't have any details regarding his method, and I haven't seen his technique anywhere on the web. In any case, he impressed upon me that no matter what I did to my shoulder going forward, there's no way I could "undo" his work.


Sounds like you found yourself a master, great work.
Thanks for all the info mate, very much appreciated.
Joel


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## tubbnation (Jul 6, 2015)

Not a problem, and, yeah, he's known as the King of Shoulders in the Raleigh area, and I think I was fortunate to have found him. He's been utilizing his clavicle securing technique for 10yrs, and has been 100% successful.

I'm sorry I couldn't have been more helpful regarding the technique details, but if you have any other questions, feel free to hit me up anytime.


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## throet (Oct 8, 2016)

joel.dunsdon said:


> Thanks for the reply mate.
> 
> I'm in the UK so doing my best to get fixed up through the NHS.
> So far i've seen a doctor and a surgeon, both of them trying to take me down the "give it 6 months" road. Seeing the shoulder specialist Monday, apparently he is on point, so i'm hoping he'll be my guy
> ...


I'm no expert, but from the Xray that looks like Grade V. With a Grade IV, the clavicle is more displaced, kind of poking into the trapezius. Either IV or V should be repaired surgically I believe. Mine was done in a fashion similar to what woodchips describes, using what's called a tightrope to hold the clavicle in place while scar tissue forms to permanently secure the joint. Such a procedure is best done within 2 weeks of the acute episode. If you end up doing something down the road, they will likely want to use a grafting technique, which is more complicated. Make sure they are checking your sternocavicular joint as well though. With a severe separation like yours, there is often dislocation of the clavicle at the sternocavicular as well. My doctor didn't really address that and now when I rotate my shoulder my clavicle pops out from my sternum. It doesn't hurt, but it feels funny. I'm not sure there is really anything they could have done for that anyway, but good to ask. I think that I have pictures of my before and after posted somewhere several months back on this thread.


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## workout2 (Aug 1, 2018)

*Hello Everyone,*

Hello all,

Guys I have a grade 2-3 Separation of my AC Joint. This is not something I want to live with. I can't train and do what I really love and I am 24 years old. The entire shoulder is unstable and I have no function it is totally impossible to train. The Collarbone is moving when I press on it. It is higher up than the other one. Not the big separation like other people but there is certainly a difference compared to the other one. My entire right side has no muscles. Could you guys please tell me who is the best surgeon for the AC Joint repair if you want you can tell me about the surgey you had and the results you got from it and who the surgeon that repaired your AC Joint is. I would also appreciate and be thankful if you could tell me the best procedure for this injury. Please I am in need for the best surgeon for my injury to help me repair it.

I would be really thankful for your help.

With Love


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## tubbnation (Jul 6, 2015)

^^^ Try researching Shoulder Specialists in and around your area to schedule an appt for an evaluation.


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## joel.dunsdon (Jul 23, 2018)

throet said:


> I'm no expert, but from the Xray that looks like Grade V. With a Grade IV, the clavicle is more displaced, kind of poking into the trapezius. Either IV or V should be repaired surgically I believe. Mine was done in a fashion similar to what woodchips describes, using what's called a tightrope to hold the clavicle in place while scar tissue forms to permanently secure the joint. Such a procedure is best done within 2 weeks of the acute episode. If you end up doing something down the road, they will likely want to use a grafting technique, which is more complicated. Make sure they are checking your sternocavicular joint as well though. With a severe separation like yours, there is often dislocation of the clavicle at the sternocavicular as well. My doctor didn't really address that and now when I rotate my shoulder my clavicle pops out from my sternum. It doesn't hurt, but it feels funny. I'm not sure there is really anything they could have done for that anyway, but good to ask. I think that I have pictures of my before and after posted somewhere several months back on this thread.


Thanks for the post throet, that's solid info.
I saw the local shoulder specialist on Monday and he too advised against surgery. He is the second-second opinion too, the first doctor and surgeon I spoke to were also against surgery.
The specialist says i'm making good progress and (like the others) seems to be more concerned with the potential risk of surgery than the reward. We spoke for a little while and his choice of method is the "surglig" procedure. We agreed that i'd see him again in 2 weeks.
I'm really torn (pun intended) as if I can make a full recovery without surgery, then that's fantastic. But the thought of spending 6 months "fake" healing just to need surgery down the line is a tough pill to swallow.
Oh and today marks 5 weeks out for the crash. Apparently to get an operation in the "acute" phase under the NHS is pretty much unheard of unless your clavicle is displaced 4600%


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## humptybump (Sep 17, 2015)

Just a quick update on my gr. 3 separation which I'd suffered on my right (dominant) shoulder in Aug. 2017. I decided to go the surgical route after the scapula wouldn't stabilize, went with an allograft reconstruction on Sept 12 of this year, a little more than a year after the original injury. The surgery was pretty uneventful, I was sedated but conscious for the procedure. The first four days afterward were not a lot of fun (mainly for sleeping) but not terrible, had some pain meds to help which I stopped taking after that point. Pain was easily manageable. I've been in a sling full time except for bathing and exercises since then; full time sling use ends as of tomorrow (6wk point). I started physio at 4 wks per surgeon's protocol, with passive and active-assist exercises for range of motion. Now's when it gets real since while it's pain free in a sling regaining range of motion with exercises particularly using the muscles in the shoulder definitely leads to some soreness. In terms of outcome it's still TBD, the reasons for going with surgery are functional not cosmetic so it's a long process to regain full range of motion and strength. 

The scapula stayed winged somewhat after the surgery and my affected shoulder has been riding high compared to the other, but both things seem to be settling down and without the sling I can now sit comfortably in a chair or car seat again without my scapula sticking out and bugging me which is great. I'd returned to work 2wks post-surgery (desk job), getting more adept at doing things with my left hand. I was back on the bike trainer on day 5 post-surgery and have been doing that and a lot of walking to maintain some fitness.

Other functional things like stability when pulling up on handlebars etc I won't know until next summer. I'm supposed to not start any strength training until 12wks post-surgery which will be mid-December. 

Cosmetically the surgery was brilliant, if that's all I was after I'd be thrilled there were just two small incisions for the arthroscopic reconstruction and a larger incision right on top for removing a bit from the clavicle which was open surgery. All this is nearly invisible unless you look for it and the shoulder looks normal. 

Overall the surgery has been no worse than the original recovery other than the first four days, which would have been worse were it not for pain meds and cryotherapy. 

I've been advised that it's a good idea to continue using a sling for riding the trainer to avoid stressing the shoulder, until wk 12. I won't be able to drive a car for some time yet (I drive standard, ), probably another 3-4 weeks. 

Anyway, so far so good and no regrets. Knock on wood!


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## sturge (Feb 22, 2009)

See post #1108 describing my Grade 3 which occurred in Jan 2018. I was able to do my first ride after about 4 weeks and ramped it up from there. Also did a fair amount of spring skiing in March/April. 

Been almost 10 months and it has responded well to 3 rides/week during that time but it's never going to be the same. There are times I wonder if I should look into surgery because it still crunches and feels kind of loose. I have had periods where it aches and feels 'overworked' so I have to back off and skip a ride or so. Then I remind myself that at 59 I should probably leave well enough alone and be thankful I can still get out and rip. I just add it to the list of aching joints that bark from time to time.

Ibuprofin before the ride...IPA after!


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## MI-XC (Mar 14, 2018)

sturge said:


> See post #1108 describing my Grade 3 which occurred in Jan 2018. I was able to do my first ride after about 4 weeks and ramped it up from there. Also did a fair amount of spring skiing in March/April.
> 
> Been almost 10 months and it has responded well to 3 rides/week during that time but it's never going to be the same. There are times I wonder if I should look into surgery because it still crunches and feels kind of loose. I have had periods where it aches and feels 'overworked' so I have to back off and skip a ride or so. Then I remind myself that at 59 I should probably leave well enough alone and be thankful I can still get out and rip. I just add it to the list of aching joints that bark from time to time.
> 
> Ibuprofin before the ride...IPA after!


Reading your post it looks like you did too much too soon. I've had two Grade 3 separations (left and right) and both have healed to 100% without any limitations. Other than the bumps, I would have never known I injured my shoulders. That being said, I took PT and recovery very seriously and meticulously.

First 3 weeks in a sling. Weeks 4-10 physical therapy and no weight in the affected arm over 5 lbs. Only road and trainer riding until 2 months post injury. The ligaments are still healing during this time and any jarring or weight will affect already comprised attachments, possibly inhibitting their ability to fully heal.

Many people often get back on the trail when pain has subsided. True, pain may be gone but the shoulder is probably only about 60% healed. It's getting it to that full 100% that takes patience and persistence.

I'd also be careful with regular ibuprofen use or you may run into a whole new set of issues.


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## dirtrider76 (Sep 19, 2012)

sturge said:


> See post #1108 describing my Grade 3 which occurred in Jan 2018. I was able to do my first ride after about 4 weeks and ramped it up from there. Also did a fair amount of spring skiing in March/April.
> 
> Been almost 10 months and it has responded well to 3 rides/week during that time but it's never going to be the same. There are times I wonder if I should look into surgery because it still crunches and feels kind of loose. I have had periods where it aches and feels 'overworked' so I have to back off and skip a ride or so. Then I remind myself that at 59 I should probably leave well enough alone and be thankful I can still get out and rip. I just add it to the list of aching joints that bark from time to time.
> 
> Ibuprofin before the ride...IPA after!


I'm 2 years post separation in my right shoulder. I took rehab way serious and was released back to work in 4 weeks as a auto tech. Continued rehab for another 2 months after. I caught the last day at the local bike park before the closed for winter then just took it easy rehabbing and riding through winter. Took about a year till it felt good. I don't mind it all now.

Odd this came up, I'm going to get my left shoulder checked tomorrow.


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## joel.dunsdon (Jul 23, 2018)

Good to hear people are making progress.

Update from original post #1127

Four and a half months from separation. Shoulder is better but still not right. Still being advised against surgery by my shoulder specialist but I have had an MRI (not fun) and nerve conduction check, which both came back ok.

Sleeping - I still tend to favour my right (non injured side) for most of the night but can sleep on my left (original sleeping side) for some of the night, which is nice.

Riding - I can ride pretty much as before except for a few specific things. I ride BMX and airing, manuals, jumps etc are fine, the only challenge is bunnyhopping which is gradually starting to feel comfortable again.

Resistance training - Scapula retractions and stretching at various points throughout the day. Training back, shoulders and arms every few days. I do have trouble with pressing movements. I have tried working back up to press ups a few times but always seem to aggrevate the injury, right under the collarbone every time. I was never a fan of press ups anyway so might not be too much of a concern, can do wall presses and dumbell presses with light weight so may just build those up.

Bump - Definitely less visible, as the trap and deltoid muscles has found its place again, but it is still quite prominent. Especially in the morning. I certainly wouldn't call myself a vain person but it does annoy me.

Pain - Depends on the day. It's at the point now where I forget about it some days, other days it aches a little. Occasionally I push it a little hard and it lets me know.

Plan - In the early days I wanted surgery and would have had it if any of the doctors/surgeons I saw (NHS) would have done it for me. Now I'm not so sure. I certainly don't want to go back to zero again and the recovery is better than i'd expected after 4.5 months, I can technically do everything I did before (with some modifications) and while i'm in good shape i'd feel like an idiot if I pushed surgery and suffered complications.
The shoulder specialist in my area told me about a patient he has who basically forced his hand to perform surgery and ended up suffering a complication and losing proper use of his arm, probably for good. A very high percentage of the surgeries have great results, but I guess you don't want to be the one in a hundred or so where it goes sour.

Stay strong fellas.


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## throet (Oct 8, 2016)

joel.dunsdon said:


> Good to hear people are making progress.
> 
> Update from original post #1127
> 
> ...


It took me 2 years to regain full "pushing" strength after my injury. The ability to do overhead shoulder presses at full strength returned first, but it took longer to regain forward pushing strength, i.e. chest presses. I think that may have been partially due to me tearing my pectoral muscles at the same time I separated my shoulder.


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## joel.dunsdon (Jul 23, 2018)

throet said:


> It took me 2 years to regain full "pushing" strength after my injury. The ability to do overhead shoulder presses at full strength returned first, but it took longer to regain forward pushing strength, i.e. chest presses. I think that may have been partially due to me tearing my pectoral muscles at the same time I separated my shoulder.


That would certainly make sense. One of the main areas of pain that has only just started to (mostly) subside was in my front deltoid muscle, I do wonder if I did some damage to that in the crash too. Any specific pressing excercises that helped you in the early days?

I'm in a similar boat, overhead stability seems to have been largely unaffected and aside from some working around the joint I can overhead press just fine. But yes, push ups are a no go. Even "girly" from the knee push ups feel horrible, as if my collarbone is being torn through my chest. But then I never liked press ups, even before the injury they have always felt weird to me and given me trouble. Bench press feels fine. Weird. I would like to be able to do dips again, in my mind once you can bust out a set of full dips and pull ups with good form you can pretty much take your shoulders anywhere!


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## throet (Oct 8, 2016)

joel.dunsdon said:


> That would certainly make sense. One of the main areas of pain that has only just started to (mostly) subside was in my front deltoid muscle, I do wonder if I did some damage to that in the crash too. Any specific pressing excercises that helped you in the early days?
> 
> I'm in a similar boat, overhead stability seems to have been largely unaffected and aside from some working around the joint I can overhead press just fine. But yes, push ups are a no go. Even "girly" from the knee push ups feel horrible, as if my collarbone is being torn through my chest. But then I never liked press ups, even before the injury they have always felt weird to me and given me trouble. Bench press feels fine. Weird. I would like to be able to do dips again, in my mind once you can bust out a set of full dips and pull ups with good form you can pretty much take your shoulders anywhere!


For me the key was doing as many different exercises as I could to hit the chest and shoulders from multiple angles, but using low weight and high reps. In addition to the typical overhead and chest press movements, I did a lot of standing, single-arm cable movements.

Also, if you can find a weight-assisted or belt-assisted dip / pull-up machine, those are great for getting range of motion and building strength over time without putting too much strain on the recovering joint. I bought a Gold's Gym branded machine for under $200 (US) that came with a few different belts that supported your weight on a knee board through the complete motion. That was a great investment!


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## dirtrider76 (Sep 19, 2012)

joel.dunsdon said:


> That would certainly make sense. One of the main areas of pain that has only just started to (mostly) subside was in my front deltoid muscle, I do wonder if I did some damage to that in the crash too. Any specific pressing excercises that helped you in the early days?
> 
> I'm in a similar boat, overhead stability seems to have been largely unaffected and aside from some working around the joint I can overhead press just fine. But yes, push ups are a no go. Even "girly" from the knee push ups feel horrible, as if my collarbone is being torn through my chest. But then I never liked press ups, even before the injury they have always felt weird to me and given me trouble. Bench press feels fine. Weird. I would like to be able to do dips again, in my mind once you can bust out a set of full dips and pull ups with good form you can pretty much take your shoulders anywhere!


Pretty common to tear other stuff. Did you see a physical trainer? They should have checked for that in the initial evaluation. I had a torn pec as well and they worked everything else till that healed enough to work on strengthening it.

Outside from the rowing machine I used at PT visits I didn't use any equipment. A few resistance bands, small weights and kettle bells and body weight. I actually went yesterday to the same guy to have my other shoulder looked at. In a hour he had me setup on a plan to get it sorted. A good PT is worth seeing, if your driven you will recover pretty quickly. I was set on 2 times a day doing my excercises and stretching a few times a day.


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## teK-- (Dec 3, 2011)

MI-XC said:


> Reading your post it looks like you did too much too soon. I've had two Grade 3 separations (left and right) and both have healed to 100% without any limitations. Other than the bumps, I would have never known I injured my shoulders. That being said, I took PT and recovery very seriously and meticulously.
> 
> First 3 weeks in a sling. Weeks 4-10 physical therapy and no weight in the affected arm over 5 lbs. Only road and trainer riding until 2 months post injury. The ligaments are still healing during this time and any jarring or weight will affect already comprised attachments, possibly inhibitting their ability to fully heal.
> 
> ...


I had a similar recovery to yours; grade 3 separation on dominant shoulder.

about 3 weeks up to 10 was rehab physio then I jumped back on MTB but wore a support brace for about 4 weeks.

Am now 4.5 years post injury (no surgery) and feeling pretty good I am riding harder than I did before I injured the shoulder, my only limitation being can't lift too heavy weights during shoulder press and benchpress.

Shoulder feels a little tired after a big ride or carrying a heavy backpack all day.


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## iabra (Aug 20, 2017)

UPDATE ---

August 8, 2017 I was doing laps in Central Park and hit the southwest corner at 30mph on highest gear and speed. In short, chain popped, I slammed on brakes and hit the pavement shoulder/trap and head first. Helmet saved my head but I had a grade 5 AC separation and SLAP tear. I tried physical therapy for 2 months but no improvement. Here what I learned - if you NEED surgery, the longer you wait the lower the likelihood your ultimate surgery will be successful. If you NEED surgery, dont delay.

November 15, 2017 I had full shoulder reconstruction surgery and 2 anchors to repair my SLAP tear done at HSS by Dr. Frank Cordasco. Hes a specialist in shoulder reconstruction and one of the best at HSS which is one of the best in these types of surgeries. In any event, first month was hell. Minor movements were excruciating and sleeping was horrible. Physical therapy for 6 months was annoying after so many visits but its needed. PT is very important to prevent scar tissue from permanently forming in the wrong spots that limit range of motion.

Its been 1 year since my surgery and in hindsight, im glad I did it. All the bad experiences and bad memories are way behind me. I have full range of motion and recently starting lifting weights again (shoulder press, shoulder lateral raises, bent-over raises, front delt raises, etc...). I am also back to fully biking. In the time I couldnt bike, I actually started running as an outlet for cardio so technically I do more cardio today than I did before. One thing to consider is that many type-A personalities have mental side effects after surgery so be prepared. Its normal to dip into a minor depressed state so keep yourself occupied, have lots of visitors and be around people that love you and will take care of you. If you NEED the surgery, do it ASAP. And if youre in NY, see Dr. Cordaso. Good luck to all!


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## starry (Jun 9, 2009)

wow, this is quite the thread. I'm 2.5 weeks out from a grade 3 separation. I wasn't even on my mtb trying some technical stuff - was on my gravel bike rolling on pavement about 18mph. Stick kicked up into spokes and/or drivetrain and immediately went from 18 to zero, OTB onto head and left shoulder. concussion, grade 3. No time to react, could have been worse of course. In many years of technical mtb, cross and road riding, this is my real first significant injury (well, i broke a couple of ribs in 2011 MTBing, which did suck but it was like "ok, done, now heal" - while this is more complicated).

So ends my cyclocross race season just as it was getting fun and i was rounding into good form. Ce la vie. 

My story so far at this early stage: 

- two orthos (though from the same office) both recommended against surgery. I have a fairly noticeable bump/lump, but i don't think it's insane (seriously can't even bring myself to TRULY look at it super close - i'm surprised at how much the thought of it bothers me, but....it does. Not squimish with blood, or much else, but bone-out-of-place things just freak me out. And not stoked on thinking about how it will look long term - obviously kinda vain of me, and ppl have things way worse, but still)). 

- first week sucked, feels def better second week, but still "heavy" and dull pain. I honestly can't tell what my "range of motion" really is, because i'm just babying it. Not in sling after first week, but def keeping it mainly sorta still, yet working my desk job. It seems like a lot of guys test out ROM like almost right away - maybe i'm just a wimp, but i just don't even want to test it yet. 

- Immediately i got out on walks after the injury (with sling), for my own sanity and kinda keep blood flowing. Got on my smart trainer for a half hour last night, first time. Actually didn't feel great stretching forward to grab hoods. Mainly rode it one handed.

- Starting PT (in whatever form that will be) on Monday, at the 3 week mark. I have no idea if that's when i'm supposed to, but the PT guy specializes in shoulders, so he should tell me. 

- The surgery/non surgery dilemma is maddening, but i know most of you guys with grade 3s know that. I like doing pullups and military presses at the gym, and really just being able to lift (nothing crazy) as a part of my life, and i'm nervous about whether i can get back that stuff. I guess i'll have a better idea of what kind of healer i am once i start light range of motion and strengthening stuff. With grade 3, ligaments are torn, and it sort of blows my mind that you don't just have noodle arm without ligaments. but hey, what do i know. 

- On that note, what IS it I'm actually rehabbing right now, if i don't have ligaments anymore??? what am i "healing?" simply the soft tissue trauma/bone bruising? Are you supposed to be "careful" with the shoulder in these weeks because you want scar tissue to form? (sounds like scar tissue essentially takes the place of your ligaments, in terms of giving you stability?) im sure the PT guy could answer this stuff, but figured i'd ask. 

The whole things been a bummer obviously - cross season always has me in the best shape of the year, I love riding in the fall, etc etc, and just being off the bike like this sucks. But then you also couple that with how complicated this injury seems to be, and how lengthy recovery is to "get back to normal" (if you even do). I had no idea. 

Anyway, best of luck to all on it....


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## Ricisan (Aug 30, 2006)

My shoulder injury was long ago. My surgeon works for NY Jets. Said mine was 2nd worst shoulder he has done! WTF
Not a list I wanted to be on.

Long story short: Did everything I was told to do. 6 miserable weeks w/brace. Walked 480 mi over 12 weeks at park. 
Each PT eval I was told "You are doing fine" Whatever
At 9 weeks I made 12 week goals at 58 yrs old.

I still have things I can't do, but I work w/it.
Just retired and have a 100 mi on my bucket list.
After that comes Mt. Whitney. 
24 hr summit would be nice!

R


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## teK-- (Dec 3, 2011)

starry said:


> wow, this is quite the thread. I'm 2.5 weeks out from a grade 3 separation. I wasn't even on my mtb trying some technical stuff - was on my gravel bike rolling on pavement about 18mph. Stick kicked up into spokes and/or drivetrain and immediately went from 18 to zero, OTB onto head and left shoulder. concussion, grade 3. No time to react, could have been worse of course. In many years of technical mtb, cross and road riding, this is my real first significant injury (well, i broke a couple of ribs in 2011 MTBing, which did suck but it was like "ok, done, now heal" - while this is more complicated).
> 
> So ends my cyclocross race season just as it was getting fun and i was rounding into good form. Ce la vie.
> 
> ...


With rehab after non surgical option you are basically retraining your muscles to support the shoulder in the absence of the ligament which no longer does its job.

After about 4 years I have good strength in my shoulder and the extra muscle now mostly covers the bump it's not that noticeable.

Grade 3 separation is always 50/50 for surgical option it comes down to how highly you require overhead strength.


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## starry (Jun 9, 2009)

teK-- said:


> With rehab after non surgical option you are basically retraining your muscles to support the shoulder in the absence of the ligament which no longer does its job.
> 
> After about 4 years I have good strength in my shoulder and the extra muscle now mostly covers the bump it's not that noticeable.
> 
> Grade 3 separation is always 50/50 for surgical option it comes down to how highly you require overhead strength.


thanks..."how highly you require overhead strength" - so what does that mean - you likely won't have 100 percent of the strength (overhead) that you had before? I'm assuming (hopefully) that you can get pretty darn close, though?


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## teK-- (Dec 3, 2011)

starry said:


> thanks..."how highly you require overhead strength" - so what does that mean - you likely won't have 100 percent of the strength (overhead) that you had before? I'm assuming (hopefully) that you can get pretty darn close, though?


Put it this way I used to be able to shoulder press 16kg no worries . Now I prob wouldn't push it much past 12kg.


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## murlsquirl (Dec 10, 2018)

I found this thread one of the most informative on the web, so I thought I would take the time to add another data point.

Two weeks and two days ago I had an AC III separation from a pretty lame crash, but it was direct impact to the shoulder. Not a scratch on me otherwise, but I knew as soon as it happened that it was separated....a buddy did the same thing on a ride only a few months earlier. Hurts like hell.

I was pretty bummed when I started reading about how long people were out and how difficult the recovery is, but mine has been pretty good. I am fairly young (35) and in good shape and I definitely think that helps. I took the sling off after the first week and really just started doing anything my pain tolerance would allow. I continued to alternate ice and heat and took Ibuprofen every now and then to help with the inflammation. After a few days out of the sling, my range of motion dramatically improved. The pain was still there, but it was moving towards discomfort more than pain....unless I tweaked it or went overboard. My buddy is a PT and recommended some easy exercises and I ordered a pulley on Amazon (very useful). Two days shy of the two week mark, I was able to lift my arm above my head with only moderate discomfort. On Saturday (two week mark), I did an 8 mile XCish ride and while I felt it the entire time, it wasn't bad at all. It was very sore afterwards from all the weight on it but after some ice and heat, it felt much better....I was really itching to get out there because I ordered a new bike 3 days before the wreck. 

Anyways, it's feeling pretty damn good as I sit here and type this. It's far from fully recovered and I feel it every second, but I'm more than happy so far. Don't really plan on doing any in person PT sessions as I have what I need to do it at home. 

These injuries suck.


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## tubbnation (Jul 6, 2015)

murlsquirl said:


> ...
> 
> These injuries suck but I think the best thing you can do is just start using it as much as possible as you can manage the pain. It seems to be working for me....but no real downhill for another month or so. Not worth the risk.


First, of all, I'm glad you're doing better, but...

I was diagnosed with a separation between 2-3. Using it as much as possible, as you can manage the pain, was the worst thing for me. Another specialist opinion, several weeks later, revealed that I actually did more damage, all 3 ligaments we're now severed.

These types of injuries are mostly so patient specific that no one size fits all - regardless of degree of separation. Way too many variables.


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## murlsquirl (Dec 10, 2018)

woodchips said:


> First, of all, I'm glad you're doing better, but...
> 
> I was diagnosed with a separation between 2-3. Using it as much as possible, as you can manage the pain, was the worst thing for me. Another specialist opinion, several weeks later, revealed that I actually did more damage, all 3 ligaments we're now severed.
> 
> These types of injuries are mostly so patient specific that no one size fits all - regardless of degree of separation. Way too many variables.


Edited...I definitely agree with you. In my case though (and others like it you could say), it's a grade III so the damage is done. Nothing left to tear.


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## tubbnation (Jul 6, 2015)

murlsquirl said:


> Edited...I definitely agree with you. In my case though (and others like it you could say), it's a grade III so the damage is done. Nothing left to tear.


No way would I say damage is done once you've received a diagnosis of a grade 3; I turned my grade 3 into a low grade 5.

Again, not one size fits all...


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## murlsquirl (Dec 10, 2018)

woodchips said:


> Again, not one size fits all...


Agree. Let's hope I can take it easy and not do what you did....that sucks.


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## tubbnation (Jul 6, 2015)

murlsquirl said:


> Agree. Let's hope I can take it easy and not do what you did....that sucks.


You admittedly saying, using it as much as possible as you can manage the pain, leaves little hope for you to take it easy. Thankfully, 
however, your grade 3 doesn't seem to be as serious as mine was.

Again, not one size fits all.


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## starry (Jun 9, 2009)

that's cool - good you're doing better. I'm exactly 5 weeks, grade 3 (no surgery). I have decent range of motion. Clicks and pops and feels kinda weird and sore at night still sometimes. Doing PT with an actual PT. He has me on ROM stuff, and nothing with strengthening yet. I can get my arm overhead, but it's wonky.

I will say im kinda glad i've been to the gym all these years in addition to riding. My shoulders were fairly well developed (nothing massive, i'm still a skinny cyclist , but i feel having a "foundation" of both strength and muscle is helping both from a recovery standpoint, and maybe even a cosmetic standpoint. Maybe i'm fooling myself, but my "hump" isn't as bad as i've seen. My shoulder does still look pretty "droopy" though. That sucker got POUNDED down.

Only done 1 ride, at about the 3.5 week mark, on my cross bike. Did 10 easy miles, nothing off road. Otherwise just been running, and doing legs at the gym. Reasons for no riding are varied and many. a.) its been really cold here b.) i do NOT want to fall on this shoulder and c.) it's apparent that i was fooling myself that my nerve irritation in upper glute (via disc bulge) was not made worse via tons of cycling. It think i was fooling myself. It took 4 weeks of no riding (was averaging 10 hours a week before crash), but i suddenly DO NOT have that nerve pain, by and large (little in the morning). Which i had constantly for 3.5 agonizing months. Love to race mtb and cross, and maybe i still can, but i think my days of cycling-only big training weeks might be over. I think i need to become way more well rounded in the things i do. Maybe this injury was a wake-up call to other parts of my body that i was in denial over relative to cycling. I was definitely addicted to the bike. I feel like i've broken that some, and it's a bit freeing now, actually. At first after this shoulder sep, i was devastated not riding. Now over a month in, i see things a little differently.


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## dirtrider76 (Sep 19, 2012)

murlsquirl said:


> I found this thread one of the most informative on the web, so I thought I would take the time to add another data point.
> 
> Two weeks and two days ago I had an AC III separation from a pretty lame crash, but it was direct impact to the shoulder. Not a scratch on me otherwise, but I knew as soon as it happened that it was separated....a buddy did the same thing on a ride only a few months earlier. Hurts like hell.
> 
> ...


My left shoulder is how you describe and hurt like hell. Literally a explosion of pain. It wasn't separated though and healed up(so I thought) fast. Only it never really was right and your body will let you do things and compensate for injury till its actually a issue. I've been rehabbing it for almost 2 months now to get it corrected. Notable did not go to the full sag broken wing type position, literally took my pack off with only pain and drove 2 hours home. By the time I got home the pain was much less but still pretty bad. Was riding chunky enduro terrain 1 week later with minor aching.

My right shoulder was a legit grade 3 AC tear. Felt it pop, next to no pain only got a little sore. Shoulder dropped way down and arm went into the broken wing position like they all do. 2 weeks later I had a hard time even riding the trainer with my weight on it let alone ride XC, it just wouldn't hold the weight right.


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## NewEnglandRunner (Dec 11, 2018)

Hi all, new member here. Was recently on a bike accident (slid on black ice and landed on left shoulder at 20 MPH - non-dominant side) and was diagnosed with a grade III AC separation (picture below).









This thread has been a great resource. I had a 10-day post injury follow-up in the doctor yesterday and was asked to get rid of the arm sling at this point. Pain has improved in the last 2-3 days but my ROM is very limited. If I try to reach my opposite shoulder or pull/push something with the affected arm it hurts considerably. Since I'm a runner training for a marathon in 11 weeks, I asked the Dr if I can go back to my training because I'm very concerned about losing my gains. I was told I can give it a try if not painful. I run yesterday for 15 min after a warm up in the stationary bike and it was a little painful, but doable. I wonder based on your previous experiences, should I keep adding some daily running to my activities or wait more? Today it feels the same as yesterday in terms of pain, so it looks like the running did not made it worse but could it slow down recovery?


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> Hi all, new member here. Was recently on a bike accident (slid on black ice and landed on left shoulder at 20 MPH - non-dominant side) and was diagnosed with a grade III AC separation (picture below).
> 
> View attachment 1228470
> 
> ...


i just wrote a long winded response to this but it didn't go through i think, so i will paraphrase. I would wait until the 2.5 week timeframe. I started running at 3 weeks, and it felt right. but only like 3, 3.5 miles, and "thinking" light - ball of my feet, etc. My PT was surprised i started running. Just listen to your body. I did a harder interval running session the other day (at about week 5) and i was pretty sore that night. I know you need to do way more volume than i'm doing, so this isn't what you want to hear, but honestly i think you have to accept reality a little. You don't want to suffer more than normal through those 26.2 miles - you want your shoulder at least feeling somewhat painfree by then.


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## NewEnglandRunner (Dec 11, 2018)

starry said:


> i just wrote a long winded response to this but it didn't go through i think, so i will paraphrase. I would wait until the 2.5 week timeframe. I started running at 3 weeks, and it felt right. but only like 3, 3.5 miles, and "thinking" light - ball of my feet, etc. My PT was surprised i started running. Just listen to your body. I did a harder interval running session the other day (at about week 5) and i was pretty sore that night. I know you need to do way more volume than i'm doing, so this isn't what you want to hear, but honestly i think you have to accept reality a little. You don't want to suffer more than normal through those 26.2 miles - you want your shoulder at least feeling somewhat painfree by then.


OK, thanks. I'm cross training in the stationary bike/elliptical plus some strength (can't do any core or anything that need both arms at this point) to minimize my losses but the reality of marathon training is that I need to get back to building running mileage as soon as possible. I'm aware my hopes for a PR in 11 weeks (Race is March 3) are pretty much gone because I'm not sure I will be able to do any hard tempo or interval runs before the race but I have another marathon in mid-April that I plan to do my best.

By the way, I forgot to add in my OP, the Dr. definitively recommended conservative nonoperative treatment based on: my age (42), non-dominant arm, and my primary sport being running does not require a high energy from the shoulders.

I think I may wait 1 more week, but it is hard!


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> OK, thanks. I'm cross training in the stationary bike/elliptical plus some strength (can't do any core or anything that need both arms at this point) to minimize my losses but the reality of marathon training is that I need to get back to building running mileage as soon as possible. I'm aware my hopes for a PR in 11 weeks (Race is March 3) are pretty much gone because I'm not sure I will be able to do any hard tempo or interval runs before the race but I have another marathon in mid-April that I plan to do my best.
> 
> By the way, I forgot to add in my OP, the Dr. definitively recommended conservative nonoperative treatment based on: my age (42), non-dominant arm, and my primary sport being running does not require a high energy from the shoulders.
> 
> I think I may wait 1 more week, but it is hard!


yeah bike trainer (even if one handed, or the recumbent style at a gym is better) would be really good to just try and keep the engine maintained...

And yeah, i had two orthos both recommend conservative treatment vs surgery (though they are both from the same office, so, for what it's worth). I'm also non-dominant. But my primary sport is indeed cycling - cyclocross and mtb racing, both of which require direct usage of that AC joint when lifting front wheel over obstacles and/or full bunny hopping. I know that for now, even over 5 weeks in, that motion of lifting something up in front of me, with arm straight or slightly bent, is totally no-go.

So, my road will be harder than a pure runner. Hope i can get back to both sports somewhat pain free. Also, super scared of going down on top of that shoulder every again any time in the future, which is also obviously way more likely cycling. Wait, am i talking myself into becoming more of a runner? heaven forbid, haha ....But seriously like i said above in a post, i try to look at the positive side, and maybe running more as opposed to just 10 to 12 hour cycling training weeks all the time will probably make me healthier person overall. Probably NOT a better bike racer, but...really - i mean, i should think higher level/holistically. I'm no pro. Really then, what does it matter.


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## NewEnglandRunner (Dec 11, 2018)

starry said:


> yeah bike trainer (even if one handed, or the recumbent style at a gym is better) would be really good to just try and keep the engine maintained...
> 
> And yeah, i had two orthos both recommend conservative treatment vs surgery (though they are both from the same office, so, for what it's worth). I'm also non-dominant. But my primary sport is indeed cycling - cyclocross and mtb racing, both of which require direct usage of that AC joint when lifting front wheel over obstacles and/or full bunny hopping. I know that for now, even over 5 weeks in, that motion of lifting something up in front of me, with arm straight or slightly bent, is totally no-go.
> 
> So, my road will be harder than a pure runner. Hope i can get back to both sports somewhat pain free. Also, super scared of going down on top of that shoulder every again any time in the future, which is also obviously way more likely cycling. Wait, am i talking myself into becoming more of a runner? heaven forbid, haha ....But seriously like i said above in a post, i try to look at the positive side, and maybe running more as opposed to just 10 to 12 hour cycling training weeks all the time will probably make me healthier person overall. Probably NOT a better bike racer, but...really - i mean, i should think higher level/holistically. I'm no pro. Really then, what does it matter.


Yeah I also had 2 orthos looking at it in addition to the ER doctor. I was not given a grade by the ER doc and I did not ask because I was not aware of it at that time, but I think he thought this was a grade 1-2 because he sent me home with a sling and said I should feel better and return to my running in 3-4 days, really? Not a chance. I have had several sport-related injuries in the past but nothing hurts like this. I love riding my bike, I'm no MTBiker, but a pretty dedicated bike commuter for years, 2500 miles/year on average, all seasons, never had an accident, but I don't know if I will be able to ride my bike in the winter again.


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> Yeah I also had 2 orthos looking at it in addition to the ER doctor. I was not given a grade by the ER doc and I did not ask because I was not aware of it at that time, but I think he thought this was a grade 1-2 because he sent me home with a sling and said I should feel better and return to my running in 3-4 days, really? Not a chance. I have had several sport-related injuries in the past but nothing hurts like this. I love riding my bike, I'm no MTBiker, but a pretty dedicated bike commuter for years, 2500 miles/year on average, all seasons, never had an accident, but I don't know if I will be able to ride my bike in the winter again.


Ahh, ok for some reason i thought you were a grade 3 (which is what i am). That said, you should be back in the game much sooner with a 1/2. Perhaps then revise what i said about your timeline for running. I assume it can be sooner then. With my grade 3, my ligaments are gone/blown (from what i understand). But yours are likely partially torn, and can regrow? So given that, i think you still need to be careful and baby it some, for healing to happen. The kind of healing you need to do is i guess just sort of different than the "healing" i need to do (what the hell then AM i healing, if my ligaments are blown? ha...)


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## NewEnglandRunner (Dec 11, 2018)

starry said:


> Ahh, ok for some reason i thought you were a grade 3 (which is what i am). That said, you should be back in the game much sooner with a 1/2. Perhaps then revise what i said about your timeline for running. I assume it can be sooner then. With my grade 3, my ligaments are gone/blown (from what i understand). But yours are likely partially torn, and can regrow? So given that, i think you still need to be careful and baby it some, for healing to happen. The kind of healing you need to do is i guess just sort of different than the "healing" i need to do (what the hell then AM i healing, if my ligaments are blown? ha...)


No, I am a grade 3. The doctor in the ER maybe thought this was a grade 1-2 because he said I should be back to running in 3-4 days but the 2 follow-up orthos both agreed this is a traditional grade 3. I'm even due for an MRI because doc wants to see the extent of ligament/muscle damage to design the physical therapy in a month. I felt some pain while running at a slow pace yesterday (10 days after injury), and that's what is holding me back and appreciate you sharing your experience. The ortho said running will not aggravate it but since it is still painful, I'm worried it could slow down recovery or influence in my posture/gait.


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> No, I am a grade 3. The doctor in the ER maybe thought this was a grade 1-2 because he said I should be back to running in 3-4 days but the 2 follow-up orthos both agreed this is a traditional grade 3. I'm even due for an MRI because doc wants to see the extent of ligament/muscle damage to design the physical therapy in a month. I felt some pain while running at a slow pace yesterday (10 days after injury), and that's what is holding me back and appreciate you sharing your experience. The ortho said running will not aggravate it but since it is still painful, I'm worried it could slow down recovery or influence in my posture/gait.


ok - got it, i'm clear now. I think that's good the ortho ordered an MRI. Mine didn't. He basically called it a grade 3, which (supposedly) means the ligaments are "gone" - not to regrow back. Your doctor, by ordering the MRI, seems to leave open the possibility that that may not necessarily be the case. That's interesting.

I will say, these orthos were so quick with me, and matter-of-fact. I go back in for my first follow up Dec 17, and i will ask them about the MRI, and this whole question about ligaments. I'd feel way better knowing maybe i DO have ligaments left! I think the likely answer is that they are indeed gone, but....this is still a little hazy for me in terms of my understanding.


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## dirtrider76 (Sep 19, 2012)

NewEnglandRunner said:


> Hi all, new member here. Was recently on a bike accident (slid on black ice and landed on left shoulder at 20 MPH - non-dominant side) and was diagnosed with a grade III AC separation (picture below).
> 
> View attachment 1228470
> 
> ...


Use a evs sb03 shoulder support to keep your shoulder from bouncing while running. You can find them pretty cheap. I used one for a little for DH riding right after my G3.


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## NewEnglandRunner (Dec 11, 2018)

dirtrider76 said:


> Use a evs sb03 shoulder support to keep your shoulder from bouncing while running. You can find them pretty cheap. I used one for a little for DH riding right after my G3.


Thanks, like this one?









Does that affect your arm movements while running do you know?


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## MI-XC (Mar 14, 2018)

starry said:


> ok - got it, i'm clear now. I think that's good the ortho ordered an MRI. Mine didn't. He basically called it a grade 3, which (supposedly) means the ligaments are "gone" - not to regrow back. Your doctor, by ordering the MRI, seems to leave open the possibility that that may not necessarily be the case. That's interesting.
> 
> I will say, these orthos were so quick with me, and matter-of-fact. I go back in for my first follow up Dec 17, and i will ask them about the MRI, and this whole question about ligaments. I'd feel way better knowing maybe i DO have ligaments left! I think the likely answer is that they are indeed gone, but....this is still a little hazy for me in terms of my understanding.


The ligaments aren't gone, you still have them, lol. They were just torn, or in the case of a grade 3, likely just 1 of the ligaments were ruptured (Acromioclavicular Ligament). This is the ligament that attaches the collar bone to the shoulder blade. This AC ligament (along with other ligaments)holds the collar bone down (normal position). So in an AC separation (grade 3) the ligament is ruptured (other ligaments torn or ruptured) and the collar bone is no longer being held down, thus the collar bone, or bump commonly referred to, is sticking out a bit. Once that AC ligament is ruptured, outside of surgery there's no way to bring that collar bone back down because there is nothing connected to it to do so. It's cosmetic at this point.

So, as the shoulder heals the ligaments form scar tissue reconnecting the collar bone to the shoulder blade. However, it forms scar tissue and heals in its new position, which is a raised collar bone and the "shoulder bump". This is why you're in a sling to allow that scar tissue to form. Those that rush back to activity never allow that scar tissue to properly form back together and have lasting issues. After about 3 weeks that scar tissue is strong enough to start light physical therapy and range of motion stretches. Then it just becomes about gaining full range back and strengthening the shoulder and supporting muscles over the following 2-3 months.

The orthopedics were so matter of fact because it's not a big deal in the scheme of orthopedics. Come in with a grade 5 AC separation and then you'll get their attention!


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## dirtrider76 (Sep 19, 2012)

NewEnglandRunner said:


> Thanks, like this one?
> 
> View attachment 1228532
> 
> ...


No clue, haven't run like that in ages TBH. I only used mine to catch the tail end of the DH season. By spring I was well past that part. From what I remember it just held it together and gave it support not really making it much harder to move. Also the x-brace over the shoulder is removable and adjustable.


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## starry (Jun 9, 2009)

MI-XC said:


> The ligaments aren't gone, you still have them, lol. They were just torn, or in the case of a grade 3, likely just 1 of the ligaments were ruptured (Acromioclavicular Ligament). This is the ligament that attaches the collar bone to the shoulder blade. This AC ligament (along with other ligaments)holds the collar bone down (normal position). So in an AC separation (grade 3) the ligament is ruptured (other ligaments torn or ruptured) and the collar bone is no longer being held down, thus the collar bone, or bump commonly referred to, is sticking out a bit. Once that AC ligament is ruptured, outside of surgery there's no way to bring that collar bone back down because there is nothing connected to it to do so. It's cosmetic at this point.
> 
> So, as the shoulder heals the ligaments form scar tissue reconnecting the collar bone to the shoulder blade. However, it forms scar tissue and heals in its new position, which is a raised collar bone and the "shoulder bump". This is why you're in a sling to allow that scar tissue to form. Those that rush back to activity never allow that scar tissue to properly form back together and have lasting issues. After about 3 weeks that scar tissue is strong enough to start light physical therapy and range of motion stretches. Then it just becomes about gaining full range back and strengthening the shoulder and supporting muscles over the following 2-3 months.
> 
> The orthopedics were so matter of fact because it's not a big deal in the scheme of orthopedics. Come in with a grade 5 AC separation and then you'll get their attention!


thanks, that's helpful....and yeah, i was using the term "gone" as another way of saying "torn/ruptured." I know they don't dissolve or something


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## starry (Jun 9, 2009)

seems like this thread isn't quite as active as in years past, or maybe it's my imagination.

6 weeks on from grade 3, no surgery. ROM is really fairly good. PT is has only done ROM, think strengthening starts now, essentially. 

It still feels a bit "raw" under my shirt, for lack of a better word. Hard to describe it really, i guess just tender. I rode my gravel bike twice last week on super mellow dirt and pavement paths. No problem really at all. I can tell the issue will be lifting front end for obstacles and bunny hops and such.

I can say, now that my ROM motion is really pretty good, i can see in the mirror the movements that make the free range clavicle look SUPER pronounced...like when i reach up and across to my other shoulder to scratch or something. Kinda made me gasp the first time. 

Still curious to hear about how other racers got back to not really thinking about crashing on it once they returned full on (especially heavy "traffic" racing like cyclocross, where it's easy to endo hard over a washed out body/bike right in front of you). There's probably not a really solid answer to that question..Just gotta get back at it, and go.


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## DinoRidge (Aug 29, 2007)

starry said:


> seems like this thread isn't quite as active as in years past, or maybe it's my imagination.
> 
> 6 weeks on from grade 3, no surgery. ROM is really fairly good. PT is has only done ROM, think strengthening starts now, essentially.
> 
> ...


Commenting after grade 3 2.5 years ago, as your comments about cyclocross made me chuckle as I just crashed in a race last week.

I remember thinking about crashing A LOT after getting back to riding. The main solution was just as you said: get back at it. The thoughts will fade.

The thoughts faded for me quite a bit, over time, to the point where I started daydreaming and clipped a rock and did crash! I thought for a while I had done the other shoulder, but it turned out ok.


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## starry (Jun 9, 2009)

DinoRidge said:


> Commenting after grade 3 2.5 years ago, as your comments about cyclocross made me chuckle as I just crashed in a race last week.
> 
> I remember thinking about crashing A LOT after getting back to riding. The main solution was just as you said: get back at it. The thoughts will fade.
> 
> The thoughts faded for me quite a bit, over time, to the point where I started daydreaming and clipped a rock and did crash! I thought for a while I had done the other shoulder, but it turned out ok.


Ha! classic. Good to hear you're racing cross, riding mtb, and back strong with a sweet free range clavicle


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## MI-XC (Mar 14, 2018)

starry said:


> Still curious to hear about how other racers got back to not really thinking about crashing on it once they returned full on (especially heavy "traffic" racing like cyclocross, where it's easy to endo hard over a washed out body/bike right in front of you). There's probably not a really solid answer to that question..Just gotta get back at it, and go.


Having done now my left and right (grade 3 separation) its all about easing back into it. I'd say after a couple months of getting back into it its generally out of your mind, at least it is for me. Once in the race I'm so focused on the race that competing has my full attention.

Can't be afraid to fall and can't race scared. You will fall again, many times, and it will be fine. I just tell myself that racing is crashing if you're pushing yourself to your limits. Just control what you can and avoid the stupid things. Good luck!

Here's my grade 3 Separation from September 2018, at the 52:20 mark.... ENJOY!





Still finished the race and took 5th, HTFU!


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## teK-- (Dec 3, 2011)

starry said:


> Still curious to hear about how other racers got back to not really thinking about crashing on it once they returned full on (especially heavy "traffic" racing like cyclocross, where it's easy to endo hard over a washed out body/bike right in front of you). There's probably not a really solid answer to that question..Just gotta get back at it, and go.


It probably took me a good 6 months before I stopped thinking about it, and went back to riding as hard as I was pre-crash.

I did a skills camp to brush off some old habits and that helped.


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## starry (Jun 9, 2009)

MI-XC said:


> Having done now my left and right (grade 3 separation) its all about easing back into it. I'd say after a couple months of getting back into it its generally out of your mind, at least it is for me. Once in the race I'm so focused on the race that competing has my full attention.
> 
> Can't be afraid to fall and can't race scared. You will fall again, many times, and it will be fine. I just tell myself that racing is crashing if you're pushing yourself to your limits. Just control what you can and avoid the stupid things. Good luck!
> 
> ...


right on, this helps, thanks man. HTFU indeed


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## starry (Jun 9, 2009)

teK-- said:


> It probably took me a good 6 months before I stopped thinking about it, and went back to riding as hard as I was pre-crash.
> 
> I did a skills camp to brush off some old habits and that helped.


thanks man - good thoughts...


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## starry (Jun 9, 2009)

MI-XC said:


> Having done now my left and right (grade 3 separation) its all about easing back into it. I'd say after a couple months of getting back into it its generally out of your mind, at least it is for me. Once in the race I'm so focused on the race that competing has my full attention.
> 
> Can't be afraid to fall and can't race scared. You will fall again, many times, and it will be fine. I just tell myself that racing is crashing if you're pushing yourself to your limits. Just control what you can and avoid the stupid things. Good luck!
> 
> ...


damn so you were second place there at time of crash, and still got 5th...you guys had a decent gap on the main field i bet. Man, i kind of miss racing at the really pointy end of cat 2/Sport....Part of me regrets going up to Cat 1/Expert a couple years go. Haven't done much better than mid pack there, really. No one has any weaknesses in cat 1. No one.... Ah, it all fun either way...


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## MI-XC (Mar 14, 2018)

starry said:


> damn so you were second place there at time of crash, and still got 5th...you guys had a decent gap on the main field i bet. Man, i kind of miss racing at the really pointy end of cat 2/Sport....Part of me regrets going up to Cat 1/Expert a couple years go. Haven't done much better than mid pack there, really. No one has any weaknesses in cat 1. No one.... Ah, it all fun either way...


It's actually worse than that. Yes I was in 2nd and 1st place was struggling, I was pulling him in Lap 1. I was just waiting to attack and I all but had 1st place wrapped up. If I finished 1st I would have also gotten 3rd overall for the Championship Point Series. Ohhh..... what could have been:madman:.

That being said I made huge gains in 2018 and it's fun racing for the podium every race. I'll stay Cat 2 (Sport) for 2019 and hopefully turn those 2nd-5th place finishes into some wins and consistent podium finishes. The plan is to move to Cat 1 (Expert) in 2020. But as you said, I'm in no hurry to become pack fodder.


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## starry (Jun 9, 2009)

MI-XC said:


> It's actually worse than that. Yes I was in 2nd and 1st place was struggling, I was pulling him in Lap 1. I was just waiting to attack and I all but had 1st place wrapped up. If I finished 1st I would have also gotten 3rd overall for the Championship Point Series. Ohhh..... what could have been:madman:.
> 
> That being said I made huge gains in 2018 and it's fun racing for the podium every race. I'll stay Cat 2 (Sport) for 2019 and hopefully turn those 2nd-5th place finishes into some wins and consistent podium finishes. The plan is to move to Cat 1 (Expert) in 2020. But as you said, I'm in no hurry to become pack fodder.


ah, the one that got away. hey you blew up your shoulder ligaments and still got 5th, and rode on it. kudos.

yeah, i cat'd up but by and large my training stayed the same. i think if you cat up from 2 to 1, obviously you might need to do some different, harder, meaner things  ....but even then, if i did that i don't know that i'd move THAT much more out of lower pack/mid pack. Just strong ass riders. Heck i feel happy to just beat a handful of guys in cat 1.

You could be different though - you sound motivated, and you never know. Good call having another fun season of podium hunting, but then yeah, challenge yourself with the move up to 1. I will say it made me a better rider overall.

Coming up on 7 weeks post grade 3 separation...done a few easy and short road rides, but that's it. Def not gonna hit the trails for a bit (too icey and muddy here anyway)...Thing still feels weird and clicky and "out of place" - but better. I never knew how long these take. And i understand it will never be "perfect" again...


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## milehi (Nov 2, 1997)

I'm seven weeks in with an AC separation. The doc didn't grade it and called a strain. It happened as I was leashing one dog and the other leashed dog jumped out of the back of the Jeep jerking my arm. I didn't have ant ROM for five weeks, then started with PT at home.

I haven't been on the bike as I severely bruised my ribs two weeks later, then later strained my tibial collateral ligament, so I've been kicking back. The knee and shoulder are on the left side; the ribs on the right, so sleep sucks.


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## teK-- (Dec 3, 2011)

Vader said:


> I'm seven weeks in with an AC separation. The doc didn't grade it and called a strain. It happened as I was leashing one dog and the other leashed dog jumped out of the back of the Jeep jerking my arm. I didn't have ant ROM for five weeks, then started with PT at home.
> 
> I haven't been on the bike as I severely bruised my ribs two weeks later, then later strained my tibial collateral ligament, so I've been kicking back. The knee and shoulder are on the left side; the ribs on the right, so sleep sucks.


 If it's just a strain you are lucky and will make a full recovery!


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## FL mtb (Mar 19, 2016)

NewEnglandRunner said:


> Hi all, new member here. Was recently on a bike accident (slid on black ice and landed on left shoulder at 20 MPH - non-dominant side) and was diagnosed with a grade III AC separation (picture below).
> 
> View attachment 1228470
> 
> ...


Just seeing the latest posts now... Did you fracture the scapula as well?


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## NewEnglandRunner (Dec 11, 2018)

FL mtb said:


> Just seeing the latest posts now... Did you fracture the scapula as well?


Yes, this is actually a complication I'm going through right now. At first the X-ray in the picture above I shared, which was taken the day of the injury in the ER, showed a small fracture in the dorsal border of the scapula. This was seen as minor and should resolve quickly as the AC separation injury improves. However, a second doctor ordered an MRI to check for the rotator cuff and the report revealed a fracture to the coracoid process of the scapula. Since this fracture is very uncommon, I had a CT scan done yesterday to help determine how extensive it is and confirm location; the follow up appt with the doctor is on Tue and my case now was transferred to an ortho who is one of the shoulder experts of the Boston Celtics, not sure if that doctor change is good or bad news. Hopefully it will be OK but pain and ROM has improved considerable the past 4-5 days (tomorrow will be 5 weeks since accident) but I was prohibited from running until the follow up from the CT scan.


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> Yes, this is actually a complication I'm going through right now. At first the X-ray in the picture above I shared, which was taken the day of the injury in the ER, showed a small fracture in the dorsal border of the scapula. This was seen as minor and should resolve quickly as the AC separation injury improves. However, a second doctor ordered an MRI to check for the rotator cuff and the report revealed a fracture to the coracoid process of the scapula. Since this fracture is very uncommon, I had a CT scan done yesterday to help determine how extensive it is and confirm location; the follow up appt with the doctor is on Tue and my case now was transferred to an ortho who is one of the shoulder experts of the Boston Celtics, not sure if that doctor change is good or bad news. Hopefully it will be OK but pain and ROM has improved considerable the past 4-5 days (tomorrow will be 5 weeks since accident) but I was prohibited from running until the follow up from the CT scan.


Runner, good luck with it...shoulders are complicated as is, and it sucks to be dealing with something beyond a severe shoulder separation.

I'm 2 months in from grade 3. Still a fair amount of tenderness at the joint (weirdly certain slim fit shirts hurts it) more times than others. Been doing short runs (though i just got achilles tendonitis it seems, so backing off), and actually rode outside today for an hour and a half (fixating on black ice way too much to make it really enjoyable)...Was nice to do some hill repeats and really feel the burn. Interestingly enough if i really get deep into an interval and I'm breathing really hard, i feel it in my shoulder and it almost impedes deep breathing a little. Hope that dissipates eventually.

Anyway - good luck with your complications and recovery. I'm in Boston too, and i'm curious on the name of the Celts doctor. I think my guy at is fine/ok, and that i'm still likely on path to *not* ending up needing surgery, but other days i'm not super sure. Might be good to have another good guy to go to in a few months if it's still giving me bad issues...


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## FL mtb (Mar 19, 2016)

Glad that didn’t get missed! It probably explains why you had a little more pain than the average isolated shoulder separation. Good luck with your recovery!


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## NewEnglandRunner (Dec 11, 2018)

starry said:


> Anyway - good luck with your complications and recovery. I'm in Boston too, and i'm curious on the name of the Celts doctor. I think my guy at is fine/ok, and that i'm still likely on path to *not* ending up needing surgery, but other days i'm not super sure. Might be good to have another good guy to go to in a few months if it's still giving me bad issues...


Thanks! The Dr's name is Paul Weitzel. I also learned that he reconstructed both shoulders of a co-worker chronically injured from competitive skiing and she praises that he essentially saved her life.


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## NewEnglandRunner (Dec 11, 2018)

FL mtb said:


> Glad that didn't get missed! It probably explains why you had a little more pain than the average isolated shoulder separation. Good luck with your recovery!


Thanks! The caveat in my case is that I would now be eligible for PT fro the AC separation except I can't do it until the fracture is healed, which will delay recovery.

I have 2 key bucket-list marathons in the spring, both of which I have invested a great deal of effort and money to run. The first one is only 8 weeks away and then Boston on April 15. I'm not too worried about Boston unless Dr. decides I need surgery, which does not appears to be the case, but I'm super worried about the first race. I was well trained before the accident and keeping cardiovascular fitness to some degree with stationary bike/elliptical (not quite like running but it helps) but I will need a few weeks of running before the race to build some endurance back. At this point I'm just hoping I can finish the first race even if I have to dog my way to the finish line.


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## FL mtb (Mar 19, 2016)

It's a bummer to miss an event, but it sounds like you'll be back for both! I started walking the first day after my separation, and it bored the heck out of me. On day 3 I went for a walk with my wife and attempted running, but it felt as though too much strain was being applied at the joint. The next day I was on the road bike, where it felt good when the arm was supported on the bars. The first run that felt good was in St. Maarten about 2 weeks after the MTB fall (I couldn't take 2 weeks out of work at home in FL, so we got on a boat for the second week! It is one of the perks of living just over 2 hours from three major cruise ports!). You'll bounce back quickly!


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## NewEnglandRunner (Dec 11, 2018)

Thanks and glad to know your recovery went so quickly. It will certainly be an interesting journey for me the next 8 weeks. I will keep this thread updated, even though my AC separation with this fracture is very uncommon (if not rare), someone could still benefit of information sharing on the recovery progress and procedures.


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## NaelC (Feb 4, 2019)

Hi guys,
Road bike crash exactly 7 weeks ago
Type 3 separation, treated conservatively 
Stayed in a sling for the first ~3 weeks as per my ortho'srecommendations 
Full ROM back at ~24 days 
Physio started at the 4-week mark, 3 sessions a week alongwith home band exercises on other days
The injured shoulder is now slightly shorter than the otherdue to the separation.

For those that are into lifting, how long til you were ableto pull-up/military press/dip/deadlift etc. and how are doing after a few months?Did you ever get your strength back where it was prior to injury?

Cheers


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## Burning Matches (Mar 14, 2011)

NaelC said:


> For those that are into lifting, how long til you were ableto pull-up/military press/dip/deadlift etc. and how are doing after a few months?Did you ever get your strength back where it was prior to injury?
> 
> Cheers


Took me probably a good six months before I felt like I was finally getting back to normal. After about a year I was back to about 95% of where I was pre-injury. Grade 3, no surgery. Like you, my injured shoulder is dropped below the other side.


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## NaelC (Feb 4, 2019)

Burning Matches said:


> After about a year I was back to about 95% of where I was pre-injury.


Tx BM. Where do you feel the remaining 5%?


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## Burning Matches (Mar 14, 2011)

NaelC said:


> Tx BM. Where do you feel the remaining 5%?


General stability and strength I'd say. It will never be the same as it was before the injury, obviously. My accident was close to 10 years ago. I still get a slight bit of discomfort if I sleep on that side for too long. I remember swimming after I was fully healed and it felt like my collarbone was going into my neck. I guess I've gotten used to it over the years. But it doesn't really limit me in any way -- still doing the same things I did before.


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## MI-XC (Mar 14, 2018)

NaelC said:


> Hi guys,
> Road bike crash exactly 7 weeks ago
> Type 3 separation, treated conservatively
> Stayed in a sling for the first ~3 weeks as per my ortho'srecommendations
> ...


Grade 3 separation on Sept 29, 2018. I was able to do set of 5 pull ups starting in February 2019 (4 months post injury). Starting 3 months out I started transitioning into assisted pull ups and light weight DB press. I kept increasing this week after week. I'd say it would take me about another month (6 months post injury) to get back to pre-injury strength. That being said, I was meticulous with my rehab and only doing what my physical therapist allowed.


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## NaelC (Feb 4, 2019)

Great feedback. Thanks - keep it coming!


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## NewEnglandRunner (Dec 11, 2018)

I'm just over 9 weeks since my grade 3 separation. This is my last week of 4 weeks (twice a week) of PT, and ROM is almost back to normal. Can't do any weights other than very light but I'm supposed to keep doing the PT exercises in the gym at least twice a week and progressively increase weight to tolerance level. I've running for almost 3 weeks now because I'm training for a marathon in just 4 weeks, so I have no choice. Both Dr. and PTherapist authorized running to tolerance level, it starts bothering me after 40-50 min of running, then hurts more after 1h but not terribly. Lowering the arm to a more relaxed position helps reducing the pain. My case will likely require more time for full recovery because I also had a fracture in the coracoid process of the scapula (shoulder blade), which ruled out surgery because they use that part of the blade to anchor the separated clavicle (collar bone). Dr and PTherapist says it may take a whole year until I'm completely pain free doing upper body strengthening or running, let alone lifting heavy weights.


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## starry (Jun 9, 2009)

Had my grade 3/4 exactly 3 months ago, Nov 4. I'm doing pretty well. What i've now found is that it is sort of a non-linear recovery. I have weeks where I'm feeling really good, then i had a week like last week, where i traveled from New England to LA, and it really bothered me out there for whatever reason. Maybe it was from lifting my heavier carry-on into the bin at a weird angle, or whatever, but that's how it seems to go. All of a sudden i'll have a bad couple of days. Not terrible, but...

It sort of bums me out when that happens. You get really impatient and after a couple of months you think "i should be pretty much all good, right?" but i don't think that's the way it works. It's those times that i start to wonder about surgery, but then that thought leaves me when i have a good week. I know surgery is a bit of a last resort thing, best evaluated maybe after 6 months or a year or something.

Ok, so for:

riding: i was good to ride (road) 1 month after injury, basically. It got cold here so i really just did a few short rides, and mainly cause i was freaked out a little. Mainly did trainer and ran...Only recently have i don't some gravel single track (not technical) and fireroad. It seems to mainly be fine. I did like 20 miles today of a lot of off road, and it started to get a little barky, but not bad. Really haven't done technical mtb yet. I really think i'm gonna wait until spring on that. trails are mainly not good to ride on anyway right now. 

Gym stuff: I've mainly been light, and i've been doing only machines (doing bar pull downs for back, chest machine light), except for 15 pound dumbells for shoulder press. I was kinda hitting it a little hard for maybe too many times a week, and i've actually taken a step back and gone lighter, and just twice a week now, after i've had these bad spells. I honestly haven't been back to bench yet and i don't know when i will. I tried a close grip pull up and it felt kinda shitty. I also have done some pushups, and they are weak. My shoulder kind of feels like wooden and stiff when i do them. Hard to explain, but that's the word that comes to mind. If i continue to have good days consecutively, i am going to start to ramp it up soon and push through and do some serious pushups. I love dips, but haven't tried those, either. All those full body weight exercises seem kinda hard now. Hope it gets better. 

All in all, it's ok. Still trying to get used to the pretty prominent hump/step look to the clavicle, especially when i roll the shoulder forward. Weird stuff. And definitely weird angles when you pull something (like pulling on ski boots, or just heavy snow boots) makes it bark in that joint. That AC joint definitely lets you know when you've pulled on something at the wrong angle or hand position.


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## NewEnglandRunner (Dec 11, 2018)

Glad you mentioned the nonlinear recovery, definitively the case for me, it looks like the stock market, i.e. overall gets better with time but definitively have stretches of days that seem to be getting worse. One day I run for 80 min and the last 20 min were painful, next day I planned for 90 min but thought would not be possible, guess what, run all 90 min with less pain, so obviously the running in the day before did not cause it to be sorer the next day.


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> Glad you mentioned the nonlinear recovery, definitively the case for me, it looks like the stock market, i.e. overall gets better with time but definitively have stretches of days that seem to be getting worse. One day I run for 80 min and the last 20 min were painful, next day I planned for 90 min but thought would not be possible, guess what, run all 90 min with less pain, so obviously the running in the day before did not cause it to be sorer the next day.


yeah it's weird like that. So no surgery for you, with the coracoid fracture - that sounds like good news. And yeah, it's kind of nice in a way that the decision on the shoulder separation surgery is just taken away from you. I do still think non-surgery is best way to go anyway, provided obviously you are healing pretty well and long term is mainly pain free.


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## starry (Jun 9, 2009)

3.5 months removed from my grade 3/4. I think i mentioned i'd been doing light machine work in the gym. It's mainly fine...also light dumbbell presses.

I actually tried pure bodyweight stuff today for the first time. So, ok this will be where the issues lie, at least for now. I tried a regular old, unassisted dip - something i was good and and one of my faves. Total failure. It hurt, and i was wildly off balance while in mid "dip." No go i guess. Really didn't complete even one. 

Pushups - not good at all either. Shoulder feels "wooden" and off balance, like i can't get anything out of it to complete them. 

I didn't try full widegrip pullups but i have to imagine those wouldn't be great. I was doing the bar pulldowns, with "ok" weight (wide grip) and it wasn't terrible.

I know my crash was Nov 4, not that long ago, but i was actually pretty bummed at how i was with simple body weight excersizes.

Shoulder was sore after.

All in all though, my shoulder has been feeling pretty good, when at rest, when running, and when riding (and when doing rather light machine work).

Dips and pushups are going to be a real challenge.


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## NaelC (Feb 4, 2019)

Week 9 mark today.

Did 10 PT sessions spread over 3 weeks, then been hitting the gym ~3 times a week.

As of today, I am able to DB press ~25lbs and plank for ~2:30 
Unable to try other exercises as I also fractured a bone in my other hand which makes it difficult to use for pressing or gripping a bar/dumbell.

But been taking rehab very seriously and working my rotator cuff almost daily with elastic bands and DBs, with a lot of pulling exercises.

I feel a good amount of strength is back but I will only be able to assess once I can make roper use of my opposite hand.

My advice to those going conservative, it is important to immobilize the shoulder joint for at least 2-3 weeks post-injury in order to allow the scar tissue to form properly - even if you feel that you can move freely.


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## NewEnglandRunner (Dec 11, 2018)

starry said:


> All in all though, my shoulder has been feeling pretty good, when at rest, when running, and when riding (and when doing rather light machine work).


Good to hear! Question, what is the duration of your nonstop running? I'm at the 11-week mark and getting better but still hurts pretty consistently after running for 50-60 min. It is not too bad initially, but gets considerably painful around 80-90 minutes. If I stop for just a few minutes I gain another 20-30 minutes of pain free running.


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## starry (Jun 9, 2009)

NewEnglandRunner said:


> Good to hear! Question, what is the duration of your nonstop running? I'm at the 11-week mark and getting better but still hurts pretty consistently after running for 50-60 min. It is not too bad initially, but gets considerably painful around 80-90 minutes. If I stop for just a few minutes I gain another 20-30 minutes of pain free running.


Yeah, i'm not the runner you are - i run to supplement cycling fitness, and/or only in offseason when i'm either burned out on 3 season riding or it's too cold to ride outside (and i can't face the indoor trainer)...So i'm not the best to ask - after 45 min and 4 or 5 miles i'm done. And it doesn't seem like it hurts really near the end.

Once again, having a couple days now where it feels "not great." i think in general the gym just makes it sore. Always wonder if you should "push through" that or really take a step back. Hard to say. I'm "done" with going to my PT, and he just said "no restrictions" really. I know it's still only been a few months, but i really get the feeling this is something that will always be "with" me, in some form. Which make sense, considering unless you actually get surgery and tie that clavicle back down, you're in effect forever separated. I feel like i will always have some sort of joint pain from time to time with this (and apparently that can still be the case even if you get surgery and tie it back).

I admit if i have to put socks on multiple times a day, my shoulder hates it.


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## tubbnation (Jul 6, 2015)

The acromioclavicular joint, or AC joint, is the bony point on the top of the shoulder. It stabilizes the scapula to the chest, by connecting the acromion on the scapula to the clavicle, or "collarbone". A thick disk of fibrocartilage acts as a shock absorber between the two bones. The surrounding capsule and ligaments give this joint great stability.

Grade 3 - A complete separation of the joint. The acromioclavicular ligament, the coracoclavicular ligaments, and the capsule surrounding the joint are torn. Usually, the displacement is obvious on clinical exam. Without any ligament support, the shoulder falls under the weight of the arm and the clavicle is pushed up, causing a bump on the shoulder. 

So, if you've got a legit grade 3 or higher (like I had), you're pretty much screwed without having surgery (unless you live a mostly sedentary lifestyle). It will be "with you" the rest of your life to a certain degree depending on the demands you put on your body. Even the most mundane movements can now pose problems, aches or pains.

I wanted to avoid surgery but knowing how physically demanding I am of my body, I was willing to take a risk on surgery. Sure glad I did it. I don't experience any aches or pains - whether I'm riding, drumming, lifting, or putting socks on multiple times a day.

I've said it before, and I'll say it again, not one size fits all. Meaning, not all grade 3's, and higher, are the same. People are different. Injuries are different. Etc. However, bottomline, if you've been treating your grade 3 non-surgically for any length of time, and are not liking what's going on with your body (have aches/pains, etc.), and want things to get better, stop wasting time. Do some research, and be informed. Find a good doctor and make an appt. If you don't like the doctor - keep making appts with different doctors until you find one you're happy with.

Btw, not everyone is a good candidate for surgery - it's a long and difficult road to recovery. It will test you mentally and physically. However, you combine a good doctor and surgical repair method, lots of determination and perseverance, you have a much better opportunity of living the lifestyle you want to live free of aches and pains.


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## NewEnglandRunner (Dec 11, 2018)

I read most of the messages in this thread, there are many posts with Grade 3 here with and without surgery and most cases appear to draw a similar conclusion: it takes a long time for pain-free recovery, especially in very active people. My doctor approach was no surgery because in his experience most patients come back to normal (or near 100%) activity with no pain without any need for surgery but he did say if after a year or so it still bothers me while running/riding my bike then we can revisit and discuss the possibility of surgery. It is clear to me that recovery in this injury, in general, is very slow and takes a lot of patient and perseverance.


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## tubbnation (Jul 6, 2015)

People that don't get surgery for Grade 3's; I bet most, if they were being totally honest, would say that they are still experiencing some aches and pains to a certain degree years later - and/or have adjusted their lifestyle to accommodate their injured condition.

On the flip side, there are some doctors and techniques out there that don't serve the patient well.

From my reading, when I was doing research, I think it depends on the doctor, and the technique used.

My "first" specialist approach was no surgery because, like you said, in his experience most patients come back to almost "normal" (around 95%), etc. Well, I decided this dude was a clown - hell, he didn't even ask me to take off my shirt to take a look at anything, or to perform any tests.

After I did some research into doctors, I got a 2nd opinion with another shoulder specialist, and he said, yeah, you definitely want surgery. It didn't take him long to decide this after a few tests.

Why waste time going the conservative route (when you may or may not be happy with the results) when you could use that time to recover from surgery, and start rehabbing in earnest to get back to the lifestyle you ultimately want?


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## starry (Jun 9, 2009)

woodchips said:


> People that don't get surgery for Grade 3's; I bet most, if they were being totally honest, would say that they are still experiencing some aches and pains to a certain degree years later - and/or have adjusted their lifestyle to accommodate their injured condition.
> 
> On the flip side, there are some doctors and techniques out there that don't serve the patient well.
> 
> ...


i do appreciate your take, and obviously your decision has served you well. i really don't know what to say, other than "well see" i guess. It's been little over 3.5 months, and i can't say "no you're wrong" of course, and i can't say you're right. We shall see. It's good to hear your story.


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## tubbnation (Jul 6, 2015)

Both shoulder specialists I saw said whatever you feel at 16wks is what you will feel (more or less) for the rest of your life.

You have a serious injury, and it has not been repaired. The body is trying to do its best without surgical intervention. 

As a result, other parts of the body compensate for the injured area, and sometimes other problems occur as a result. As the kinetic chain is broken, it can sometimes snowball into a worsening condition.

Btw, it's not about if I'm right or wrong, it's simply whatever you're able to live with. 

I got my injury repaired, you have not..., and the results speak for themselves; you are having issues, and I am not.

The doctor that worked on me knows his stuff, and has been utilizing his technique for years with a 100% success rate.

I wish you the best of luck...


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## NewEnglandRunner (Dec 11, 2018)

woodchips said:


> Both shoulder specialists I saw said whatever you feel at 16wks is what you will feel (more or less) for the rest of your life.
> 
> You have a serious injury, and it has not been repaired. The body is trying to do its best without surgical intervention.
> 
> ...


Sorry but that wasn't very nice. I'm glad your decision worked for you but it does not mean it's the right thing to do in every situation. If you go back and read the messages in the thread, you will definitively notice that the statement "whatever you feel at 16wks is what you will feel (more or less) for the rest of your life" is just not true. It can take quite a while to get back to normal, several months to an year.

I'm sure you are confident your doctor "knows his stuff" because it is working after all. I'm not sure what technique he/she used but you are probably aware, since you said you researched the topic a lot, that the literature shows that the outcome of surgical interventions looking at a variety of techniques do not guarantee problem-free for life, nor they show a better profile compared to conservative non-surgical. This is just the most recent but there are others.

https://journals.lww.com/jorthotrau...ersus_Nonoperative_Management_of_Acute.2.aspx

I forgot to mention previously that my doctor also said I'm not a good surgery candidate to begin with because I also had a fracture in the base of the coracoid, which would need to be intact for anchoring the separated clavicle. In fact one of the complications mentioned in patients with surgery is fracture in the coracoid in cases of excessive force/or repeated trauma. But even if I did not have the fracture, he confirmed he would still stand by his decision of conservative treatment based on his experience and I would like to think I can trust him based on recommendations and being one of the Boston Celtics surgeons.

I know there is a risk I will need surgery later on, so be it, but right now at almost 12 weeks it only bothers me when I run over an hour or the occasional soreness depending what I do. I have been back to core/hips strengthening as part of my training routine (lots of plank-type exercises that need shoulder support) with no problems. I'm fully aware my 2 upcoming marathons in the spring won't be the most enjoyable, but surgery would have meant missing both, and trust me, they are both very hard to get in.


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## tubbnation (Jul 6, 2015)

NewEnglandRunner said:


> Sorry but that wasn't very nice. I'm glad your decision worked for you but it does not mean it's the right thing to do in every situation. If you go back and read the messages in the thread, you will definitively notice that the statement "whatever you feel at 16wks is what you will feel (more or less) for the rest of your life" is just not true. It can take quite a while to get back to normal, several months to an year.


I don't know what your issue is but here's what I said, "Both shoulder specialists I saw said whatever you feel at 16wks is what you will feel (more or less) for the rest of your life". In other words, it's not what I believe to be true or not, this is what the doctors told me.

Now, in my case, I didn't need 16wks to go by to determine if I thought it was true or not. I found my condition unacceptable after several weeks and wasn't going to waste any more time.



NewEnglandRunner said:


> I'm sure you are confident your doctor "knows his stuff" because it is working after all. I'm not sure what technique he/she used but you are probably aware, since you said you researched the topic a lot, that the literature shows that the outcome of surgical interventions looking at a variety of techniques do not guarantee problem-free for life, nor they show a better profile compared to conservative non-surgical. This is just the most recent but there are others.
> 
> https://journals.lww.com/jorthotrau...ersus_Nonoperative_Management_of_Acute.2.aspx


This is why I researched the hell out of doctors across the nation.

In general, I think a lot of doctors are just not that good at repairing this injury. That's why the success rates are basically a flip of a coin, and why they typically do not want to operate. In any case, I happened to get lucky finding a doctor in my area that I was satisfied with when talking to him, and allowed him to work on me.

Like I did, people need to find the doctors that are well versed in repairing this injury - the success rates are much higher (than a coin toss).

Btw, I was confident in my doctor because he's had a 100% success rate. This was before he even worked on me. Fortunately, everything has been working out for me thus far, however, there's no guarantee it will be problem-free the rest of my life, and no doctor will make that guarantee (well, except for mine, and maybe others who are just as cocky as my doctor). But, I can tell you this much right now, my quality of life is much better having had the surgery than had I done nothing about it.



NewEnglandRunner said:


> I would like to think I can trust him based on recommendations and being one of the Boston Celtics surgeons.



The first shoulder specialist I saw, who I referred to as a clown, was (and still is) a Carolina Hurricanes surgeon.

Just because a doctor is affiliated with a professional sports team doesn't necessarily mean he has your best interests in mind.


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## NewEnglandRunner (Dec 11, 2018)

woodchips said:


> I don't know what your issue is but here's what I said, "Both shoulder specialists I saw said whatever you feel at 16wks is what you will feel (more or less) for the rest of your life". In other words, it's not what I believe to be true or not, this is what the doctors told me.


Yes, I wasn't implying it was you, what I meant was that your doctor statement is just not consistent with other users of this thread have reported on their conditions. There are many examples earlier on here of improvement way beyond the 16 weeks. Doctors can say whatever they want but real patient experiences always matters, can't ignore those.



> Now, in my case, I didn't need 16wks to go by to determine if I thought it was true or not. I found my condition unacceptable after several weeks and wasn't going to waste any more time.
> 
> This is why I researched the hell out of doctors across the nation.
> 
> ...


I do not think this is simply a case of flip of a coin, there are a few key systematic reviews in the scientific literature pointing out similar outcomes between conservative vs. surgical, I'm surprised those did not came across your extensive research.



> Btw, I was confident in my doctor because he's had a 100% success rate. This was before he even worked on me. Fortunately, everything has been working out for me thus far, however, there's no guarantee it will be problem-free the rest of my life, and no doctor will make that guarantee (well, except for mine). But, I can tell you this much right now, my quality of life is much better having had the surgery than had I done nothing about it.
> 
> The first shoulder specialist I saw, who I referred to as a clown, was (and still is) a Carolina Hurricanes surgeon. Just because a doctor is affiliated with a professional sports team doesn't necessarily mean he has your best interests in mind.




How do you know he has a 100% success rate, that is a very difficult claim to prove. One would have to assume that there was 100% long-term follow-up in 100% of his/her patients, and that every single one never had recurring problems and went to another doctor for further treatment. My first doctor sent me home with a sling saying that my injury should resolve in 3-4 days, I obviously never came back to him since this was obviously something more serious, so he may think his successful rate is 100% too!

Even the most positive scientific data on surgical intervention with very reputable peer reviewed journals showing very high successful surgical intervention notes in the conclusion that _"__complications related to acromioclavicular surgery still may occur"_*

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596186/*

Again, it's nice to know the surgery is working great for you and I like the fact that my doctor kept the surgery door open down the road if absolutely needed, which I could potentially revisit during my training off-season, but looking at testimonials here in this thread and what the scientific data has shown so far, and knowing that no surgeon is perfect, I feel comfortable giving it time to recover naturally. We shall see


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## tubbnation (Jul 6, 2015)

NewEnglandRunner said:


> Yes, I wasn't implying it was you, what I meant was that your doctor statement is just not consistent with other users of this thread have reported on their conditions. There are many examples earlier on here of improvement way beyond the 16 weeks. Doctors can say whatever they want but real patient experiences always matters, can't ignore those.


One size does not fit all, and sure, some might have seen some improvements beyond 16wks, but that doesn't mean that they're necessarily satisfied with their current condition.

Again, I was just relaying what my doctors told me. And be it that my 2nd doctor seems to hit out of the park with the surgery he performed on me, I'm going to believe him over you, and others on this thread. I'm a real patient, and this thread is just a small sampling. Nonetheless, the consistency I see most (within this thread) seems to reflect people who are not satisfied with their condition.



NewEnglandRunner said:


> I do not think this is simply a case of flip of a coin, there are a few key systematic reviews in the scientific literature pointing out similar outcomes between conservative vs. surgical, I'm surprised those did not came across your extensive research.


When you're dealing with doctors who are not well versed at repairing this injury, it basically is a flip of a coin. Hell, my first shoulder specialist pretty much commented as such.



NewEnglandRunner said:


> How do you know he has a 100% success rate, that is a very difficult claim to prove. One would have to assume that there was 100% long-term follow-up in 100% of his/her patients, and that every single one never had recurring problems and went to another doctor for further treatment. My first doctor sent me home with a sling saying that my injury should resolve in 3-4 days, I obviously never came back to him since this was obviously something more serious, so he may think his successful rate is 100% too!


If you're serious about getting yourself repaired, and are interested in my doctor, let me know, and he can prove it to you, or not.



NewEnglandRunner said:


> Again, it's nice to know the surgery is working great for you and I like the fact that my doctor kept the surgery door open down the road if absolutely needed, which I could potentially revisit during my training off-season, but looking at testimonials here in this thread and what the scientific data has shown so far, and knowing that no surgeon is perfect, I feel comfortable giving it time to recover naturally. We shall see


This thread is one small sampling, and most of the people are having some issues to some extent or another (including yourself).

Scientific data I'm more interested in, and others should be to, would come from other doctors who know wtf they are doing with regards to successfully repairing this injury.

Take it or leave it, but just know that there are doctors out there (other than yours) that can help should you decide to help yourself.

I wish you the best of luck...


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## NewEnglandRunner (Dec 11, 2018)

woodchips said:


> This thread is one small sampling, and most of the people are having some issues to some extent or another (including yourself).
> 
> Scientific data I'm more interested in, and others should be to, would come from other doctors who know wtf they are doing with regards to successfully repairing this injury.
> 
> ...


I'm not having issues, less than 12 weeks in and feeling like I'm on track with others despite of my fracture. I got a total different perception reading this thread, most non-surgical people with no issues just like what the literature suggests. Good luck to you too!

*Just edited:* BTW, I was curious to see what your accident was (link below) and it turns out this discussion we are having is completely pointless. You probably had a Grade 5, not the first misdiagnosed Grades 2-3. Any doctor in the world would treat that surgically; that is simply standard operating procedure. The surgical technique you described is also the most standard one, nothing really innovative about it. This is also the one described in much of the scientific literature.

https://forums.mtbr.com/rider-down-...houlder-separation-300318-2.html#post13342412


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## scotts25 (Mar 9, 2018)

Please whatever you do, do not listen to this jackass. Anybody that tries to give an opinion of anybody other than themselves is a clown. I am 18 months no surgery on a 3-5 and other than the bump, couldn't be happier. Elite professional football players (Jordan Reed) have suffered a full separation and opted against surgery and returned to an elite level. Probably not the level of woodchuck, but who is? 

Every case is different, but I have zero restrictions and he is full of nonsense to say the 16 weeks is the full benchmark. Obviously his doctor is a clown too.


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## starry (Jun 9, 2009)

if it was a grade 5, then yes this is sort of a pointless conversation. I bet woodchips will say "grade 3 or grade 5, either way, your not 'fixed'" - ie your collarbone is still floating free range after ligaments ruptured. 

Fair point, and yes obviously true. And to be totally honest it's weird - for me - to accept this notion of sort of "not fixing" it. Look only a more time will tell how i (or NE Runner and others that didn't choose surgery) end up on this. I won't have surgery just because of this notion of not being "fixed" per say, or because of the hump. It will be entirely based on how i feel in another 6 months. Sometimes i'm tracking fine, other times not totally sure.

there are tons of guys on here who are happy they had surgery, and tons who are happy they didn't. 

I guess we're probably going in circles now on it, but either way it's interesting to hear about it. You came on strong with the surgery advocacy - that's fine. It's all about what's important to you individually and what's your tolerance level i guess. 

I know one thing either way - unless i take a real step back from where i am now and/or it suddenly gets MORE sore than it does now on certain days, i am definitely not going to even think about surgery this spring and miss an entire race/rides season. That decision would be hard look at myself come November or so...


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## tubbnation (Jul 6, 2015)

NewEnglandRunner said:


> I'm not having issues, less than 12 weeks in and feeling like I'm on track with others despite of my fracture. I got a total different perception reading this thread, most non-surgical people with no issues just like what the literature suggests. Good luck to you too!
> 
> *Just edited:* BTW, I was curious to see what your accident was (link below) and it turns out this discussion we are having is completely pointless. You probably had a Grade 5, not the first misdiagnosed Grades 2-3. Any doctor in the world would treat that surgically; that is simply standard operating procedure. The surgical technique you described is also the most standard one, nothing really innovative about it. This is also the one described in much of the scientific literature.
> 
> https://forums.mtbr.com/rider-down-...houlder-separation-300318-2.html#post13342412


You have no clue ... but I still wish you the best of luck.


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## tubbnation (Jul 6, 2015)

scotts25 said:


> Please whatever you do, do not listen to this jackass. Anybody that tries to give an opinion of anybody other than themselves is a clown. I am 18 months no surgery on a 3-5 and other than the bump, couldn't be happier. Elite professional football players (Jordan Reed) have suffered a full separation and opted against surgery and returned to an elite level. Probably not the level of woodchuck, but who is?
> 
> Every case is different, but I have zero restrictions and he is full of nonsense to say the 16 weeks is the full benchmark. Obviously his doctor is a clown too.


Name calling - very mature.

I never said 16wks is a benchmark. Reading comprehension is fundamental.

Although I'm done with you, too, I'm glad you couldn't be happier.


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## tubbnation (Jul 6, 2015)

starry said:


> if it was a grade 5, then yes this is sort of a pointless conversation. I bet woodchips will say "grade 3 or grade 5, either way, your not 'fixed'" - ie your collarbone is still floating free range after ligaments ruptured.
> 
> Fair point, and yes obviously true. And to be totally honest it's weird - for me - to accept this notion of sort of "not fixing" it. Look only a more time will tell how i (or NE Runner and others that didn't choose surgery) end up on this. I won't have surgery just because of this notion of not being "fixed" per say, or because of the hump. It will be entirely based on how i feel in another 6 months. Sometimes i'm tracking fine, other times not totally sure.
> 
> ...


It's not a secret what my injury was... and regardless of a high grade 3 or low grade 5, the conversation is far from pointless. Do some research.

In any case, my whole point of posting again here is to actually help others. Why people try to fight me is absurd, and that's what's pointless.

Remember, I was injured just like the rest of you. I, however, decided to take matters in my own hands and find somebody that I trusted would do an awesome job repairing my injury.

There are good doctors out there that actually do good work repairing this type of injury.

For those that actually don't have surgery, and are totally happy with where they are at with their injury - great. I really couldn't be happier. No one wants to have surgery, and not one size fits all. Injuries and people come in all shapes and sizes.


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## starry (Jun 9, 2009)

woodchips said:


> It's not a secret what my injury was... and regardless of a high grade 3 or low grade 5, the conversation is far from pointless. Do some research.
> 
> In any case, my whole point of posting again here is to actually help others. Why people try to fight me is absurd, and that's what's pointless.
> 
> ...


"It's not a secret what my injury was... and regardless of a high grade 3 or low grade 5, the conversation is far from pointless. Do some research."

Don't understand this comment. All i was saying is that isn't it a foregone conclusion that you'd have surgery on a low grade 5, versus the classic "debate" about higher grade 3s...thus, no one would ever debate the desired path if you're diagnosed with that high a grade separation.


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## tubbnation (Jul 6, 2015)

starry said:


> "It's not a secret what my injury was... and regardless of a high grade 3 or low grade 5, the conversation is far from pointless. Do some research."
> 
> Don't understand this comment. All i was saying is that isn't it a foregone conclusion that you'd have surgery on a low grade 5, versus the classic "debate" about higher grade 3s...thus, no one would ever debate the desired path if you're diagnosed with that high a grade separation.


It's not a foregone conclusion either way (i.e., whether it's a high grade 3 or a low grade 5).

I could either go the non-surgical route (which I did for several weeks), or have surgery. With this type of injury, it's a situation many of us are faced with. However, considering how active my lifestyle was (and is), I took a risk with surgery because I didn't like the lack of improvement taking place.

Again, if people are happy with their condition, that's great. However, if people are being honest with themselves, and are not happy with their condition (like I was), and want to do something about it - know that there are good doctors out there that actually can repair this type of injury.

I see lots of people talking themselves into not opting for surgery when they are obviously not feeling good about their condition. It happens, no one wants to have surgery, and people make compromises concerning their condition.

Hell, I was pissing myself when I decided to go for it (the surgery) - it's a big fvckin' deal, and I didn't know what the result was going to be like. However, I did a lot of research into doctors and found some that are pretty damn successful at repairing this type of injury.

Good luck, dude, and to others!


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## NewEnglandRunner (Dec 11, 2018)

woodchips said:


> I see lots of people talking themselves into not opting for surgery when they are obviously not feeling good about their condition. It happens, no one wants to have surgery, and people make compromises concerning their condition.
> 
> Hell, I was pissing myself when I decided to go for it (the surgery) - it's a big fvckin' deal, and I didn't know what the result was going to be like. However, I did a lot of research into doctors and found some that are pretty damn successful at repairing this type of injury.
> 
> Good luck, dude, and to others!


Hey I think we all got it, you had surgery and worked great, good for you, but I think you should stop assuming those of us who opted (or recommended by Doctor) for conservative treatment are not being honest or not feeling good. This thread (the most comprehensive information on AC separation I could find anywhere) is absolutely loaded with Grade 3s with no surgery and very happy, but especially glad for not being sidelined so long because of post-surgery recovery.

This is a bad injury, all right, we all know that, but one good thing about it is that if someone is a clear Grade 3 like I am (confirmed by CT and MRI and 2 doctors), conservative treatment makes sense because the data show that it has similar outcomes as surgery but with the advantage of possible surgical intervention later if needed when it fits better with people's lifestyle (like winter for mountain bikers or the racing/training off-season for runners). There is overwhelming evidence now that most clear Grade 3s or below that treat conservatively never reconsider surgery, but if they do, having the surgery shortly after the injury does not translate into a more positive outcome, i.e. you can have the surgery anytime later if not completely satisfied with the same results.

Frankly, it sounds like you are posting the same thing over and over trying to justify your decision to yourself. Well if that is the case, you should not even think about it anymore because the standard care for Grade 5 is surgery. It's too bad your first Doctor appeared to have misdiagnosed it and you had to wait 7 weeks to find out but that is past now, so enjoy your life!


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## tubbnation (Jul 6, 2015)

NewEnglandRunner said:


> Hey I think we all got it, you had surgery and worked great, good for you, but I think you should stop assuming those of us who opted (or recommended by Doctor) for conservative treatment are not being honest or not feeling good. This thread (the most comprehensive information on AC separation I could find anywhere) is absolutely loaded with Grade 3s with no surgery and very happy, but especially glad for not being sidelined so long because of post-surgery recovery.
> 
> This is a bad injury, all right, we all know that, but one good thing about it is that if someone is a clear Grade 3 like I am (confirmed by CT and MRI and 2 doctors), conservative treatment makes sense because the data show that it has similar outcomes as surgery but with the advantage of possible surgical intervention later if needed when it fits better with people's lifestyle (like winter for mountain bikers or the racing/training off-season for runners). There is overwhelming evidence now that most clear Grade 3s or below that treat conservatively never reconsider surgery, but if they do, having the surgery shortly after the injury does not translate into a more positive outcome, i.e. you can have the surgery anytime later if not completely satisfied with the same results.
> 
> Frankly, it sounds like you are posting the same thing over and over trying to justify your decision to yourself. Well if that is the case, you should not even think about it anymore because the standard care for Grade 5 is surgery. It's too bad your first Doctor appeared to have misdiagnosed it and you had to wait 7 weeks to find out but that is past now, so enjoy your life!


Again, you have no clue, but I still wish you the best of luck.


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## NaelC (Feb 4, 2019)

For those who squat, how long did it take you before you were able to rest the bar on your shoulders/traps?
I am almost 10 weeks post-injury and it still feels uncomfortable to get under the bar, even though I can DB press and have full ROM.
Tx


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## tubbnation (Jul 6, 2015)

NaelC said:


> For those who squat, how long did it take you before you were able to rest the bar on your shoulders/traps?
> I am almost 10 weeks post-injury and it still feels uncomfortable to get under the bar, even though I can DB press and have full ROM.
> Tx


Before my injury, the bar never felt good resting on my shoulders so I always use a bar pad. Started squating again about 14wks (post surgery). No issues.


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## starry (Jun 9, 2009)

NaelC said:


> For those who squat, how long did it take you before you were able to rest the bar on your shoulders/traps?
> I am almost 10 weeks post-injury and it still feels uncomfortable to get under the bar, even though I can DB press and have full ROM.
> Tx


About 16 weeks and i tried long bar squats last week with just 25s on each end, and it was no-go on my shoulder. Not happening. Not sure when or if that will be doable. Switched to just split squats, reverse lunges, and leg press on machine.


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## tubbnation (Jul 6, 2015)

Hit some without the pad tonight, and all felt good. Bar resting on my shoulders without any issues. I normally use a pad, so it was awesome to feel comfortable squatting without the pad.


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## workout2 (Aug 1, 2018)

Hi,

Would anyone mind giving any advice of a well known surgeon that repairs this injury. I am in Europe but if you know somebody in the US I am open to that also.

Thanks for everything


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## koraapbt (Mar 8, 2019)

I had a grade 5 separation back in August. Docs said there was no choice besides surgery for me, I have several Fiberwires, bone anchors and mesh holding it all back together. I fully invested in PT for as long as my insurance let me then continued at home. I have full ROM and probably 70% strength now. I have only ridden a moving bicycle a couple times, but the season is almost here.

My question for the separated shoulder world is about protection. I want to be able to go out and ride as hard as I ever have, keep up with the same friends I always have, but I am fearful of another fall on that shoulder. 

Has anyone found a decent pad, brace, or setup to protect a compromised shoulder from another injury? My surgeon says my ligaments+hardware should be stronger than they were before the injury but I don't feel like testing it. Seems like a pad or pad+shell would help a lot to distribute force and prevent reinjury but I haven't found anything that seemed right.


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## tubbnation (Jul 6, 2015)

koraapbt said:


> ... Has anyone found a decent pad, brace, or setup to protect a compromised shoulder from another injury? My surgeon says my ligaments+hardware should be stronger than they were before the injury but I don't feel like testing it. Seems like a pad or pad+shell would help a lot to distribute force and prevent reinjury but I haven't found anything that seemed right.


After my shoulder separation surgery, I wore one of these for awhile. The compression felt good, and although I never tested the padding protection, the shirt provided an extra boost of confidence while riding. Eventually, I stopped thinking about the "what ifs" and stopped wearing the shirt. I have taken a couple of knocks to the repaired shoulder since I stopped wearing it, but everything has been fine.


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## teK-- (Dec 3, 2011)

koraapbt said:


> I had a grade 5 separation back in August. Docs said there was no choice besides surgery for me, I have several Fiberwires, bone anchors and mesh holding it all back together. I fully invested in PT for as long as my insurance let me then continued at home. I have full ROM and probably 70% strength now. I have only ridden a moving bicycle a couple times, but the season is almost here.
> 
> My question for the separated shoulder world is about protection. I want to be able to go out and ride as hard as I ever have, keep up with the same friends I always have, but I am fearful of another fall on that shoulder.
> 
> Has anyone found a decent pad, brace, or setup to protect a compromised shoulder from another injury? My surgeon says my ligaments+hardware should be stronger than they were before the injury but I don't feel like testing it. Seems like a pad or pad+shell would help a lot to distribute force and prevent reinjury but I haven't found anything that seemed right.


TBH I'm not sure if any sort of pad or brace is going to give you protection against an AC joint injury. Such is the injury is typically caused by a downward blow on the tip of the shoulder.

If you encase the tip and your collarbone in some sort of rigid pad you are just going to be transferring force to your collarbone and break it in some rather complicated fashion.

If on the other hand you want a brace just to give your shoulder some extra support whilst recovering then there are a few options out there. I used this one for about a month when I first got back on the bike but with persistent physiotherapy I was able to lose the brace as I had built up enough strength.

https://www.ottobock.com.au/orthotics/products-from-a-to-z/acro-comfort/


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## bikeguy0 (Aug 5, 2007)

I just had a grade 4 with large vertical separation repaired on Wednesday. Live in Fort Collins Colorado and Sean Grey at the orthopedic and spine center of Northern Colorado did the surgery for me. He uses the Lockdown technique, and from everything that I have read it is far and away the best way to repair these types of injuries.


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## nfrizz (Sep 20, 2015)

Hi, I joined the club last week with a grade III AC separation. 
There was a meta analysis of studies which looked at operative vs non operative treatment of high grade AC separations. Even though they still have their limitations, a meta analysis like this is the highest level of evidence when trying to answer a clinical question. 
‘Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis.’ Chang et al 2018
The full article is behind a paywall which I have access to but you can read the summary if you google it. 
To summarise, ‘No clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome’


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## tubbnation (Jul 6, 2015)

nfrizz said:


> Hi, I joined the club last week with a grade III AC separation.
> There was a meta analysis of studies which looked at operative vs non operative treatment of high grade AC separations. Even though they still have their limitations, a meta analysis like this is the highest level of evidence when trying to answer a clinical question.
> 'Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis.' Chang et al 2018
> The full article is behind a paywall which I have access to but you can read the summary if you google it.
> To summarise, 'No clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome'


Sorry to read about your injury.

Hook plate stabilization method was used in the study.

If I was currently thinking about surgery, I'd seek out a qualified doctor utilizing a better technique than the hook plate method.


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## nfrizz (Sep 20, 2015)

woodchips said:


> Sorry to read about your injury.
> 
> Hook plate stabilization method was used in the study.
> 
> If I was currently thinking about surgery, I'd seek out a qualified doctor utilizing a better technique than the hook plate method.


Thanks, I survived three days of downhill riding the week before only to get injured playing indoor soccer. 
The article I referenced is not a 'study' in the sense that it didn't look at only one intervention. It is a review article of many different individual studies and reviews. For that reason meta analyses are the highest level of evidence to answer a clinical question. 
The article I referenced encompasses several types of operative managements of high grade (3 or above) AC separations, not just the 'ol hook plate! And 
Bottom line is no clinical difference in functional outcome between getting an op and not getting an op. However, if you don't get an op you will be back to work sooner but with a bump on your shoulder. Also, no risk of surgical complications if you don't get an op. Some people who don't get an op will need one later but it's at the same rate as the need for revisional surgeries in people who got an op to begin with and had a failure. 
I think as the more outdated/suboptimal techniques such as K-Wire and Bosworth Screws get dropped out of future analyses it may start to show more favourable outcomes for surgery. 
At the end of the day the vast majority of us will be fine no matter what we chose to do and you have to make a decision which feels right for you.


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## tubbnation (Jul 6, 2015)

nfrizz said:


> Thanks, I survived three days of downhill riding the week before only to get injured playing indoor soccer.
> The article I referenced is not a 'study' in the sense that it didn't look at only one intervention. It is a review article of many different individual studies and reviews. For that reason meta analyses are the highest level of evidence to answer a clinical question.
> The article I referenced encompasses several types of operative managements of high grade (3 or above) AC separations, not just the 'ol hook plate! And
> Bottom line is no clinical difference in functional outcome between getting an op and not getting an op. However, if you don't get an op you will be back to work sooner but with a bump on your shoulder. Also, no risk of surgical complications if you don't get an op. Some people who don't get an op will need one later but it's at the same rate as the need for revisional surgeries in people who got an op to begin with and had a failure.
> ...


I ignored data from doctors utilizing less desirable techniques (such as the hook/plate method in the article you referenced), and found a good doctor utilizing a good technique.

You're right about one thing, you have to make a decision which feels right for you.

I wish you the best of luck.


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## Razorclaw (Aug 19, 2008)

Hello AC separation gang. I wanted to share my story as I have read this whole thread and nobody is doing quite what I am doing for my G3 separation. People have had questions about it, but I have seen no answers, so I will share my experience thus far (3weeks since injury tomorrow).
Like many of you I got my separation doing what we love, mountain biking! Was going downhill, clipped a tree with bar end on a drop where you must thread the needle between 2 trees. I got pitched, bike stayed between the trees, went for the ol’ tuck and roll, landed on my Rt. shoulder extremely hard, and just stopped, hit my head so hard I thought for sure I broke my helmet, but I didn’t. Now a FOX helmet guy for life! Went to E/R, said I had G3 AC sep., got in with my ortho. the next day, he has fixed my ankle (plate and screws) and my detached bicep (pin in rt. arm) in the past. He also has patched up 3 others I know personally, saved by buddy’s arm. Point is, I trust him. He basically said no surgery, no sling, unless I was in too much pain and if it hurts don’t do it, to let pain be my guide. He had a separated shoulder himself & didn’t have surgery. I asked if I should wear a brace or anything and he said he has tried everything and nothing makes a difference. I felt like he was pretty nonchalant about the whole thing.
I then remembered I had a new MTB buddy who had an G3 AC sep. a year ago. I called him and he said his doc told him to stay in a sling for 6wks. then start rehab. He is 100% now. Since his treatment was so much different than mine, I didn’t feel like I should just “not do what hurts”. I went to academy to look for a shoulder brace, they didn’t have one that fit, but I saw the KT tape and thought that that might help. Looked up taping AC sep. and found some good info., I bought the tape. Got home and found a decent shoulder brace online and ordered it. Started taping my shoulder on Day3. Basically I would push my clavicle down as far as I could and have my wife stretch a full strip of KT tape 100% and tape my clavicle down with the tape going over my shoulder like a backpack strap, then I would take a ½ strip and tape it the opposite direction (from my neck to my shoulder @ 100% stretch). This made me wonder if there was some kind of device to hold the clavicle down. I ended up finding clavicle support/posture correcting device online (basically an adjustable figure 8 strap). I ordered it.
I got the clavicle brace a few days later and started wearing it (day 7 since injury). I did notice that with my shoulder taped down certain movements like washing hands and drying hands with arms extended would cause the ruptured tendons to rub on each other causing discomfort, so I tried to do movements like that with my hands close to my body. With the brace on this discomfort was even worse. I figured this meant that the tendons may be close enough to heal better than if they weren’t. The brace was super uncomfortable to wear all day. I could wear it ½ the day, and would have to take it off. Then I thought an under shirt would help, which it did, but I still couldn’t wear it all day. Then I decided to try a dry-fit shirt as an undershirt and this helped a lot. I could now wear the brace all day. It was now 2 weeks since the injury. With the tape and brace combined, my clavicle was almost all the way down. I also started taking amino acids and doing ROM exercises, even though I never really lost my ROM. I did not do movements over my head and I tried not to reach across my body. Within a few days the rubbing tendon discomfort was better. 
I took the tape off last night which was 19 days since the injury, 6 consecutive days of wearing the brace all day and 16 days of taping. To my amazement it looks like all my efforts are paying off. The bump was noticeably lower than it was from when I started wearing the brace. It looks more like maybe a grade 2 injury now, and my shoulder feels more normal when I move it. I wish I could get an x-ray to see the position of my clavicle now to compare the position from the day I was injured. Granted I do not sleep with the brace on, only tape and when I wake up in the morning it does bulge a little more than when I go to bed. I also must add that I still only sleep on my back because with the weight of my body pushes my shoulder forward it aligns my clavicle pretty well, plus I can’t sleep with the brace on, it is hard enough to sleep on my back all night. I also found slightly different taping method. I use two half strips of KT tape stretched 100% in an x pattern over the clavicle while holding it down and one full strip going over the clavicle like a backpack strap. This method feels a little more stable and holds the clavicle down a little better. The end of my clavicle is still tender, so I know I am still healing. Tomorrow will be 3 weeks post injury and it takes 6 weeks for the tendons to heal. I will continue sleeping on my back, taping and wearing the brace for the next 3 weeks and hopefully all this effort will pay off. I will keep everyone updated as I progress.


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## teK-- (Dec 3, 2011)

Razorclaw said:


> Hello AC separation gang. I wanted to share my story as I have read this whole thread and nobody is doing quite what I am doing for my G3 separation. People have had questions about it, but I have seen no answers, so I will share my experience thus far (3weeks since injury tomorrow).
> Like many of you I got my separation doing what we love, mountain biking! Was going downhill, clipped a tree with bar end on a drop where you must thread the needle between 2 trees. I got pitched, bike stayed between the trees, went for the ol' tuck and roll, landed on my Rt. shoulder extremely hard, and just stopped, hit my head so hard I thought for sure I broke my helmet, but I didn't. Now a FOX helmet guy for life! Went to E/R, said I had G3 AC sep., got in with my ortho. the next day, he has fixed my ankle (plate and screws) and my detached bicep (pin in rt. arm) in the past. He also has patched up 3 others I know personally, saved by buddy's arm. Point is, I trust him. He basically said no surgery, no sling, unless I was in too much pain and if it hurts don't do it, to let pain be my guide. He had a separated shoulder himself & didn't have surgery. I asked if I should wear a brace or anything and he said he has tried everything and nothing makes a difference. I felt like he was pretty nonchalant about the whole thing.
> I then remembered I had a new MTB buddy who had an G3 AC sep. a year ago. I called him and he said his doc told him to stay in a sling for 6wks. then start rehab. He is 100% now. Since his treatment was so much different than mine, I didn't feel like I should just "not do what hurts". I went to academy to look for a shoulder brace, they didn't have one that fit, but I saw the KT tape and thought that that might help. Looked up taping AC sep. and found some good info., I bought the tape. Got home and found a decent shoulder brace online and ordered it. Started taping my shoulder on Day3. Basically I would push my clavicle down as far as I could and have my wife stretch a full strip of KT tape 100% and tape my clavicle down with the tape going over my shoulder like a backpack strap, then I would take a ½ strip and tape it the opposite direction (from my neck to my shoulder @ 100% stretch). This made me wonder if there was some kind of device to hold the clavicle down. I ended up finding clavicle support/posture correcting device online (basically an adjustable figure 8 strap). I ordered it.
> I got the clavicle brace a few days later and started wearing it (day 7 since injury). I did notice that with my shoulder taped down certain movements like washing hands and drying hands with arms extended would cause the ruptured tendons to rub on each other causing discomfort, so I tried to do movements like that with my hands close to my body. With the brace on this discomfort was even worse. I figured this meant that the tendons may be close enough to heal better than if they weren't. The brace was super uncomfortable to wear all day. I could wear it ½ the day, and would have to take it off. Then I thought an under shirt would help, which it did, but I still couldn't wear it all day. Then I decided to try a dry-fit shirt as an undershirt and this helped a lot. I could now wear the brace all day. It was now 2 weeks since the injury. With the tape and brace combined, my clavicle was almost all the way down. I also started taking amino acids and doing ROM exercises, even though I never really lost my ROM. I did not do movements over my head and I tried not to reach across my body. Within a few days the rubbing tendon discomfort was better.
> I took the tape off last night which was 19 days since the injury, 6 consecutive days of wearing the brace all day and 16 days of taping. To my amazement it looks like all my efforts are paying off. The bump was noticeably lower than it was from when I started wearing the brace. It looks more like maybe a grade 2 injury now, and my shoulder feels more normal when I move it. I wish I could get an x-ray to see the position of my clavicle now to compare the position from the day I was injured. Granted I do not sleep with the brace on, only tape and when I wake up in the morning it does bulge a little more than when I go to bed. I also must add that I still only sleep on my back because with the weight of my body pushes my shoulder forward it aligns my clavicle pretty well, plus I can't sleep with the brace on, it is hard enough to sleep on my back all night. I also found slightly different taping method. I use two half strips of KT tape stretched 100% in an x pattern over the clavicle while holding it down and one full strip going over the clavicle like a backpack strap. This method feels a little more stable and holds the clavicle down a little better. The end of my clavicle is still tender, so I know I am still healing. Tomorrow will be 3 weeks post injury and it takes 6 weeks for the tendons to heal. I will continue sleeping on my back, taping and wearing the brace for the next 3 weeks and hopefully all this effort will pay off. I will keep everyone updated as I progress.


My understanding of AC separations is that the ligament (once completely severed) doesn't heal back together unless you have very good immobilisation (similar to a bone fracture). If your approach is successful then it is possible that it was not a complete separation (just a bad tear).

I'm about 4 years on with mine I only had a sling for about 5 days then started physio at about 3 or 4 weeks. the collarbone still protrodes slightly but I have done so much rebuilding of that area that all the extra muscle bulk makes it hardly noticeable unless you look closely.

Anyway best of luck for your recovery keep us updated!


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## Razorclaw (Aug 19, 2008)

teK-- said:


> My understanding of AC separations is that the ligament (once completely severed) doesn't heal back together unless you have very good immobilisation (similar to a bone fracture). If your approach is successful then it is possible that it was not a complete separation (just a bad tear).
> 
> I'm about 4 years on with mine I only had a sling for about 5 days then started physio at about 3 or 4 weeks. the collarbone still protrodes slightly but I have done so much rebuilding of that area that all the extra muscle bulk makes it hardly noticeable unless you look closely.
> 
> Anyway best of luck for your recovery keep us updated!


Yes, once fully ruptured a tendon will never heal as it was. But a re-connection does occur by the means of fibrous tissue that eventually turns into scar tissue which is inferior to the original tendon. I figure if the clavicle can heal and become stable in a higher location then why couldn't it heal in a lower location closer to the original joint.
I went to see my PCP for a different reason and I asked him if what I was doing is an exercise in futility and he said it will probably help if I can stand the pain and discomfort from wearing the brace. He said they tried to put them on people when he worked the ER and everyone would take it off from the pain.
What I am doing may not help at all, but I figure I only have one shot at healing and I don't want to regret not trying something that may make it heal closer to the original position.
As far as my injury only being a bad tear, I can only hope. My clavicle is a little more that 100% displaced and my shoulder hangs lower that the other. When I would shrug that shoulder, nothing would happen, until yesterday. Now when I shrug, the shoulder does come up some, so something is re-connecting.


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## teK-- (Dec 3, 2011)

Razorclaw said:


> Yes, once fully ruptured a tendon will never heal as it was. But a re-connection does occur by the means of fibrous tissue that eventually turns into scar tissue which is inferior to the original tendon. I figure if the clavicle can heal and become stable in a higher location then why couldn't it heal in a lower location closer to the original joint.
> I went to see my PCP for a different reason and I asked him if what I was doing is an exercise in futility and he said it will probably help if I can stand the pain and discomfort from wearing the brace. He said they tried to put them on people when he worked the ER and everyone would take it off from the pain.
> What I am doing may not help at all, but I figure I only have one shot at healing and I don't want to regret not trying something that may make it heal closer to the original position.
> As far as my injury only being a bad tear, I can only hope. My clavicle is a little more that 100% displaced and my shoulder hangs lower that the other. When I would shrug that shoulder, nothing would happen, until yesterday. Now when I shrug, the shoulder does come up some, so something is re-connecting.


When the AC joint is severed basically all that holds up the shoulder is the remaining joint (depending on your level of separation) , and your muscles (the traps neck, and to some extent the lats). All the muscles basically work overtime to compensate.


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## AC Straighter (Feb 17, 2013)

I had a grade 3 separation while playing hockey in college. The recommendation at the time was non-surgical. I’m now 39, 20 years post injury, very active, lift weights (pullups, pushups, bench press, etc), still play hockey, have 3 young kids to keep up with. There isn’t a day that goes by that I don’t think about my shoulder or have some kind of pain with it. It just feels heavy, as if it hangs and stretches my trap. Im curious to hear from anyone that has ended up having surgery years out, and how things went. Ive been reading studies and am encouraged by the increase in research into this injury and its treatment.


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## Ricisan (Aug 30, 2006)

My surgeon worked for Jets! 
Been 7 yrs and all is good!

rehab is critical.


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## KingOfOrd (Feb 19, 2005)

Ouch, a lot of pain in this thread. I can relate. I had a few bad moto and mtb crashes when I was younger and blew out my left shoulder. Never got it diagnosed, it kept me away from surfing for about a year and it prohibits me from playing golf. Other than that I feel great, I will experience the occasional partial dislocate but its manageable. Certain movements don't feel great but I still do a bit of weight lifting and I can throw a Frisbee golf disc over 500'. Not sure if there are many disc golfers around here but that's well above average. I've accepted that its something I'll just have to live with and I do my best to balance out the muscles and maintain good posture.


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## AC Straighter (Feb 17, 2013)

Sooo... did u have it repaired after 7 yrs of non-surgical, or had it repaired right away and it’s been 7 yrs? What surgical technique was used?


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## Ricisan (Aug 30, 2006)

I fought the shoulder for about 5 yrs. Finally couldn't take it. Screws had to be put in shoulder for tendon to be tied off to. 3 mos in a brace.
Do yourself a favor and get an ice machine from Amazon, best $ ever spent!
Now that I am retired and have time for the gym.
A pull up is my goal! OMG


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## marzjennings (Jan 3, 2008)

Just finished reading through this thread and it's great to find so many folks sharing their stories with AC injuries. I joined the AC separation club 6 days ago by going over the bars after taking a drop I've ridden before, but this time way too casually. Didn't lift enough and ended up pitching forward and landing on my right shoulder. I got up from the crash pretty quickly, and started checking off the bike and the body and everything felt fine until I put my hand on my shoulder. I could feel something (this was my first major shoulder injury in 30 years of riding) sticking up, a half inch lump on shoulder. There was a lot pain and I could not move or lift with my right arm. A passing rider helped me push my bike off the trail and asked if I needed help. I wasn't thinking clearly and just said no and started to ride the 5 miles home. Initially I held my right arm to my chest, riding left handed, in attempt to minimize shoulder movement, but this was too painful. I found after the first mile it was less painful just to rest my right hand on the bar and keep riding pretty normally. Which makes sense now I know the injury I had. I got home and my wife took me down to the ER. They patched up all the major abrasions (knee, back, arms, shoulder, etc), took a few x-rays and declared I had an AC joint separation with less than 100% displacement. They gave me a sling and told me to wear it constantly for maybe 2-3 weeks and that I should go see my doctor. 
Well it's been 6 days and visiting my doctor yesterday they seem ok with my recovery. On the day I crashed I couldn't even turn my arm for my xrays, everything was really painful. Took Monday off work, not so much because of the shoulder, more because ever section of road rash was still 'wet' and I didn't want to bleed through my shirt. By the fifth day I could shave again if I supported my right hand with my left and wear a normal button down shirt again. As of today I started using KT strips with the sling to really hold the AC in place. I couldn't apply KY strips before as there was too much damage to surrounding skin. So far they do seem to be helping.

Reading through other posts it's great to think I may be back on the bike in 6-8 weeks and possibly hucking fully in a few months. I intend to go back to that drop and clear it without crashing this time.

But, as I approach 50 this year I do need to take extra precautions and so I'm thinking of using a shoulder brace. I've ordered a EVS SB05 dual shoulder brace and I wondered if anyone else has used the same brace or similar?


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## teK-- (Dec 3, 2011)

I used this one for about 4 weeks after I did a grade 3 separation.

https://www.ottobock.com.au/orthotics/products-from-a-to-z/acro-comfort/

I chose this one over other designs such as the EVS, because it hardly has any neoprene in it (so it breathes well and less itchy from sweat etc).

On my second ride I completed a 50km XC race through some fairly rough descents, and then a Super D Race the following day. The brace helped immensely.

Good luck with the recovery!


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## Chowder Head (Sep 26, 2010)

Great thread/resource/support group. Two weeks ago I was shredded by the gnar, my family keeps telling me I'm doing it wrong. Just because I've injured myself numerous times, including compound tib/fib, broken ribs on both sides multiple times, broken both hands, grade one AC separation on left shoulder, not to mention the countless broken fingers and abrasions over the years, whatever! Well, now I can add grade 3 AC separation. On my right shoulder to the list. Oh, and add another broken finger to the list







__
Sensitive content, not recommended for those under 18
Show Content





















Doing pretty good two weeks out, have nearly 100% range of motion, with a bit of pain on certain movements still, but getting better.

I got the opinion of three separate orthopedic surgeons and they all recommended against surgery in my case for now unless I have pain or mobility issues in the future.

Thanks for all the info everyone this thread is a great read for this injury.

Matt


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## Felt Ryder (Jul 6, 2018)

I'm 5.5 weeks out from a grade III AC Separation.

Doing some PT and light cable weights...very light. Noticing on pushups and presses, pull downs some weird movement feeling at the rear of the shoulder. Is this normal to feel the light popping and "movement" in the shoulder while in motion during PT?

I have the same rotator pops I did before on top of that so it's a mess in there.


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## humptybump (Sep 17, 2015)

humptybump said:


> Just a quick update on my gr. 3 separation which I'd suffered on my right (dominant) shoulder in Aug. 2017. I decided to go the surgical route after the scapula wouldn't stabilize, went with an allograft reconstruction on Sept 12 of this year, a little more than a year after the original injury.
> ...


Thought I'd come back to post a (hopefully) last note on my Gr. 3 separation story.

It's now 26 months post accident and 14 months post-surgery.

My recovery was mainly uneventful, returning to activity pretty much on schedule BUT I should mention that return to full performance (as in feeling as good as pre-injury) took about a year post-surgery. I did have one incident in the spring where I must of slept on the shoulder in an odd way leading to pain and a visit for xray and a checkin with the surgeon but whatever it was that caused the pain, what did not cause it was anything letting loose from the surgery. The pains of that flareup went away in a couple weeks. I would say the crossover point where my post-surgical outcome was better than pre-surgery was at about 8 months post-surgery. After a full year post-surgery things were definitely much better and I was able to comfortably do the things that involve strong pulling on the handlebars (obstacles, sprinting) which now feel pretty much normal, as in as good as pre-accident. I now get more occasional pains and aches out of my 'good' shoulder than the shoulder that was separated. The one downside that remains is that there is a surgical button on my collarbone, which sticks out slightly and can cause some skin irritation when wearing some backpacks. However I do commute with a light backpack every single day and it doesn't bother me, in fact I never think about it except when I wear a heavier backpack over longer distances.

So overall, a good outcome but I do wish in retrospect that I'd gone straight to see an orthopedic surgeon right after the original injury, as it could have saved that second year of recovery.


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## Slowandfat (Jan 4, 2020)

For the benefit of those reading this thread (and I was one of them a couple of months ago, worried sick over what to expect in terms of my own recovery), I want to add my own experience with an AC separation. I crashed hard December 7, 2019, and was diagnosed with a grade 5 AC separation. I saw two different doctors at Duke, and to my surprise, they both advised against surgery. I couldn't believe it. I spent one month in a sling followed by nearly a month of physical therapy. My strength and range of motion came back quickly. On February 4, 2020, just two months after my crash, I was back on the trail again. The same trail where I injured myself. I was apprehensive about it, but my shoulder held up just fine during the ride. When I finished my hour long ride, I nearly cried tears of joy. So those of you that have suffered an AC separation, don't get discouraged. Even a grade 5 can heal well enough that it doesn't have to keep you from doing the things you love. Stay positive!


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## vitma (Oct 3, 2016)

Joined the AC separation club on September 9th last year. On a non-technical section, I went suddenly OTB and hit the ground hard on my side. Of course, I was furthest away from my starting point but had fortunately only downhill and was able to take a fire road. The diagnosis was a AC separation grade 3. 
I spend a week in a sling and the pain was manageable. Started physical therapy shortly afterwards to keep range of motion and build strength up. No surgery. I was able to go for a 10k run around twenty days afterwards. Surprisingly, I had no pain surfing either. Maybe the wetsuit held everything “in place”? It took me 3 month to hop on my bike again.

Going just like that OTB is creepy. If there had been a jump or drop, it would be understandable. Anyhow, went back where the accident happened and a tree was lying down and the trunk with the roots were sticking out on the side of the trail. I assume that I did not pay attention and hit that tree trunk with my front wheel.

Now five month later, I can still feel my separated AC joint and the bump is visible, but I have no pain or major weaknesses in the shoulder.

Stay safe out there!


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## Tkeeo761 (Aug 16, 2014)

I did not want to join this club but I did on March 11th. Grade 3 doing a big drop went over the bars and slammed pretty hard on the shoulder. We are in COVID lockdown now here in Houston,TX and the surgeon can't do any elective surgeries, but thinks that I may make it with just rehab even though he really wants to do the surgery. Unfortunately I can also not get rehab because of the COVID lockdown, so I am just sitting around sometimes in a sling, but most times not, trying to sleep at night but I am a roll-over-constantly-side-sleeper so that has been trash. 

I had a question though. I have tremendous yellow bruising on my chest under the injury and on my tricep on the side of the injury as well. They aren't bruising I got in the crash, they don't hurt to the touch, but look much more internal? Did anyone else experience this as well?


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## Felt Ryder (Jul 6, 2018)

Tkeeo761 said:


> I did not want to join this club but I did on March 11th. Grade 3 doing a big drop went over the bars and slammed pretty hard on the shoulder. We are in COVID lockdown now here in Houston,TX and the surgeon can't do any elective surgeries, but thinks that I may make it with just rehab even though he really wants to do the surgery. Unfortunately I can also not get rehab because of the COVID lockdown, so I am just sitting around sometimes in a sling, but most times not, trying to sleep at night but I am a roll-over-constantly-side-sleeper so that has been trash.
> 
> I had a question though. I have tremendous yellow bruising on my chest under the injury and on my tricep on the side of the injury as well. They aren't bruising I got in the crash, they don't hurt to the touch, but look much more internal? Did anyone else experience this as well?


Normal gravity bruising. Blood flows down. My entire chest to ribs were yellow for 3 weeks. I didn't get surgery until close to 9 weeks after. You'll be ok. You can lookup basic therapy you can do at home. Perhaps the most important thing is you'll need to get used to the unselltling knowledge your clavicle is detached. And get used to the bump which is just weird. I had two surgeries.


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## Tkeeo761 (Aug 16, 2014)

Felt Ryder said:


> Normal gravity bruising. Blood flows down. My entire chest to ribs were yellow for 3 weeks. I didn't get surgery until close to 9 weeks after. You'll be ok. You can lookup basic therapy you can do at home. Perhaps the most important thing is you'll need to get used to the unselltling knowledge your clavicle is detached. And get used to the bump which is just weird. I had two surgeries.


Thank you for the reply. It is just a weird feeling like my arm and arm muscles just kind of hanging around because of the skin sack. I think I am more worried that I will ride again at some point and do this again because I DO NOT want to do this again.


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## Tkeeo761 (Aug 16, 2014)

I also just watched that video and felt it all over again!


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## Slowandfat (Jan 4, 2020)

Tkeeo761 said:


> I did not want to join this club but I did on March 11th. Grade 3 doing a big drop went over the bars and slammed pretty hard on the shoulder. We are in COVID lockdown now here in Houston,TX and the surgeon can't do any elective surgeries, but thinks that I may make it with just rehab even though he really wants to do the surgery. Unfortunately I can also not get rehab because of the COVID lockdown, so I am just sitting around sometimes in a sling, but most times not, trying to sleep at night but I am a roll-over-constantly-side-sleeper so that has been trash.
> 
> I had a question though. I have tremendous yellow bruising on my chest under the injury and on my tricep on the side of the injury as well. They aren't bruising I got in the crash, they don't hurt to the touch, but look much more internal? Did anyone else experience this as well?


I also had yellow bruising on my chest. It lasted for a month, or more. Hang in there.


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## MXIV424 (May 30, 2018)

I concussed myself and separated my ac 5 weeks ago....grade 3 from a crash on my dirt bike.

Had two orthos tell me no surgery, as well as a nice talk with Dr. G (supercross doc). The doc that gave me the second opinion says he prefers to wait until the injury is at max healing, and then to consider surgery to fix exactly where the pain is...and if it heals without pain then no surgery is needed....which I would prefer

The biggest frustration was the ER and the first doc not telling me I needed to keep it slung. They had actually said I needed to keep it mobile so it wouldn't lock up. In hind sight I should have slung it for 14 days and not done crap, then start with ROM pt stuff. I think not doing that is why I feel behind at this point. 

The only good news is I can ride the road bike now and I don't have too much pain while riding, so at least I won't get too fat sitting around lol


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## Tkeeo761 (Aug 16, 2014)

Three weeks into this now, one weird side-effect is the new chafing on the site where the collarbone now sits higher and subsequently rubs the skin in a new way that's never happened before. Did anyone have this? It isn't every day, but probably three out of seven where by the end of the day it feels like I sat and scraped my shoulder on concrete over and over.


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## eragotte (Apr 14, 2015)

Little bit of a different question for you shoulder separation experts.

I plowed the top of my shoulder into a tree yesterday and decided to go get it checked out today. Doctor called it a grade 1/2 AC joint separation. ROM is pretty good, but it's reasonably painful. Anyone with experience with a more minor separation and getting back on the bike? I did 4 DH laps after the injury yesterday on adrenaline (was a bit painful) and managed okay. Sort of wondering if I can just keep riding and push through it, or if I'm risking pushing it to a more serious tear.

If you all agree pushing through it is dumb, when do you think it's worth riding again? Presumably I don't need it to be 100% pain free.

Thanks! and happy healing to all y'all.


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## Slowandfat (Jan 4, 2020)

I'd rest it for a week or two. You don't want to risk tearing something up because you weren't patient.


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## eragotte (Apr 14, 2015)

Slowandfat said:


> I'd rest it for a week or two. You don't want to risk tearing something up because you weren't patient.


Yeah - not sure I have a ton of choice afterall. It's really stiffened up 36 hours after the injury and is pretty painful. Still interested in other folks experiences with more minor separations. Anyone back on the bike in a week or two? Or mostly longer?


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## MXIV424 (May 30, 2018)

I'm sure you googled the crap out of it...doc saying its a 1 or 2 means you didn't get X-ray or mri? There's big difference. Can you see a bulge or any deformity on the top of the shoulder?

If so, probably grade 2 and you should absolutely immobilize for two weeks, and probably seek PT. My buddy with a 2 from hockey ignored it and he has pain a few years after the event. 

A grade 2 separation is a tear of the ligaments in the most complex joint in your body... take care of it!! If I could go back, I would have kept my arm in a very good sling until I could see a PT doc and believe I'm behind in the healing process by 2-4 weeks by not doing so.


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## MXIV424 (May 30, 2018)

Oh... and ice, lots of ice to reduce swelling


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## eragotte (Apr 14, 2015)

MXIV424 said:


> I'm sure you googled the crap out of it...doc saying its a 1 or 2 means you didn't get X-ray or mri? There's big difference. Can you see a bulge or any deformity on the top of the shoulder?
> 
> If so, probably grade 2 and you should absolutely immobilize for two weeks, and probably seek PT. My buddy with a 2 from hockey ignored it and he has pain a few years after the event.
> 
> A grade 2 separation is a tear of the ligaments in the most complex joint in your body... take care of it!! If I could go back, I would have kept my arm in a very good sling until I could see a PT doc and believe I'm behind in the healing process by 2-4 weeks by not doing so.


I did get an x-ray. Doc said that the level of separation looked like a level 3, but the fact that I rode 4 more DH runs after the injury suggested that it couldn't be a 3. She also said she saw a previously fractured collarbone that had healed, so she assumes that I injured the shoulder previously, potentially a low grade separation, had it heal improperly, and that's why this separation looks worse on x-ray than it feels.

I guess it doesn't really matter. Ice + PT + no biking for a bit. I'll keep folks updated as the weeks pass


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## sturge (Feb 22, 2009)

It took me a week or so before I could even do range of motion for my Grade 3 (also had some strange bruising like you described). Starting at week 2 I did rehab exercises with rubber bands for 2-3 weeks and it progressively got stronger. Some days it barked and I backed off to rest it for a couple days. I did my first trail ride after about a month and kept going from there. It shouldn't take long but everyone is different. It will tell you when you need some time off. I was back to 100% by 3 months. It's been over 2 years and all I have to remember it by is 'the bump'.


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## gdg1 (Apr 10, 2020)

Just wanted to add my experience here as on Mother's Day I became symmetrical, adding a left AC separation to my right AC separation. The right is at least a grade 3 from roughly 25 years ago. No surgery involved, was in an immobilizer for 6 to 8 weeks and took a while to get strength back. Pretty significant bump and can't really carry stuff on that shoulder as it grinds into the clavicle and hurts like the dickens. Because the arm is so far out of socket, I've had to change to a back sleeper as it will do a number on your traps and lats sleeping on that side and pulling it out of place all night. Other than that, range of motion is fine, lifting is fine, etc., though I went slow with things like shoulder presses and still do whenever starting a new weight routine. Went to the ortho a few years ago, and his basic advice was, if you can move the shoulder, don't get surgery.
The left shoulder is probably a Grade 2, maybe a 3, the swelling is still too much to really tell and I skipped the doctor this time as all they did was take my time and my money, but left the pain and lump for me. In any event, this one is ice, ibuprofen, and low activity for a while. Need to shop for a new helmet now too, as I cracked mine (actually waiting for more back-ordered helmet to ship - which I suppose is good as it would have sucked to crater a brand new one). Guess I have time for it to get back in stock.
Anyway, stay safe, and wanted to give some perspective on on long term impacts of a G3 AC. In short, ROM and strength come back, but that heaviness and soreness really doesn't leave but at least for me has been manageable so long as I sleep on my back.


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## RikVan (May 18, 2020)

*shoulder separation grade*

Hey guys,

Could anyone tell what grade is this separation? It s been more than 2 months and still painful. Did not do surgery.


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## Slowandfat (Jan 4, 2020)

I'm pretty sure the doctor has to measure the distance between the bones to determine the grade of separation. Sorry I can't be more helpful.


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## RikVan (May 18, 2020)

I am stuck in a country where doctors are not as strict (in Africa). He just looked at the x ray and said not to worry. Did not even bother doing any measurement. I am not very convinced by his conclusion.


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## MI-XC (Mar 14, 2018)

RikVan said:


> Hey guys,
> 
> Could anyone tell what grade is this separation? It s been more than 2 months and still painful. Did not do surgery.
> 
> View attachment 1333931


That's not that bad at all. Based on the two AC separations (grade 3) I've had, I'd say it's no more than a grade 2. The biggest thing about recovery is allowing it to heal and then regaining range of motion and strengthening it back with physical therapy. What happens so often is people rush back too soon and the injury never heals.

For my grade 3s I was in a sling for 2 weeks and then didn't carry anything in that arm over 5 lbs for another 2 weeks. Following that it was 4-6 weeks of physical therapy. After all that I've fully recovered 100% without any pain or weakness.


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## MXIV424 (May 30, 2018)

Looks grade 3 to my untrained eye. Complete tear of ligament at the joint. 

It was about 10 weeks with good pt and daily workouts before the majority of my pain lessened. 

If you can find a good pt there do it. If not find range of motion exercises online and do those. Don’t even think about weights.


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## MI-XC (Mar 14, 2018)

RikVan said:


> I am stuck in a country where doctors are not as strict (in Africa). He just looked at the x ray and said not to worry. Did not even bother doing any measurement. I am not very convinced by his conclusion.


That's about all he needs to do, no "measurements" needed. You aren't gonna need surgery and the injury isn't bad, so there's really nothing for the doc to do. It's now in the hands of a good PT to get you back to normal.


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## RikVan (May 18, 2020)

MI-XC said:


> The biggest thing about recovery is allowing it to heal and then regaining range of motion and strengthening it back with physical therapy. What happens so often is people rush back too soon and the injury never heals.


I did some research and people do not seem to agree on what to do after injury. I personally did not wear a sling as i was told that sprains heal faster if there is motion in that area (good for blood flow i guess) and did some over head work during 1st month in my house which resulted in very strong pain but i felt better the next day. now i would say i have gained rom of 90%, the hardest is when i try to reach something head high but opposite corner. Then I do hear my bones rubbing against each other.


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## Slowandfat (Jan 4, 2020)

Mine was a grade 5 a-c separation. No surgery needed in my situation. I think you will be fine with a little time.


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## RikVan (May 18, 2020)

Slowandfat said:


> Mine was a grade 5 a-c separation. No surgery needed in my situation. I think you will be fine with a little time.


Thanks. I hope so. I had fair amount of surgeries in my life and do not really wish or can afford to go through that unless i really need it for my swimming.


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## Ft.Rock (May 7, 2020)

And into the club I go. I crashed on April 21st, pedal caught a rock that was hidden under leaves as I was sprinting down a fire road going home from the trails (ugh). I never hit my shoulder but got twisted and thrown onto my forearm. Not a mark on me, no bruise but sure did get that lump. I've had AC separations before, as well as dislocating my clavicle from the sternum twice, so this is not new. My ROM was not bad even right away and the pain was not as bad as in past injuries. Due to Covid and sick of getting ripped off by healthcare I bagged the doctor, it doesn't hurt enough for a break. I did a sling 1 week and lots of icing. Yesterday I attempted to hit a tennis ball with my wife and saw God, but pain went away fast and today I installed an air conditioner with just minor discomfort. I have full verticle ROM and good horizontal if I'm not holding a 12 oz racquet in my hand. Will start bands today and see how it goes. Question - I don't want to do this again, would the EVS shoulder braces help? Every time I've done it I have fallen on forearm/elbow not hitting shoulder, seems a brace may hold it together better in such a fall? Thanks, be well all.


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## .je (Jan 15, 2019)

Hey gang, I slid out and landed on my shoulder, without rolling, in September (10 months ago). It felt OK for a couple days but got worse, so I went to a physiotherapist who prescribed the usual exercises and ice, etc. About a month ago it felt nearly cleared up, but of course I fell again in a similar-but-not-as-bad way, so it put me back a couple of months.

I wake up quite sore for a few minutes, and am careful not to try to sleep on that shoulder. There's weakness with some functional movements, but not as bad as the first time, but my shoulder is sore throughout the day. Doing the same physio exercises helps, but not much. Ice helps more than anything, it's maybe getting better, but slowly.

I think seeing a physiotherapist again would probably be the same as I'm already doing.
Do you recommend seeing a chiropractor if recovery is slow or not happening, or continue as I am, and be patient?


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## Ft.Rock (May 7, 2020)

.je said:


> Hey gang, I slid out and landed on my shoulder, without rolling, in September (10 months ago). It felt OK for a couple days but got worse, so I went to a physiotherapist who prescribed the usual exercises and ice, etc. About a month ago it felt nearly cleared up, but of course I fell again in a similar-but-not-as-bad way, so it put me back a couple of months.
> 
> I wake up quite sore for a few minutes, and am careful not to try to sleep on that shoulder. There's weakness with some functional movements, but not as bad as the first time, but my shoulder is sore throughout the day. Doing the same physio exercises helps, but not much. Ice helps more than anything, it's maybe getting better, but slowly.
> 
> ...


I've had no luck with chiros myself, quality seems to vary with practitioner. I finally broke down and went to a sports med clinic who fixed my wife's shoulder and found out that although I did have an ac separation I also injured my rotator cuff. The exercises I was doing for ac were hurting the cuff so I actually got worse. No way a chiro would have found that though...


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## hamzasahraoui31 (Jul 14, 2020)

Hi fellas
I hope everyone is doing just fine 
I would like to share my experience with grade 3 separation 2 months ago exactly

Was sitting on the back of my friend's scooter when we had a terrible crash 
Being in the back i flew in the air landed on my shoulder 
Did some xray doctor misdiagnosed my case ahe told me go home the bone will go back eventually to the original state what
A doctor 
realize after a week the reason for lump
I start to have the pain only after like 10 days.
You can probably notice below that my clavicle went up and posterior 
Was struggling with pain for almost a month . One day i was trying to push the clavicle my self nicely went down to the original place the i had an immediate pain relief i was so happy i thought i solved tbe problem .
U can see in the second xrays on my left shoulder how the clavicle becomes.
Again after sleeping pops out waking up disappointed. 
Am a side sleeper so when i sleep on my injured side still the other shoulder still kinda dropping which is uncomfortable 
This injury was terrible for me mentally more than physically 
Surgery's results are not that promising just fixing the collarbone down doesn't solve the whole problem which is meeting the clavicle with the acromiom so that the shoulder travel again with the collarbone.

Wish you all healing guys









Sent from my SM-G960U using Tapatalk


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## Slowandfat (Jan 4, 2020)

Hang in there brother, it will get better! Fwiw, I'm also a side sleeper. After some time, I can sleep comfortably on my (injured) side. It's not a pretty sight in the morning, but the bump settles in after a bit. Wishing you a speedy recovery.


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## vitma (Oct 3, 2016)

Had a grade 3 AC separation in September 2019 and also could not sleep on the injured side for several months. 
I am happy to say that I am having no problems in any way now. I still have the bump on the shoulder but maybe it got a little smaller.

Hang in there and wishing you all speedy recovery.


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## vitma (Oct 3, 2016)

.je said:


> Hey gang, I slid out and landed on my shoulder, without rolling, in September (10 months ago). It felt OK for a couple days but got worse, so I went to a physiotherapist who prescribed the usual exercises and ice, etc. About a month ago it felt nearly cleared up, but of course I fell again in a similar-but-not-as-bad way, so it put me back a couple of months.
> 
> I wake up quite sore for a few minutes, and am careful not to try to sleep on that shoulder. There's weakness with some functional movements, but not as bad as the first time, but my shoulder is sore throughout the day. Doing the same physio exercises helps, but not much. Ice helps more than anything, it's maybe getting better, but slowly.
> 
> ...


Hi, was your first injury diagnosed as AC separation? Do you know the grade?
Be careful with forum-diagnosis. What is a relative safe recommendation might be to go to a doctor if your injury doesn't get better in some time.

Good luck.


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## .je (Jan 15, 2019)

No diagnosis the first time I went by what has been written here. Injury didn't feel as severe as people described but healing timelines seemed longer. I font6know what to say really.

Latest visit was diagnosed as 'rotator cuff strain' and that sounds right at least this time.


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## hamzasahraoui31 (Jul 14, 2020)

Am just wondering people with grade 3 
I do standing all day at work
So am not sure will my shoulder be able to handle that after this injury or no.
If so how long will take to be ok to get back to work
Now am 2 months from injury i get pain and discomfort if i walk more than an hour......

Sent from my SM-G960U using Tapatalk


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## hamzasahraoui31 (Jul 14, 2020)

*Grade 3*

After doing tons of researches noticing that tearing the ac joint is not the big problem 
Can you check the muscles around it they all play a big role for stability 
Check how muscles are detached 
Bth can u please share with us old injuries did u grow muscles around !


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## dakid48 (Jul 27, 2020)

Fellas, sharing my story - I am a week out from a Grade 3/5 on my rt shoulder. Front tire slipped out on a dry trail and I fell down the downhill side, boom, on my right shoulder.

Pain was pretty bad day of, went to ER and saw ortho 2 days later. He recommended fiber-wire and having 2nd opinion this week. I stopped wearing the ER provided sling 2 days per advice of ortho. Using my arm probably more than I should but letting pain be my indicator. it's not very painful, seems to be getting slightly better daily as i've been icing and NSAIDs. 

I would enjoy avoiding surgery and the long rehab behind it but am concerned with future pain, limitation, arthritis and falling on it again. I've read some of the folks in the community here with 3's and even 5's not having surgery and find that informative. I'm certainly leaning towards surgery but appreciate everyone's feedback and found this to be quite informative. 

Am i crazy not to have surgery?


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## vitma (Oct 3, 2016)

dakid48 said:


> Am i crazy not to have surgery?


You are crazy like all of us for hopping on a two-wheeled muscle-powered machine and blasting down a mountain just for elevated dopamine and endorphin levels!

I don't think you are crazy considering not having surgery. Get the second opinion and see if he/she also recommends surgery and why.

Hope you heal soon (one way or the other).


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## hamzasahraoui31 (Jul 14, 2020)

Hi
Some new research said stem cells injections can regrow back ligaments 
Anyone here with a good idea on that ?


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## gdg1 (Apr 10, 2020)

*AC surgery*

From my experience, it is rare a doctor would go right to surgery on a 3/5. With that said, my 3/5 on my right shoulder is almost 25 years old and took months to get full movement and functionality back and is still painful (particularly if I don't sleep right) and forget about carrying anything on it (i.e. 2 x 4s etc) as they grind into the end of the clavicle. If I could have had surgery from the onset, I probably would have given the long non-surgical "recovery". I can contrast this to my recent (3 months or so) grade 2 separation of my left shoulder which is healing well and nowhere near as painful or limiting as the right was - though between the shoulder and a sprained wrist at the same time, I am limiting DH and it took a while to get on any significant trails and was riding FS on mellow trails that normally only see my hardtail. Can't speak to arthritis of the joint either way, but haven't particularly noticed it in my shoulders. Exercise and weights are fine, but I take it slow with the increases on shoulder exercises.
To the direct question, it is not crazy to not have surgery, but it will never "recover" as the ligament is torn. Most doctors I've seen (personally and anecdotally) don't recommend surgery unless you have limited functioning after a normal healing period.


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## Tkeeo761 (Aug 16, 2014)

*AC 3 Separation No Surgery*

I got myself a nice grade three separation on a poor line choice on a decent drop in the middle of March. No surgery, sling for two days, then painful virtual PT for a bit that just focused on movements. I have two little kids so I still had to pick them up and use my arm whether it hurt or not. I can do just about everything I did previously, but I cannot do a push up anymore or any pushing movement without pain...that is worrisome and my PT thinks I need to go in and see someone. The bump is still there and I sleep on my side which makes it worse some days. I still can't ride because fast jerky movements hurt like hell still.

My doctor did say, ligaments don't grow back, so I never have to worry about tearing it all up again, it is forever torn...but I can put too much pressure and pop it out of my sternum which would be less than ideal...to be honest, really worried about falling again


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## hamzasahraoui31 (Jul 14, 2020)

Guys how do sleep with a separated shoulder am 3 months post injury can't sleep even on uninjured side cuz it make the injured shoulder dropping which feels painful


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## tantarun (Aug 7, 2020)

Hi all
I'm finding this forum very informative.
2 weeks ago I fell off my bike and sustained grades 3 AC joint separation. As others have already pointed out I have already gained reasonable range of movement and expect to keep doing the same.
I saw opinion from different orthopedic surgeon. One suggested conservative management and the other suggested a surgery in the 1st 3 weeks as there is a higher chance of spontaneous calcification and a better recovery if surgery is done in the 1st 3 weeks.
I am wondering if there is someone out there who had a surgery and accept the inconvenience of a prolonged recovery has any other issues from the surgery.
I also have prominent scapula on the injured site post injury [scapular dyskinesia]. At the moment it is not causing any problems but I am worried it may have some issues in future.
I would like to know if there is someone out there who also has shoulder dyskinesia and is experiencing any problems.

I am aware that there are multiple operations for the surgery and the success rate varies significantly. The surgery that my doctor is recommending is dog bone endobutton surgery.


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## tantarun (Aug 7, 2020)

*Ac grade 3 separation*

Hi all
I'm finding this forum very informative.
2 weeks ago I fell off my bike and sustained grades 3 AC joint separation. As others have already pointed out I have already gained reasonable range of movement and expect to keep doing the same.
I saw opinion from different orthopedic surgeon. One suggested conservative management and the other suggested a surgery in the 1st 3 weeks as there is a higher chance of spontaneous calcification and a better recovery if surgery is done in the 1st 3 weeks.
I am wondering if there is someone out there who had a surgery and accept the inconvenience of a prolonged recovery has any other issues from the surgery.
I also have prominent scapula on the injured site post injury [scapular dyskinesia]. At the moment it is not causing any problems but I am worried it may have some issues in future.
I would like to know if there is someone out there who also has shoulder dyskinesia and is experiencing any problems.

I am aware that there are multiple operations for the surgery and the success rate varies significantly. The surgery that my doctor is recommending is dog bone endobutton surgery.


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## dakid48 (Jul 27, 2020)

updating that i opted for surgey, 8 days out. Had it done at UCSF and feel confident in the department thus far for any Bay Area folks. The following article describes the technique my ortho performed: https://pubmed.ncbi.nlm.nih.gov/30046632/

while being sling-ed up for ~6 weeks before PT ROM begins is far from ideal, i am very glad i chose surgery. All 3 doc's who took a look were pretty confident that this was best route considering i'm 31 and active across the board. why live in norcal if i can't partake in the great outdoors.

upon opening me up, ortho (ben ma) said my separation was one of the more severe he's seen. take a look at x-rays in previous post if interested.

pain isn't bad, sleeping with a few pillows does the trick even though i was a lousy back sleeper. allowed to do a few non-shoulder exercises but ortho is very adamant not to move shoulder and to let it heal. will keep forum posted. lmk any questions.

injury 7/19, surgery 7/31.


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## Radium (Jan 11, 2019)

Good luck to you, dakid. Yours sounds pretty similar to mine over a decade ago. The trick is to never let up on your PT once you are cleared for it.


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## hamzasahraoui31 (Jul 14, 2020)

Radium have u done surgery 10 years ago ! 
If so kindly share your experience with us


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## fatcat92 (Aug 14, 2020)

Hey everyone. I’ve been reading through this thread along with many many ones from other forums and it’s given me a lot of insight. I’m 2 months post injury with grade 3 A/C. Was advised non surgical route but with very little info, and initially ER doc said It would heal and the bump was a muscle that would “reabsorb”. I had already waited 8 hours and was tired so took his word stupidly. 


Took sling off second day cause was told it was only for comfort and began using it lightly (doing dishes, making dinner, cleaning etc) although that was hard and painful I don’t mind pain if I know it’s going to get better. Went back work a week and half later and did “light” work which was not so light stressed my upper back by shoulder a lot but I attributed it to my muscles being overstrained and compensating because of the injury. I left work and haven’t returned, I don’t even know if I can work any job anymore, or do anything really. If I’m up and about my shoulder is the only thing I focus on because it stresses my upper back/neck. I’ve never had upper back pain before. I am(was) very active before this. 


My job is purely physical but that’s besides the point because even walking in a store I get so stressed physically and than mentally nothing else matters. The bump and the pressure and associated imbalance causing soreness/pain is unlivable for me. I’ve spent 5 years trying to get my life back after an accident where my jaw, ribs, and ankle and foot were broken, a long with 4 very visible teeth being shattered At the root and others chipped. $30k+ later in dental work and my teeth are so uncomfortable and don’t look good but I took my mind off of it with exercise and work. Having to rest and sit around all the time with uncomfortable teeth that don’t mesh and hurt isn’t fun.


3 bounces on a friends trampoline that I neglected to see had soap on it and now my entire future is ruined. I’ve been doing PT but how is that going to help me walk again normally? Or not be uncomfortable all the time? I talked to a few different clinics who all said no surgery but they won’t even see me in person. I have a reference to another orthopaedic surgeon I hope soon but I can’t see any path that’s going to be any good. Physio therapist said no surgery was best but would he say that if he had to feel like trash constantly? Before this I would go hard at work come home and do lawn work and then go run/workout or work on various projects. Now I barely leave my room. Hating life a lot right now. I can’t live a sedentary lifestyle. I’m 28 and barely even enjoyed any of my 20s and wasn’t planning on slowing down any future physical activity, in fact ramping up for the next 30-40 years. I’m not a profession athlete, but my job as I’m sure others do as well require a lot more physically than most sports...; But now I’m not even fit to work... anywhere! Even a computer my shoulder kills after awhile. Plus once again I hate sedentary work.


Anyways enough ranting... those who’ve had surgery and are feeling good now do you know how long after your surgery you had it and what surgical procedure they used? And I’m guessing that weird pressure and pain while walking around For a bit never goes away without surgery? Why the **** would they leave people with disconnected ****ing bones and treat them like it’s no big deal. I’ll take drinking through a straw with a broken wired jaw and ribs with a fractured ankle and deep gashes
On my backside and knee over this any day.


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## gdg1 (Apr 10, 2020)

First and foremost, please talk to a professional counselor or hotline. Second, and not to be dickish and I wouldn't say this if the injury occured riding on a trail as we all assume the risk at that point, you may want to speak with a personal injury attorney (I'll likely get flamed for that - to which I'm not planning to respond).
The first doctor was clearly an idiot, although I think for a minor grade 1 that could be possible. For a grade 3, the vast majority are not treated surgically but every case is different. Truth be told, I would have preferred the surgery 25 years ago to not treating. While it is certainly bearable and there is full range of motion and even strength, it is always there, nothing like when it was fresh, but you can feel a low ache and sleeping on it will cause back ache the next day.
Also, mine was immobilized upper and lower arm essentially velcroed to a strap across my chest for 2 to 3 months, not just a sling for a day.


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## mtbD (Sep 1, 2020)

any updates on how it worked out as far as bringing the clavical down?


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## mtbD (Sep 1, 2020)

I wish mine looked like that, I got a boulder on my shoulder


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## vitma (Oct 3, 2016)

@fatcat92 Did the ER doc X-ray your shoulder before he made the prognosis of grade 3AC? Maybe his prognosis is wrong, as he also talked about a reabsorbing muscle?


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## dakid48 (Jul 27, 2020)

Hey all, passing along my update. I am 9 weeks post-op and started PT at 6 weeks. Coming along nicely and have my range of motion back and regaining strength every day. 

I am not able to sleep on right side yet, waiting for 12 week post-op with surgeon to give me the green light and hopefully tell me I can resume all activities. I haven't ridden my mountain bike but have taken my fat-tire ebike out a few times albeit very cautiously. 

I was required to wear a sling for 6-weeks post-op and that was difficult but that's part of living the lifestyle we choose. Very little weird feelings in my shoulder, if any, at this point and am happy with surgery. I do have a bump that will be there forever. I am not sure what wearing a heavy backpack will be like or my reaction to falling on my right side will be when it happens but think I'll be all good. I did have a little clicking in my joint when doing shoulder flexion but that has passed mostly.


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## Ft.Rock (May 7, 2020)

c_dinsmore said:


> i got hit by a car one week ago today and landed directly on the shoulder. i didn't see a doctor because i hate going, it's bad for our companies worker's comp rates, and i knew they would try to make me stay off of it. and i'd rather work if i can. just in the last day or two the swelling in my shoulder went down enough that i could really clearly follow the clavicle and make sure it wasn't broken, but i figured it wasn't because i've had very little pain the whole way through. but i finally with internet research was able to self-diagnose as a level 2 or 3, probably 3 AC separation. i wish i'd known earlier, so i could have taped it for support during that vital first week of healing. i'll still tape it from now on. here are some pictures of the injury, one week after occurence.
> 
> https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00198.jpg
> https://i153.photobucket.com/albums/s230/djustins/Colin and his injury/DSC00197.jpg
> ...


It can be tough to tell with an external picture versus an xray. Mine looked a lot like yours and I suspected a 3 but when I made no progress in 2 months and went to the doc it turned out to be a 2 based on xrays. 8 weeks of PT - mostly using those bizarre suction cups to encourage blood flow, did wonders. This was my 3rd time on this side and I'm back to about 99% after 6 months, but it did seem easier to injure this time.


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## henryspencer (Jul 29, 2020)

I'm sure others have posted along these lines, but I wanted to share that I tried kinesio tape for my grade 3 separation, which happened seven months ago. It really helped to stabilize the joint for a ride, but also made sleeping much more comfortable. Worth a try if you haven't done so! KT Tape has some good YouTube tutorials on how to apply it.


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## Doctorsti (May 25, 2008)

Well I joined the AC club nearly 4 weeks ago riding on a little section of trail I’d never been on in a park I’ve ridden for many years. I’m 41 and riding 20 years and would describe myself as a relatively cautious XC rider that likes to pop off as much as I can and and don’t see many rock or tree obstacles I can’t handle. If it’s a first experience with an obstacle I’ll check it out fully before attempting EXCEPT this time. 3ft wide fallen tree with a skinny built on to its front side and I “assumed” a skinny on the other side and went for it. No skinny and didn’t prepare well enough to pull front wheel up. OTB and shoulder impact and roll. Immediate crunching in my AC area and could not put any weight on the hand. Walked out and got to my Doc and X ray showed AC separation where outside end shifted up only a tiny bit but shifted backward but not all the past it’s attachment. Doc said “probably grade 2 and tore up the capsule but probably not the coracoclavicular ligaments so sling for 2 weeks and then start PT. Now almost 4 weeks out I’m doing rotator cuff strengthening and shoulder stretching both of which are difficult and I don’t have full overhead motion at all and just got to the point I can put a shirt on somewhat normally but slow and painful. Still feel the AC joint crunching around when I try to use my arm for daily tasks and admittedly I’m stressing it more then 5lbs for sure. Can’t sleep on that side as I accidentally did and it was terrible. 

With those that have experience does the AC joint stabilize up more after 4 weeks? Definitely don’t want surgery but want to ride, do HIIT workouts and lift without issue in the future though. Currently I run Kinesio Tape on it, 3 strips stabilizing the end of the clavicle and it helps.


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## Burning Matches (Mar 14, 2011)

Doctorsti said:


> With those that have experience does the AC joint stabilize up more after 4 weeks? Definitely don't want surgery but want to ride, do HIIT workouts and lift without issue in the future though. Currently I run Kinesio Tape on it, 3 strips stabilizing the end of the clavicle and it helps.


Yes, but in my experience it took a lot longer than four weeks. Probably six to eight months before I felt like I was back to 90% strength and motion, and a year later I was back to about 98%. However, I had a grade 3, so you might recover faster. With a grade 2, surgery is typically not even considered. My doctors told me no surgery for my grade 3 and to let it recover on its own with therapy.


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## henryspencer (Jul 29, 2020)

Doctorsti said:


> With those that have experience does the AC joint stabilize up more after 4 weeks? Definitely don't want surgery but want to ride, do HIIT workouts and lift without issue in the future though. Currently I run Kinesio Tape on it, 3 strips stabilizing the end of the clavicle and it helps.


I'm eight months into a grade 3 separation. I've noticed a significant reduction in pain in most activities (scrubbing my opposite armpit remains extremely uncomfortable), but not so much a reduction in instability. It still feels quite wobbly, despite doing my PT religiously.

On sleep, I spent the first six weeks sleeping in a recliner--it was just much more comfortable than trying to sleep in a bed.

One important thing to remember is that the healing process is not linear. You'll have good days and bad. It can be discouraging to have a bad day several months into the injury, but remember that that doesn't mean you're regressing. Sometimes it's just because I've slept on my side for too long, or the barometer is falling and my scar tissue is swelling as a result.

Good luck!


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## DrDon (Sep 25, 2004)

Mine was grade 2. Out a month. Had to cross train. Took a year before I stopped noticing it. The joint is mildly unstable. 


Sent from my iPad using Tapatalk Pro


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## salinity (Sep 14, 2019)

Although there's a ton in here and every case / body is different, the info/experiences in this thread are wildly more useful than what you find when you google "AC separation recovery time". I'm 5 weeks post-incident (slow-motion fall off a short wooden feature on to my shoulder) and my recovery progression plateaued after week 2. I should know how long it takes, as I had a bout of impingement in my other shoulder from a separation that flared up a year later and took 6-months to start feeling better, but man am I getting impatient.

I did get an x-ray the next day that didn't show anything alarming - just "mild hypertrophic arthopathy of the AC joint" (which I can't find much on - don't think I separated this shoulder in the past). I have an ortho in 2-1/2 weeks (earliest available) - I am also seeing a highly recommended PT next week to see what they think in the meantime.

I surely have a separation - the telltale bump is quite evident. At this point I do have decent ROM, though it's not pain-free. Mornings are hell and I haven't slept a full 8 hours since it happened. It takes about 2 hours in the am for my shoulder to "warm up" so I can lift my arm overhead. I do find that smashing trigger points in the back of my scapula relieves the pain and offers a brief moment of full pain free ROM, albeit very temporarily). It seems to be better if I'm (carefully) active, as sitting around with my arm stable results in it quickly becoming still and painful when I try and move. 

I have been back on the bike (about 10-days post incident) - perhaps not the best idea, but I've been taking short low-risk trail rides 3-4 times a week. Riding doesn't cause any pain and it feels better afterwards compared to the days I don't ride (increased bloodflow?). I'm hoping I didn't do more harm than good by riding a bit, but winter's coming around here, so if I'm told to dial it back, it'll be easier to swallow in a month or two. 

I'll post updates, as hopefully shared experiences here will help others (or at least give some comfort in the fact that you're no alone).


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## salinity (Sep 14, 2019)

Curious how fast you all got back on the bike or to other activities? How about posting grade and activity timeline? I'm still undiagnosed (see above post), but surely have a separation of some sort. I'll start:

Grade II (tentative) - currently on week 5
- Days 1-4 sling
- Day 5 + light unweighted ROM throughout the day
- Day 7+ Low-risk trail-rides <1hr
- mostly pain free - thinking of dialing this back a bit, as I was sore after today's ride
- Day 14 + Easy band work (internal/external rotations - no issues there)

I'm thinking of dialing back the bike riding to road and/or smooth fire-road type stuff only - though there's a lack of the latter around me. I ordered a Surly Sunrise bar to be able to run my Wednesday more upright and I can put 29er wheels on it for the road. Might limit overhead ROM as well, as I'm kind of bummed with the recovery plateau over the past few weeks, so may be I was too aggressive. Of course, professional advice will dictate the course as applicable.


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## salinity (Sep 14, 2019)

Well, my shoulder situation is taking a turn the wrong way.. I’ve been taking it easy this past week - no more trail riding - just some paved or gravel roads (picked up a riser bar, so the bike is nice and comfortable for my shoulder). Doing some very light ROM work with little to no weight - so nothing crazy at all.

However, over the past couple of days I’ve developed a consistent deep aching throbbing type pain that feels like it’s originating deep in the shoulder socket and radiates down my bicep and up my neck. It’s quite disconcerting, as it’s not associated with any sort of movement - just happens whenever - even at rest.

Still a week and a half out from ortho appt and, due to insurance deductible resets likely aiming for an MRI early Jan, but this pain development has me worries. I’m 6 weeks out from the injury and seem to be getting worse, not better. Pretty bummed.


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## Ft.Rock (May 7, 2020)

I didn't go to the Dr. for the first 6 weeks and got way worse trying to pick PT/ROM exercises off the internet. Finally went and the PT did several weeks of mostly "suctioning" to get the blood flowing, adding band work really slowly. I did not ride at all during that time. I think I did 8 weeks of PT and by the time I got the MRI I was pretty much fine. For me the key was getting into PT because the exercises I got off the net were not exactly correct for my injury. They suspected RC trauma was an issue even though I had no tear and the exercises I was trying made that worse - right at about the 6 week mark. The PT guy stopped everything I was doing. 8 weeks later I was riding 3x per week, now at 8 months I'm riding 6 days most weeks, mostly pretty tech trails but no drops and I've done a few park days without issue. So that's a grade 2, a PT person can get you straight pretty quickly.


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## Doctorsti (May 25, 2008)

salinity said:


> Well, my shoulder situation is taking a turn the wrong way.. I've been taking it easy this past week - no more trail riding - just some paved or gravel roads (picked up a riser bar, so the bike is nice and comfortable for my shoulder). Doing some very light ROM work with little to no weight - so nothing crazy at all.
> 
> However, over the past couple of days I've developed a consistent deep aching throbbing type pain that feels like it's originating deep in the shoulder socket and radiates down my bicep and up my neck. It's quite disconcerting, as it's not associated with any sort of movement - just happens whenever - even at rest.
> 
> Still a week and a half out from ortho appt and, due to insurance deductible resets likely aiming for an MRI early Jan, but this pain development has me worries. I'm 6 weeks out from the injury and seem to be getting worse, not better. Pretty bummed.


I feel your pain. I am now about 6.5 wks post gradeII-gradeIII injury where I also slow speed up a ramp and OTB on the other side of a large fallen tree trunk. Was super slow and dumb. Landed on my right shoulder and rolled, bike landed on me and didn't think anything of it until I tried to get the bike back up and felt my AC joint shift and clunk pretty severely. Couldn't put any weight through my arm and felt the distal clavicle raised a little. I think I may have pushed it back down into place before walking 2 miles out of the woods and then driving myself to the Ortho docs office where my x-ray revealed a distal clavicle that was pushed posterior or backward a bit. Raised just a little too. Did sling for 2 weeks and then started moving my arm passively and started very light rotator cuff exercises and scapular retraction to try and pull the end of the clavicle back closer to where it belongs. At 6 plus weeks out I can do a lot of things but still can't put a shirt on overhead well and reaching across my body or raising my arm with weight it in produces quite a bit of joint noise and sometimes a little pain. Definitely the AC joint capsule was disrupted as the end is clearly unstable when I swing my arm back and forth in an exaggerated walking motion and if I shrug my shoulder up it elevates maybe half a centimeter or so and when I retract my shoulder blades and depress them it goes back to where it belongs. Doc doesn't think I disrupted or at least disrupted "fully" the coracoclavicular ligaments which there are two of. 
I definitely can't hold myself up in a plank position on hands or elbows due to pain and joint motion that feels really weird and the joint is still tender to touch. I was able to go zip lining, repelling, and carry a 20lb backpack during a vacation I just returned from but it wasn't super confidence inspiring.

I am also very frustrated with the speed of recovery and lack of knowledge on how much more stability I can expect from this going forward. Its unacceptable to me to not be able to do push ups planks or sleep on my right side ever again in addition to feeling like I simply can't even attempt to ride mountain right now. I'm also signed up for 70.3 half ironman next June so this thing will not only have to swim 1.2 miles but sit in aerobars for 3.5 hours or so in the near future.

Doc says I can expect it to stabilize some and I get it that I'm not yet 7 wks post injury and being impatient but I can't help it. I plan to request MRI before the end of the year due to insurance reasons and deductibles. I'm a physical therapist of 16 years and literally never treated a grade II or III AC separation as nearly all shoulder impacts I've seen have been rotator cuff tears, clavicle fractures, or grade 1 injuries so no reference from my professional career to even help me out here. I do know that getting even better scapulothoracic stability and strength is critical to recovery and have been working on pulling my shoulder blades back (scapular retraction) is a key to getting this as stable as possible but I don't know the extent to which the AC joint capsule will scar over and stabilize in the future.

I do find that the more I try to work on strength beyond rotator cuff exercises with my elbow at my side the more I see instability of the AC joint and will put myself in pain so I see a fluctuation in recovery just like you as I try to push this thing further if my body says NOPE. I am also keeping it taped with Kinesio tape using a mechanical correction star technique that you can google. That seems to help quite a bit for normal every day pain relief but tape off or on I can't support my weight closed chain on my hand or oustretched arm. If I carry anything in that arm of 15lbs or more I feel the crepitus and although it's not really painful anymore I know it's doing me more harm then good to push it right now. I plan on giving it about 12 -16 weeks before I even start searching for an experience surgeon depending on what I see in repeat x-ray and the MRI coming up in the next 2-3 weeks. If my X-ray shows less displacement and the MRI (or ultrasound) shows intact coracoclavicular ligaments I won't be pursuing surgery anytime soon but also know that a procedure to stabilize the AC joint with intact coracoclavicular ligaments would likely produce a near normal anatomy if successful but I emphasize "if successful" as there is not good evidence on which procedure or if the 1 year outcome is going to be any different.

If I can help in any way or I find out more along the way I will post here as well. Try to give it a break and cross train as others have said. I'm spending my exercise time running now so that at the least I will be able to crush the half marathon in the Ironman 70.3, if I ever get out of the water doggy paddling, lol.


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## Ft.Rock (May 7, 2020)

Pulling the scapular blades back was a huge thing for me. The physical Therapist had me do that and do some pushups at bench height and it was night and day. I've actually tried to train myself to do that while hitting a forehand and on the rare times I get it right it's just like I was pre-injury. I lucked out on the RC front. Of course this was at least the 3rd time I did it, on top of dislocating my clavicle from the scapular, so my shoulder is probably pretty compromised to begin with. I hope it goes well for you, I do think by the 12 month mark I'll see 99% or so...


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## salinity (Sep 14, 2019)

Good info all - thanks. I’ve started seeing PT, but because of insurance (high copays) I can’t go more than once a week. This guy takes a bit of a different approach too - he’s starting by giving me exercises designed to fix my base hip-core-shoulder alignment to help with overall shoulder mobility rather than focusing on the shoulder explicitly. I’m on the fence with this approach, mostly due to my impatience - I think it would be awesome for both my shoulders to fix my “base” alignment and have better mobility (I surf, so this would be huge), but I also wish he’d give me something to do for my shoulder. I get that he’s likely being careful, as I haven’t been evaluated by an Orthopedic surgeon yet, so we don’t know precisely what’s wrong.

I went for a 10mile bike ride yesterday on mixed gravel, road, and even some well packed cobble beach. Felt ok during and after - certainly no worse, but still felt that deep aching in there. However it lessened for whatever reason once I got home and was generally ok throughout the evening. I also did some serious alternating ice-heat sessions until bed, which seemed to help? Maybe?

The troubleshooter in me is really struggling with what works, what doesn’t. I stopped taking the prescription naproxen (500mg every 12hrs) a few days ago and am wondering if the deep ache was being suppressed by that. Tylenol doesn’t seem to touch it, but a CBD muscle rub my wife had oddly seems to provide some relief. Again, maybe. Thinking of trying out one of those braces or the kinesiology tape.

Suppose I’m going to have to prepare mentally for a much longer recovery than I was anticipating.


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## vitma (Oct 3, 2016)

@salinity I would trust the physiotherapist. I think that the exercises made a big difference in my recovery.

Did you go back to surfing? My PT said that I should have a try but don’t overdo it in the beginning. For me it was surprisingly ok to surf. The hardest part was getting out of the wetsuit with that injury. Maybe the wetsuit is holding everything in place while paddling  ? Check with your PT.


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## salinity (Sep 14, 2019)

Haven’t really tried surfing yet - went once on a small day about 3 weeks in - certainly felt like I shouldn’t be doing it. Paddle stroke was ok, but getting my arm up and back into position sucked. I have gone mat surfing a couple of times (mostly legs there). Not being able to surf is really what is killing me. I just bought a new 5/4 that is an absolute bear to get into - I actually just tried it on again and I definitely need to go ice down after that fiasco! The thought of trying to get in and out of that suit is a big part of what is keeping me from giving it a try. 

I have no problem going through PT - particularly if it’s going to help both shoulders long term. I’m just frustrated that I seemingly haven’t progressed in pain or ROM since week 2. ROM might be slightly better, but sleeping and mornings are still hell.


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## tubbnation (Jul 6, 2015)

Update - it's been over 3yrs since my surgery (injury was initially diagnosed as a grade 2-3 but a third diagnosis many weeks later indicated a high grade 3 or low grade 5; injury progressed) and all is well. ROM is excellent. I can sleep on it with no problems, and can also bench and squat without zero issues. As far as durability, I've crashed a few times since the surgery, some at high speed, and the shoulder is still good.


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## Doctorsti (May 25, 2008)

Now 8 weeks post diagnosed grade 2 but feel like it was pushing the limits of grade 2 into a grade 3 or grade 4 as the end of the clavicle progressed backward a bit. Going in for repeat films. Shoulder is really not painful at rest, the shoulder joint pain due to impingement I had after injury is much better but still limits full overhead reach but I can struggle through getting a shirt on or off pretty normal. I still am pretty weak overall on that side so really lifting pushing or pulling stuff that's 40-50lbs isn't happening. I have started side lying rotator cuff exercises that don't hurt and TRX rows without pain. 

BUT.... if I try to cross my body with any force and I mean any like holding the phone up against my ear or brushing my teeth the clunking and feeling of dislocating clavicle is AWFUL. Makes me a bit queasy. For the most part I feel like this situation is plateaued and I'm getting the sinking feeling I'm headed for surgery. Anyone else have this symptom?


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## tgb68 (Mar 21, 2006)

tubbnation said:


> Update - it's been over 3yrs since my surgery (injury was initially diagnosed as a grade 2-3 but a third diagnosis many weeks later indicated a high grade 3 or low grade 5; injury progressed) and all is well. ROM is excellent. I can sleep on it with no problems, and can also bench and squat without zero issues. As far as durability, I've crashed a few times since the surgery, some at high speed, and the shoulder is still good.


Did you have the surgery right at the time of injury. Sounds like mine is like yours grade 3 almost 5. I did the physical therapy thing and its ok, but still have issue with sleeping on that shoulder, no power from shoulder. Surgeon pushed off surgery. I'm at 4 months from injury. I was hoping for better results as time progressed.


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## tubbnation (Jul 6, 2015)

tgb68 said:


> Did you have the surgery right at the time of injury. Sounds like mine is like yours grade 3 almost 5. I did the physical therapy thing and its ok, but still have issue with sleeping on that shoulder, no power from shoulder. Surgeon pushed off surgery. I'm at 4 months from injury. I was hoping for better results as time progressed.


I did not. I busted my ankle the same time as the shoulder, and the ankle had first priority. I got a couple of screws inserted and after that healed a bit, I then went to get the shoulder worked on; it was about 2 to 2.5mos after the initial injury occurred.

Like you, as time progressed, I was hoping for better results but I did not find the progression acceptable, so I advocated for myself and pushed for surgery.


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## hamza ba (Jul 13, 2020)

tubbnation said:


> Update - it's been over 3yrs since my surgery (injury was initially diagnosed as a grade 2-3 but a third diagnosis many weeks later indicated a high grade 3 or low grade 5; injury progressed) and all is well. ROM is excellent. I can sleep on it with no problems, and can also bench and squat without zero issues. As far as durability, I've crashed a few times since the surgery, some at high speed, and the shoulder is still good.


Your feedback about having surgery? And what do you think the reason of having a successful surgery


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## tubbnation (Jul 6, 2015)

hamza ba said:


> Your feedback about having surgery? And what do you think the reason of having a successful surgery


Regarding your first question, can you provide specifics regarding the surgery feedback you're interested in?

Regarding the second part of your post, there were at least a few reasons, or bullet points, as to why my surgery was a success, and this is not in chronological order; 1) the doctor 2) his surgery technique (which excluded hardware; that was very important to me) (3) my mental game, and 4) my physical game. That said, you could have the greatest doctor in the world, with the greatest technique, but if you don't have the mental and physical game to follow through, the odds increase of the surgery not being as successful as it could be.


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## Surfnturf6 (Dec 29, 2020)

Hey guys! I’ve been reading this forum for weeks now, it really is the most detailed guide on the internet to shoulder separation. 6 weeks ago today I fell off my skateboard and did a grade 2 (noticeable bump, completely tore the ac but not the cc ligaments) doctor had me take the sling off at week 4. I’ve been religiously stretching and doing the pt I was given since the sling has come off. It seems the bump gets bigger with some actions and smaller with others. I can freestyle swim relatively comfortable, but breaststroke still hurts a bit. I AM AN AVID SURFER And have surfed most hurricane swells in recent years(surfing for 4-7 hours at a time no breaks) I Have been since I was a kid, I’m really scared surfing will be tough. doc said I should be fine to surf by the end of January (says the guy who has never paddled out the back on a big day), but my body tells me paddling out on a big north east swell will not be possible. I’m worried about duck dives, treading water and then getting back on my board, and obviously popping up. I cannot find anything having to do with surfing and this injury. I have a big Mexico trip planned next year where I want to paddle out in well overhead pumping waves. I’m 26 years old and it seems I now have a bad shoulder, lucky for me because of surfing I do have a solid foundation of stabilizer muscles. Any insight would be appreciated. If I didn’t surf I’d say my shoulder is at 95% but no surfing means 0% as far as I’m concerned. Thanks guys! You’ve already been more helpful over the past 6 weeks than anyone else!


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## Surfnturf6 (Dec 29, 2020)

salinity said:


> Haven't really tried surfing yet - went once on a small day about 3 weeks in - certainly felt like I shouldn't be doing it. Paddle stroke was ok, but getting my arm up and back into position sucked. I have gone mat surfing a couple of times (mostly legs there). Not being able to surf is really what is killing me. I just bought a new 5/4 that is an absolute bear to get into - I actually just tried it on again and I definitely need to go ice down after that fiasco! The thought of trying to get in and out of that suit is a big part of what is keeping me from giving it a try.
> 
> I have no problem going through PT - particularly if it's going to help both shoulders long term. I'm just frustrated that I seemingly haven't progressed in pain or ROM since week 2. ROM might be slightly better, but sleeping and mornings are still hell.


any luck with the surfing now? I hope you get better.


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## celswick (Mar 5, 2020)

I just found this thread. It just popped up on my feed as if by magic!

I had a grade 3 AC separation in an OTB crash 3 weeks ago. Didn’t require surgery and I’ve gotten almost full ROM and almost zero pain at this point. Only slight discomfort during/after doing household chores, LOL. 

Doc says my ROM recovery has been amazing and now he wants me to start physical therapy. 

I’m also a surfer and I’ve noticed a few other surfers posting here. I look forward to reading this thread over the next several days. 


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## FJSnoozer (Mar 3, 2015)

celswick said:


> I just found this thread. It just popped up on my feed as if by magic!
> 
> I had a grade 3 AC separation in an OTB crash 3 weeks ago. Didn't require surgery and I've gotten almost full ROM and almost zero pain. Doc says my ROM recovery has been amazing and now he wants me to start physical therapy.
> 
> ...


I have more ROM in my separated shoulder than my other. I had a very severe grade 3. No issues side sleeping.

I did PT and it was helpful. Always extremely painful the next day. The unique spot where there was bone kn bine contact eventually either ground down, or the nerve shut itself down exactly as my PT said it would. I stopped having those "yeow!" Moments after about 6 months.

4-5 weeks on the trainer before it was stable enough to ride road. 
Road rides resulted in a dull nerve pain after 90 minutes in a static position. 
Mtb rides has their moments of severe pain for quite some time.

I was racing MTB in less than 2 months, but i really wasnt 100% until about 6 months after. It seemed like the end of the road when it first happened and my bone was floating in and out.

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## salinity (Sep 14, 2019)

Surfnturf6 said:


> any luck with the surfing now? I hope you get better.


Well, my Ortho actually suspects rotator cuff injury and minor to no AC separation, despite the large "horn" on my left shoulder. I'm putting my money on some combination of cuff and labrum tear, as there is a clunking the the back of my shoulder that is very consistent and reproducible. I have an MRI tomorrow and follow up on Wednesday, so hopefully there will be some answers by then. I'm preparing myself mentally for surgery, and at this point, since it's been 3 months with little progress, I'm actually hoping for it.

I can still bike ok - though I'm still being quite conservative. I've been out lately on my fat bike set up rigid with either fat or plus tires and it's felt ok. No big drops or rock rolls, etc. (and NO SKINNYS), but I can pull up the front end to get over some small obstacles, etc. without too much discomfort. Shoulder feels ok afterwards too - no discernable extra pain etc.

Surfing still sucks. Actually, surfing is great - not being able to do what I want out there sucks. I went out twice last weekend - I caught a few and it was good to get out there (particularly realizing my surfing days might be numbered for quite a while if I'm due for surgery). The biggest issue is that I still have trouble matching the speed of the wave to catch it. I can still paddle around slowly if I'm deliberate, but short fast strokes (with the necessary quick recovery strokes) with the injured shoulder, are very painful. Pop up is fine, and I don't seem to be any worse afterwards. It's just the paddling into the wave that is restrictive.


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## salinity (Sep 14, 2019)

~2cm full thickness rotator cuff tear (supraspinatus). In the process of scheduling surgery for 15-Jan. Maybe be riding again by fall? Man, the decision to try to clean that funky little bridge for a 3rd time changed my life.


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## Doctorsti (May 25, 2008)

follow up on my grade II AC separation.

I am now 11 weeks out from injury. My first x-ray seemed to indicate grade II and I had a follow up at 9 weeks out that looked about the same. they also did a view where I held a 10lb weight in my hand. No change with or without weight so MD was pretty sure the coracoclavicular ligaments were intact which puts me solidly out of surgical consideration.

My general mobility is pretty good, maybe 80% of the uninjured side. My pain level is pretty much zero BUT I still get a lot of crunching and shifting when I try to use my arm across my body or support weight through my arm like in a plank or something. The end of the clavicle just shifts backward and grinds against the acromion. It feels really horrible and unstable but not necessarily painful. Maybe a 1-2/10 pain. I can take a shirt of and on normally although a little slower then I was before but can do it overhead so that's positive. I cannot sleep on the injured side as the end of the clavicle just shifts backward and feels like it's poking out behind the acromion. Not great. Woke up one time finding I was laying on that side and that's about the worst pain I've had in weeks and it was like a 4/10. I have a small bump from it being raised but it's really small. If I retract my shoulder blades the shoulders look completely symmetric and normal but If I shrug my shoulders the bump is very obvious. Still tender to touch if I push directly on the AC joint (or lack of one at this point).

Overall I have to say I'm really discouraged despite the consistent slow progress. I really thought I would be better by now and have a little more stability considering I read people with grade II injuires that are bench pressing and lifting by now. I can do some isolated rotator cuff exercises on my side and with bands and some TRX low row but no pushing over overhead press and certainly not anything that activates my pec with any kind of force.

Doc said I can get an injection to help with pain and if nothing ever progresses past this then will be a candidate for distal clavicle excision which doesn't really repair the joint it just removes it.

Can't imagine riding right now and that fact that I can't lift weights, do a HIIT program, or ride my bike is making me REALLY depressed.


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## celswick (Mar 5, 2020)

It's been one month to the day from my grade 3 and I rode the trail for the first time yesterday. Still very cautious but no pain. I've been riding on the road for a couple of weeks, just short 4-5 mile loops around the neighborhood, and those kept me sane.

No surgery and no therapy. Went to the PT and he showed me some exercises (that I had been doing already) so he said just keep doing what I've been doing. 100% ROM and only slight weakness in that shoulder.

Yesterday and today rode to the trails, did a little single track, and rode back home; 13-14 miles each day.

I have to say I am pleased and beyond thankful for my quick recovery.










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## Doctorsti (May 25, 2008)

celswick said:


> It's been one month to the day from my grade 3 and I rode the trail for the first time yesterday. Still very cautious but no pain. I've been riding on the road for a couple of weeks, just short 4-5 mile loops around the neighborhood, and those kept me sane.
> 
> No surgery and no therapy. Went to the PT and he showed me some exercises (that I had been doing already) so he said just keep doing what I've been doing. 100% ROM and only slight weakness in that shoulder.
> 
> ...


Like how does this happen in a more severe case? I'm just shocked. I'm triple your time and lower grade and can't do anything athletic but run. Do you have no pain at the AC joint? I don't have a cuff tear, I didn't dislocate glenohumeral joint, no acromion or scapula fracture that they can see. Exercising since week 4 which was the absolute earliest I could get rid of the sling and not chew on pain meds all day. What the heck. Awesome for you though. I wish.


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## FJSnoozer (Mar 3, 2015)

Doctorsti said:


> Like how does this happen in a more severe case? I'm just shocked. I'm triple your time and lower grade and can't do anything athletic but run. Do you have no pain at the AC joint? I don't have a cuff tear, I didn't dislocate glenohumeral joint, no acromion or scapula fracture that they can see. Exercising since week 4 which was the absolute earliest I could get rid of the sling and not chew on pain meds all day. What the heck. Awesome for you though. I wish.


I just looked Through Strava the other day. Apparently my first xc race back was 50 days post injury.

I was on the trainer a few days post injury. I tucked my arm into my bib and moved my shifter to the left side of the bars to zwift.

PT once a week and did the exercises they prescribed which resulted in plenty of tough days following PT. My bones were moving around so much with nerve pain and bone on bone catching i thought i might never be able to ride technical terrain again. It all came back better than ever and a thread i posted here asking for feedback helped keep the dream and goal alive.

Two Aleve and a 7% beer. After workouts and before bed did the trick.

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## celswick (Mar 5, 2020)

Doctorsti;

I understand your frustration but I don’t really have an answer for you. I truly am amazed at how how quickly I’ve healed. 

It really has given me an appreciation for the little things in life and has given me renewed focus on my overall health. I need to lose weight (probably 35 pounds) and this has really given me the motivation to do so. 

I lost 25 pounds last year after getting back on the bike, and I’d like to lose another 25-30 in the next six months. 


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## FL mtb (Mar 19, 2016)

Looking back, I was in a similar spot at one month post Grade III:

"One month:

I can run - did 6 miles on the road yesterday.
I can bike - did 12 miles in the woods today without a problem, though I did thump a tree with that shoulder on a tight left turn.
I can do pull ups and push ups with a little soreness right at the AC joint. I can do 5# standing flexion and abduction.
I feel the joint most at rest. I am able to sleep for short periods on the injured side.
Haven't been back in the water yet.
I mowed the lawn and raked the front yard after my ride today without difficulty.
I guess I'm happily surprised with where I am one month into a three month recovery."

I was 48 years old when I had my fall St. Patrick's Day 2016. I can't believe it has been almost 5 years. Still able to surf, swim, MTB, road bike, do yard and house work.


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## Heidi_y (Feb 19, 2021)

This AC separation is no joke. One second I was riding my bike. Next second I was seeing stars. Mine happened in January 31st. I immediately had a giant lump in my shoulder. Pain was excruciating. Thought I popped my shoulder out. Went straight to the emergency room. First the nurses said it was a minor separation and were just going to send me home. I asked them if it's minor then why does it hurt so bad and why do I have a giant bump on my shoulder. They sent me back in for additional xrays. This time I had to hold onto weights while taking photos. There was a lot of cursing due to the pain this caused. The nurses changed their tune and said it was probably grade 3. They still never had me move my shirt to show them my injury and due to covid they sent me home with meds asap.

Saw another ortho Dr. a few days later that said grade 2 and told me to go home and let it heal. Dude never even looked at my shoulder either. Then had a phone appt. With a 3rd Dr. and he talked so much I couldn't get a word in. It was on the phone so he didn't physically look at my shoulder either. He said it was grade 3 and to just let it heal. That you'd just be replacing a lump with a scar.

About 2 weeks passed and the pain improved but I still couldn't reach across my body or lift my arm up past my shoulder without a ton of difficulty and pain. I am a girl so I know the giant lump and drooping shoulder would bother me forever. Plus it's my right arm and I have a crazy wild 2 year old at home to deal with so I wanted another opinion.

Saw another Dr. At 2 weeks and 1 day past injury. He was the first person to actually look at me and not just my x-rays. He said it was grade 5 and scheduled me for surgery 8 days later. I am now 4 days past surgery and waiting very impatiently to feel better. I haven't left my bedroom since I got home. When I stand up it feels like my arm is being ripped off and there is no position I can find to make my arm feel comfortable. They only gave me Motrin and hydrocodone so the pain never gets much better and the medication is making me horribly nauseous. I hadn't thrown up in over 15 years before now.

On a positive note it looks like the bump is gone. Haven't taken the bandages off yet so I don't know how big the scar is. But at least you can't see the scar in my clothes.

Curious if anyone else who has gone through surgery can let me know when I should expect the pain to get better. It has been far worse than expected. Just looking forward to being able to walk more than a few steps without a bunch of pain making me hurry and lay back down.

I attached pictures of my injury.















__
Sensitive content, not recommended for those under 18
Show Content


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## Slowandfat (Jan 4, 2020)

Surfnturf6 said:


> Hey guys! I've been reading this forum for weeks now, it really is the most detailed guide on the internet to shoulder separation. 6 weeks ago today I fell off my skateboard and did a grade 2 (noticeable bump, completely tore the ac but not the cc ligaments) doctor had me take the sling off at week 4. I've been religiously stretching and doing the pt I was given since the sling has come off. It seems the bump gets bigger with some actions and smaller with others. I can freestyle swim relatively comfortable, but breaststroke still hurts a bit. I AM AN AVID SURFER And have surfed most hurricane swells in recent years(surfing for 4-7 hours at a time no breaks) I Have been since I was a kid, I'm really scared surfing will be tough. doc said I should be fine to surf by the end of January (says the guy who has never paddled out the back on a big day), but my body tells me paddling out on a big north east swell will not be possible. I'm worried about duck dives, treading water and then getting back on my board, and obviously popping up. I cannot find anything having to do with surfing and this injury. I have a big Mexico trip planned next year where I want to paddle out in well overhead pumping waves. I'm 26 years old and it seems I now have a bad shoulder, lucky for me because of surfing I do have a solid foundation of stabilizer muscles. Any insight would be appreciated. If I didn't surf I'd say my shoulder is at 95% but no surfing means 0% as far as I'm concerned. Thanks guys! You've already been more helpful over the past 6 weeks than anyone else!


I'm a year out since my grade 5. No surgery. I can surf just fine...but I'm riding small East Coast surf. Just for the record, there was a time when I actually thought my surfing days were over. Be patient and have faith.


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## tubbnation (Jul 6, 2015)

Heidi_y said:


> This AC separation is no joke.
> 
> Curious if anyone else who has gone through surgery can let me know when I should expect the pain to get better. It has been far worse than expected. Just looking forward to being able to walk more than a few steps without a bunch of pain making me hurry and lay back down.
> 
> ...


Sorry to hear about your injury!

FWIW, I endured a couple of weeks of crappy pain after my surgery. Got milder after that, but still was crappy! Btw, I had cold water circulating around my shoulder, and was taking oxy, and it still was crappy a/f!

Hang in there!


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## Heidi_y (Feb 19, 2021)

tubbnation said:


> Sorry to hear about your injury!
> 
> FWIW, I endured a couple of weeks of crappy pain after my surgery. Got milder after that, but still was crappy! Btw, I had cold water circulating around my shoulder, and was taking oxy, and it still was crappy a/f!
> 
> Hang in there!


Thanks,
Today is the first day I've ventured out of my bedroom so it's feeling a little bit better. I can stand for more than 20 seconds without feeling like someone is ripping my bicep in half. I'm on day 5. Pain is still never ending but I stopped the Norco and started with just Motrin and Tylenol so I'm not nauseous and loopy all the time. Yes the ice machine feels really good. I'll just be excited when I can find a position where my arm feels comfortable. I feel like I'm readjusting it every 5 seconds while trying not to move my shoulder. Glad to hear it should hopefully start improving soon. The worst should be behind me.


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## FJSnoozer (Mar 3, 2015)

Heidi_y said:


> Thanks,
> Today is the first day I've ventured out of my bedroom so it's feeling a little bit better. I can stand for more than 20 seconds without feeling like someone is ripping my bicep in half. I'm on day 5. Pain is still never ending but I stopped the Norco and started with just Motrin and Tylenol so I'm not nauseous and loopy all the time. Yes the ice machine feels really good. I'll just be excited when I can find a position where my arm feels comfortable. I feel like I'm readjusting it every 5 seconds while trying not to move my shoulder. Glad to hear it should hopefully start improving soon. The worst should be behind me.


My brother in law and I have both had similar protrusions to you both from hiring jumps way over our heads.

We were both advised not to have surgery for better long term success by our orthopedic surgeons. My bone was literally free floating and getting caught on other bones, so there is no way a doctor could have sent me home. The surgery is important if you care about the lump. I'd imagine with you wearing Tanks/racer backs at some point in your life this is probably the ticket!

Unfortunately, I have heard the recovery is longer with surgery than without. Either way, the pain will quickly get better over the next 3 weeks. Make sure to do your physical therapy. It hurts like hell the day after PT, but an aggressive schedule will get you back in the game.

I did my first race 50 days after surgery. I have full range of motion. No pain at all to sleep in any position. There is hope!

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## Heidi_y (Feb 19, 2021)

FJSnoozer said:


> My brother in law and I have both had similar protrusions to you both from hiring jumps way over our heads.
> 
> We were both advised not to have surgery for better long term success by our orthopedic surgeons. My bone was literally free floating and getting caught on other bones, so there is no way a doctor could have sent me home. The surgery is important if you care about the lump. I'd imagine with you wearing Tanks/racer backs at some point in your life this is probably the ticket!
> 
> ...


Wow...50 days is quick. Makes me feel hopeful.

They already scheduled me for PT just 2 weeks post op which seems a little scary. But hopefully that'll get everything working again. I already can't stand this sling.

Thanks for responding to my message. It's nice to hear positive things and know that this painful time will eventually be a distant memory.

I just can't fall again. Lol


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## FJSnoozer (Mar 3, 2015)

Heidi_y said:


> Wow...50 days is quick. Makes me feel hopeful.
> 
> They already scheduled me for PT just 2 weeks post op which seems a little scary. But hopefully that'll get everything working again. I already can't stand this sling.
> 
> ...


120 days post surgery, I wiped out in the mud at Nationals and slammed the shoulder into a tree. I sat on a log and thought about life for a second thinking I may need an EMS. 2 minutes later I was GTG!

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## Heidi_y (Feb 19, 2021)

FJSnoozer said:


> 120 days post surgery, I wiped out in the mud at Nationals and slammed the shoulder into a tree. I sat on a log and thought about life for a second thinking I may need an EMS. 2 minutes later I was GTG!
> 
> Sent from my iPhone using Tapatalk


That's funny. I think I'd ponder life for a second too. I'm glad you didn't have to start from square one again so soon after your original fall. Good to hear it held up against a tree though. That's pretty impressive.


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## Heidi_y (Feb 19, 2021)

mattedhead said:


> Grade V separation here.
> 
> Surgery:
> Double Arthrex Tightwire
> ...


I know this is an old thread. But curious how long you were in a lot of pain? When did things begin to improve? I had surgery about a week and a half ago and it still hurts to stand for very long. Shoulder feels best when I'm reclined in a chair. So far it has so been way more painful than I thought it would be. I didn't even left my room for the 1st four days after surgery. Felt like someone was trying to rip by arm off if I stood up and my meds made me feel like I had a major hangover. It was awful.


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## Desertride (Nov 1, 2012)

Last Friday I rode an unfamiliar trail for the first time too fast, hit a rut and got pitched OTB straight on to my right shoulder. Initial x-ray looked like a grade 2, but settled back and is likely grade 1. Also a moderate left wrist sprain. I think the wide padded shoulder strap of my camelbak thankfully softened the hit (there wasn't a mark on my jersey), because according to my GPS I was going at a pretty decent clip. Really thankful it wasn't worse. Starting PT on Sunday and hoping for a good outcome, but I'm 43 and not much of an athlete overall. 

I keep thinking about what went wrong because it happened so fast. No slo-mo in the air, just slammed to the ground in an instant. I was riding in a neutral balanced position on relatively smooth trail. I think the late afternoon flat light + tree cover made the rut look much shallower. I guess I'll head back there when I'm better and try to figure it out.

Best of luck to all.


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## Son of Pait (Jun 4, 2021)

I made an account just to add my input here (This injury occurred snowboarding). This forum seems to be the most comprehensive forum for stories on outcomes to this injury, hopefully it helps someone know what they may expect; after reading the entire forum it seems I have one of the highest displacement X-rays (Prize for me?)










*Grade V Separation, 170% clavicle displacement; occurred 4 months ago in non-dominant arm, 33 year old male. *

Same story as many of you - could not move my arm at first, extreme pain, etc. Started PT within a week of injury, and did professional PT for 6 weeks. I have been very aggressive trying to rehab the arm, working out more than pre-injury actually; no alcohol no drugs extreme clean eating, etc. I have done everything I can do make this arm 100%.

*I saw two specialists* (Both 1 month after injury, because the clinic I originally went to said "Grade 3 just do PT"). Even I, not knowing much about the injury, looked at the X-ray and thought how the hell is this a grade 3, it's an inch up?!) Yeah, hindsight is 20/20 and I should have saw a specialist immediately.

Specialist 1: Get surgery immediately, no question. Said this will plague me to leave it unfixed but did say that since I was past the 3 week acute phase the procedure would be the same at any point in the future (As my original ligaments could no longer heal). He was extremely clear to get surgery in my case.
Specialist 2: Wait and see what happens, as some people are satisfied with outcomes without surgery. After a 3 month follow up, did offer surgery but did not seem confident the outcome would be worth the down-time and recovery. I got the sense this specialist just wasn't very versed in this type of surgery.

*Where I am at now: *

Range of motion is 100%. Certain movements I do get a weird twinge of pain, or uncomfortable feeling (You know what I'm talking about). Very minimal clicking, popping, or catching which was prominent this first 6 weeks post injury.
Strength is about 60% in anything weighted overhead, or body weight movements. However, things that don't involve pressure (like a pull up, or rowing, are 90%+).
Pain with weighted movements listed above (i.e. push up) still involve sharp pain, to the point I avoid them now in my workout routines.
Daily aching / dull / annoying pain are my biggest gripe. Some days I'm waking up in pain, and have it all day. It feels like I've been throwing a ball all day, and the arm is just fatigued even after a good night sleep. This pain is mainly in neck, trapezius, and scapular muscles.
Little to no improvement past the 10 week mark - Basically where I'm at with 16 weeks feels about the same at the 10 week point.
*At this moment, am I happy with outcome?*

No. If I had a time machine, I'd have this fixed within the first 3 weeks. Now, work and personal life prevent me from even considering having this fixed now until late this year as I can't simply put my career and family in the position to babysit me for 2+ months until winter. If this was in my dominant arm, this would probably be bothering me to the point of having it fixed now but I can deal with it. I am able to continue doing the things I love (Like mountain biking, rowing, general exercise, etc) but I have a near constant reminder that my shoulder isn't right. Since I can't consider surgery for another 4-5 months, I have time to continue (maybe) improving the arm to the point I won't need surgery, but I am not very confident at this point. *With where I am at right now, I would not want my arm to feel like it currently does for another 45 years. *

Hopefully that adds to the data pool of stories on this forum, good luck to all who have this injury - I wish there was an easy answer but this is one of those very weird injuries that makes it hard to get clear answers of what to do and frankly it's a ***** of an injury.


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## scotts25 (Mar 9, 2018)

Hang in there. It took me almost 10 months-1 year before I was completely happy with my decision do avoid the surgery. This was on my dominant arm but like you, it just pushed me to work harder in the gym. I was not in a position where I could go on light duty work and be out of the mix for several months (due to an impending promotion and opportunity) and was able to avoid any time off. Now, 3 years later I would say that I do not even think of my shoulder 90% of the time. I can do everything at the gym that I used to be able to do, although I have a slightly weaker bench press and my right side fatigues a bit quicker. For reference, where I used to be able to do 100 pound isolateral presses for sets of 8-10, I can now do 90s for 10 my first set then 9, then 8 and 8. Small price 

Dips took the longest to return without pain and I no longer hang weights from my waist to do dips but other than that (and the obvious lump) I have no residual effects and push it to the extreme with everything I do.

Everyone is and heals different and I can only speak to my experience, but with the work and motivation you are bringing, I would bet you will have a tougher decision than you think in 4 months.


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## teK-- (Dec 3, 2011)

Grade 3 here also. Didn't get surgery on the surgeon/physio's advice at the time and because I had no health insurance.

Did 6-8 weeks of rehab and with return to weight training the shoulder is now stronger than ever. However the fact one shoulder sits about 5-10mm lower than the other, bothers me and it goes get tired sooner due to the muscles over compensating for the lack of ligament.

Now 7 years later there is no dysfunction with the shoulder it just looks off and my neck/traps get tired after long rides or workouts due to the shoulder being out of position.

At the time I think I made the right decision. If I could go back in time with money and annual leave I would have had the surgery.


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## FJSnoozer (Mar 3, 2015)

Son of Pait said:


> I made an account just to add my input here (This injury occurred snowboarding). This forum seems to be the most comprehensive forum for stories on outcomes to this injury, hopefully it helps someone know what they may expect; after reading the entire forum it seems I have one of the highest displacement X-rays (Prize for me?)
> 
> View attachment 1933420
> 
> ...


Fear not, you are way early.

Yes I was racing 50 days later, but I wouldn't call my shoulder 95% until maybe the 6 month mark. I had that pretty big scare slamming the shoulder into a tree at speed 4 months in. I swear it got even better after that impact! I put a gouge in that tree with my camelback hose retainer that rests on the shoulder.

The sharp pain (sudden or extended dull nerve pain on long road rides) subsided over the course of time. Now it will only pop bone in bone and it makes me laugh.

Like you I had my ROM back super fast. My brother in laws is worse than yours. We both throw children high in the air to each other. I notice that people with dropped shoulders tend to have this larger separated look vs someone with high shoulders like me. (You know the type of drop shoulder gate where you automatically look like you have giant trapezius?)

Also, I was not shy on sleeping in that side very early since I was a side sleeper and did not want to adjust.

You will not want to carry heavy duffle straps on that collar bone ever again. I try to keep backpack straps on my trap vs the end of that bone.

Sent from my iPhone using Tapatalk


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## MTB_Underdog (Jul 8, 2020)

My turn to join the shoulder team. Picked a bad line and couldn't avoid a jump that was bigger than I would normally hit. OTB, Managed to tuck and roll, but the urgent care says separated shoulder. Feeling much better with a sling and some drugs, hoping I can get an appointment with an orthopedist in the next day or two. Yay. Biggest problem is I'm a mechanic, and there is no such thing as light duty at work. Will be interesting to see when I can go back to work.


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## shakazulu12 (Jul 14, 2015)

Add me to the list. Grade 3. Not even a cool story, just decided to enter a berm way faster than normal because "new tires, let's see how this goes" and tucked the front on some gravel. This thread is amazing, haven't been all the way through it yet, but has me pretty optimistic. I had a grade 2 something like 20 years ago from snowboarding and honestly don't remember much. I know I went to whistler the next week with my arm taped to my chest. But don't really remember the recovery part.


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## FL mtb (Mar 19, 2016)

^^That is how I did it. “Trust the berm,” I said in my head. Feeling good over 5 yrs later.


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## shakazulu12 (Jul 14, 2015)

It was so stupid. We are talking probably 40 percent faster than I have ever gone in that one before. And I saw the gravel and stared at it as soon as I tipped in. Total rookie mistake. 

That said, still think those tires are amazing 🤣. In an odd way, I’m more motivated than ever now to work on my skills and fitness. So I’m taking that as a positive.


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## MTB_Underdog (Jul 8, 2020)

So I'm 5 weeks post injury. Got in to see an ortho the Tuesday after the injury, got pretty lucky as he is a XC racer himself and has had the same injury. Grade 3 separation. He told me I could go either way. I could do PT and see how it went, and if I wasn't happy with the result he could do the surgery later. Or I could jump in and do the surgery. I work as a mechanic and there is no light duty in my job, I have to be able to lift a wheel/ tire to chest height before I'm able to go back to work. Like everyone else here I'm pretty active outside of work as well. My decision was to fix it "right" the first time and be done with it. I know a lot of people have success going the PT route, but honestly I am not a lucky person. If anyone is going to have a problem it will be me. I'm pretty sure work would have been even less pleased if I did weeks of PT then went back and told them it would be another 12 weeks because the shoulder was unstable and I needed surgery.

Had the surgery a week later and haven't had a lot of pain. They prescribed Percocet but I only needed one each day the first two days, then switched to Ibuprofen for a few more days. The way I explain the surgery is they zip tied everything together and put in cadaver ligaments. No more hump! So four weeks out from surgery and I'm still in a sling and waiting for the grafts to fully attach so I can start PT. Shoulder feels good, getting some muscle pain in the upper arm, guessing from being in a sling and not being able to use it. Figure that will get better once I can start PT. Second follow up visit in another week, looking forward to getting being able to do some PT and get the ball rolling.

For now I'm glad I went the surgical route, really couldn't stand the instability in the shoulder before I had it done. Time will tell if it was the right call, keeping my fingers crossed.

My suggestion to anyone is make sure your ortho understands what you're looking for long term. If I was a desk jockey whose idea of exercise was walking the dog? Much more likely to have gone the PT route. Physical job, active lifestyle, no plans to slow down for years to come? For me the right call was to make sure I could do the things I want to do and not be limited because I was impatient.


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## shakazulu12 (Jul 14, 2015)

Well, three days in and after a nice hot shower and a ton of determination I can raise my arm nearly vertical. Been in contact with my specialists and fortunate to have a friend that does physical therapy and we are just attacking this as aggressively as I can tolerate. More determined than ever to be in the best shape of my life by spring.


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## shakazulu12 (Jul 14, 2015)

Coming up on four weeks and I'm doing shoulder presses with a single five pound dumbell and able to bench the bar without too much discomfort. Looking like things are going to be just fine. Bummed I'll miss the tail end of riding season, but just getting a head start on next years fitness now.


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## MTB_Underdog (Jul 8, 2020)

I'm seven weeks post surgery for my AC separation, started PT last week. Don't notice any difference as I'm doing the exercises (besides boredom because they are easy) but I gained 30 degrees of movement on two different axes so far. Get to start with weights in another week or so.


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## lil byke (Jun 16, 2021)

As others have said, be patient, everyone is different! I am 13 weeks out from a shoulder separation and I am still dealing with some pain and weakness. I know from separating the other shoulder badly some years ago that it takes a year or more for me to be pain free and 100% full strength. Most important thing is rest, I have set myself back multiple times with this injury by trying to do too much. Stay off the bike, stay away from the weights, chill on your couch for a few months.


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## MTB_Underdog (Jul 8, 2020)

lil byke said:


> As others have said, be patient, everyone is different! I am 13 weeks out from a shoulder separation and I am still dealing with some pain and weakness. I know from separating the other shoulder badly some years ago that it takes a year or more for me to be pain free and 100% full strength. Most important thing is rest, I have set myself back multiple times with this injury by trying to do too much. Stay off the bike, stay away from the weights, chill on your couch for a few months.


Riding is fine, no pain there. Still fighting weakness on the side that was injured, probably wouldn't notice except I have a very physical job. I make an effort to not favor the side I injured, I try to make sure I work it at least as hard as my good side. Making gains all the time.

Would like to find time to lift but not easy to fit in my schedule. Work third shift, have to go to bed as soon as I get home to get my 7 hours of sleep before I have to pick up my son from school. I help coach my son's NICA team, and ride with the family 1-2 times per week. Just not a lot of extra time to work it in.


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## PS mtb (10 mo ago)

JB800 said:


> I Recently Went Down Hard And Suffered A Grade 3 Shoulder Separation. I Am 5 Weeks Into This Injury And I Am Treating It Conservitively (non-surgical). It Is Very Frustrating Being That You Would Think This Injury Should Be Repaired Through Surgery But All The Doctors Are Telling Me To Leave It Alone And Physical Therapy It. I Am Also An Active Weight Lifter. I Used To Bench Press 340lbs And Now I A Struggle With 50lbs. I Know It's Only 5 Weeks Into The Injury But I Am Not Sure Where I Should Be At As Far As Lifting Weights And What's The Road Ahaed Of Me Going To Be Like Being That Is Being Treated Non-surgical. Any Info Would Be Greatly Appreciated!!!


I crashed racing a downhill race in Mammoth in '99, type 3 separation, doctor at the ER there said it would "look"better if I had surgery, but would most likely have less mobility, he also recommended I just let it heal, which I did. It took 8-10 weeks before I was pain free mostly, but zero issues...Good luck


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## willf24 (6 mo ago)

Hey everyone, separated my right AC/shoulder 8 weeks ago, still haven't done much aside from hikes and walking. Physio will most likely be giving me the green light for golf this week, but still no weights or aggressive riding (anything that isn't without bumps essentially). I've had tonnes of injuries over the years but this one just feels different. After 2 months shoulder still feels so out of whack, doesn't feel "in place" at all. Basic stuff and movement is fine but anything of what I guess I'd call "athletic substance" still feels so wrong.

Just wondering what other peoples experiences are in terms of time frame for some kind of return to regular function, weight application to the shoulder.

Have been doing physio every week, and follow up with my orthopaedic specialist at the end of August. Hope everyone is healing up!!


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## shakazulu12 (Jul 14, 2015)

So, I pretty much went back to the gym and just did as much as I possibly could as soon as I could. I separated mine end of August or early September. These days, it still clicks and looks funny. But I don't actually think about it much and am back to doing everything I was doing previously. The only thing that is a little wonky is flat bench with a bar. Though I mostly do pushup and dip variations these days anyway.


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## teK-- (Dec 3, 2011)

willf24 said:


> Hey everyone, separated my right AC/shoulder 8 weeks ago, still haven't done much aside from hikes and walking. Physio will most likely be giving me the green light for golf this week, but still no weights or aggressive riding (anything that isn't without bumps essentially). I've had tonnes of injuries over the years but this one just feels different. After 2 months shoulder still feels so out of whack, doesn't feel "in place" at all. Basic stuff and movement is fine but anything of what I guess I'd call "athletic substance" still feels so wrong.
> 
> Just wondering what other peoples experiences are in terms of time frame for some kind of return to regular function, weight application to the shoulder.
> 
> ...


Started physio at about 8 weeks and I was back on MTB in about 11 weeks (albeit being super careful). After about 16 weeks I was back to my usual weights training but starting on light weights, and 6 months later back to lifting normal weights.

The floaty weird feeling is due to your shoulder sitting in a different position and your muscles and ligaments not having compensated yet. 

Good luck!


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## MTB_Underdog (Jul 8, 2020)

I went the surgery route for my Grade 3 and very happy with the results. Shoulder is 100% now, no pain or loss of range of motion, and back to full strength. No weird popping or shifting, other than the scar you'd never know i had a problem.


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## ForbiddenBeat (Jan 21, 2008)

Very thankful I found this thread. I fell 3 months back. I got distracted and fell off the side of a trail that has terrible exposure – fell way down the side before rolling, caught a tree branch before plummeting (probably to my death or a bad trip to the ER). Felt fine afterwards but about a week later noticed the lump on my left shoulder and pain. 

I was diagnosed by the ortho doc after x-ray as Grade 1 AC separation. He said no biggie, keep doing whatever activity-wise. I haven't been back on the MTB (honestly debating just giving it up after this fall), but riding my road bike or surfing/paddling makes it hurt for a day or two. Was helpful to learn others have had long recoveries, since all the articles online say 2 weeks and it's healed. Wishing a speedy recovery to you all!


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## SIE2 (4 mo ago)

Grade 5 separation here after a pretty small crash, had surgery 1 week ago. No prescription drugs required, feels like I got away easy pain-wise. I’m not a tough guy, probably just less sensitive nerves in the area or something. We’ll se how I’ll feel about that once active recovery sets in, for the first weeks it’s just small mobility exercises. 
Appreciate all the posts here, wishing everyone a speedy recovery.


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## SIE2 (4 mo ago)

Oh and the before/after pic:


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