# Level 3 AC separation: to cut or not to cut?



## genemk (Sep 15, 2009)

Anyone had experience with level 3 shoulder separation recently? Trying to get some info on whether ppl recover well enough without surgery for DH. Here's the scoop:

Level 3 separation with both sets of ligaments to collarbone torn. Can let heal as is and resume some basic activity in 6-8 weeks (longer for good stuff prob). Might heal fine for all activities, but may have some issues with overhead activities such as rock climbing/unhooked kiteboarding if collarbone moves around too much and causes problems (after healing). Aggressive DH OK?

Alternative is to have surgery to replace ligaments but that puts me in sling for 3 months plus recovery after. Surgery can be done at any point so waiting just mainly results in lost recovery time. I'm leaning towards seeing how it heals naturally, which is what surgeon said he'd prob do since I'm not a pro athlete. If anyone has useful feedback tho or knows ppl that have been thru a similar situation I'd be interested to hear your thoughts.

Thanks!


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## HelloMyNameIsSean (Sep 14, 2011)

I don't have any first hand knowledge of that injury. But I've been juggling whether to have back surgery or not for 5 or 6 months now. I'll say that I waited and tried to give it time to heal on its own, no need to get cut open for a quick fix when it might heal on its own, like you said, not pro athletes. 7 months of pain later, I'm finally going for the surgery. 

My friend dislocated his shoulder a few years back, and than it happened again 6 months later, and the ligaments must have given up, because I swear I think I've watched my friends set his shoulder at least 6 times. Just from jumping into a pool, or minor little things that shouldn't cause a shoulder to pop out. After the 12th or 13th time in 2 years, he decided to get surgery to have the ligaments fixed. He's been 100% ever since. 

Just take it easy for now, see how you feel once your allowed to do what you want and than make up your mind. Good luck, really hope you can heal naturally.


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## Swell Guy (Jan 20, 2005)

I had a borderline class 2/3 sep, and my ortho said that the long-term outcome on surgery was not a recommended option "unless you were John Elway." That being said, your injury sounds like it could be much worse. I have the piano key, but I was back to windsurfing in a couple weeks and riding within a month. Other than aesthetics, my shoulder works fine.

I've had surgery several times on other ortho injuries, been under a general anesthetic a few times and surgery, imho, is always an option of last resort for me. Going in the hospital, beside being expensive as h*ll, is also quite traumatic, takes a long time to recover from, including the anesthesia, and is fraught with a variety of possible negative outcomes due to complications. I would hold out for the non-surgical option until absolutely necessary.


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## Craw (Feb 10, 2004)

I have a max grade (whatever that number is) AC separation from a moto crash in 2009. I opted not to have the surgery based in discussions with my ortho. Since then I have not had any major issues with the injury, however the area gets sore quickly. Pain is manageable and most days are pain free. I climb. Mtb., ride dh. Snowboard, swim etc etc. some days are fine, with no noticable fatigue or pain. Some days are rough. Usually if ive been really really active multiple days in a row. Usually my whole body hurts by then anyway. Haha 

I've got a gnarly bump on my shoulder. 

I rode dh today for a few hours. Everything's fine. 

Of course this is just my experience. Yours may differ but I know where you're coming from.


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## Scrub (Feb 3, 2004)

I had a level 4+ seperated shoulder and had to wait several months to go under the knife for my appt. It had healed by the time I went in for surgery but it wasn't good. It popped, clicked and had sharp pains during normal use and especially riding DH. I had surgery and did the PT and it is better now but not 100%, maybe 85-90%. Look into the Weaver Dunn procedure, that is not what I had but wish I had after knowing what my Dr. did to me. Now after my recovery from that shoulder, I babied it so much that I tore the rotator cuff in my other shoulder and just had surgery for that back in Feb. go figure.. There are some threads on seperated shoulders here on MTBR if you do a search


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## jmallory (Jul 29, 2008)

Both my shoulders had a class 3 separation, 6 months apart from each other. The first one I got surgery for, the second one I opted to let it heal by itself. It's been close to 7 years now and it's hard to say which one is stronger. I definitely have the big ugly bump on the non-surgery shoulder, but now I feel like the surgery one is coming loose causing a bump to form. I don't really have any problems in day to day life, the only real problems I have are push-ups, pull-ups, and bench press. I don't ever go to the gym anymore and I think my shoulders have something to do with it. I now focus on cardio like running and riding my bike as much as possible. I haven't had any problems with DH riding, I also surf and snowboard without any problems too. 
Getting the surgery took longer to heal but felt stronger quicker than doing nothing. All in all there isn't a big difference between the 2 except visually. If I had to do it again I would probably get surgery, but I think if you take care of it and do your PT you should be ok to let it heal without having to go under the knife. Hope this helps and hopefully I didn't ramble too much!!


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## FreeRidin' (Dec 26, 2006)

Had a class 4 separation this past March. I opted for surgery immediately and was ready (ish) for opening day. Looks alone convinced me for surgery, there's still a notable bump but it is nothing like would it was. I also had previous labrum issues that got repaired at the same time.

There are numerous procedures for a separated clavicle. Some require hardware that is later taken out, some is permanent. I don't recall the name of what I had done but it involved "tying" the clavicle down with a cord and some metal hardware. I believe it is the most "up to date" but largely varies on the separation and the orthopedic you choose.

Get the surgery, do PT, ride your bike in 2-3 months.

EDIT: Disregard that....you mentioned separated ligaments and clavicle.
My ligaments were good to go (aside for the labrum)


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## thesacrifice (Mar 12, 2004)

Shoulder surgery is imo always a last option. There is almost always a loss of range in motion after surgery.

Go see a physical therapist


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## Scrub (Feb 3, 2004)

thesacrifice said:


> There is almost always a loss of range in motion after surgery.
> 
> Go see a physical therapist


Go see more than one PT, try to see as many as you can as well as doctors if you plan on the surgery. Make sure to tell them that you are very active in sports and such and not just a couch potato. It is important that they know this so they take you seriously about your situation and not just tell you to take some meds for the pain and deal with it for the rest of your life.


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## SUITEDFINGERS (Aug 21, 2006)

I completely separated mine about 4 years ago and had the surgery done immediately. The surgery was worse than actually separating it. I had the screw in my shoulder for six months while the joint healed. During that six months, I did have a hard time with range of motion and strength. Once the screw came out, recovery was very quick. From what I had read, there was evidence for and against the surgery, but I figured I'd just go with my doctors best judgement. It's healed 100% now so I'm going to say I did the right thing. I ride almost every day, weight lift and climb regularly at the gym and do not even notice it. 

I had a very surgery happy Orthopedist who was good at what he did though. He also put a plate on my collar bone when I snapped it a couple years ago, and just like the shoulder, it's healed just fine. I think it really comes down to a case by case situations whether surgery is necessary. Make sure you find a good orthopedist and get a second opinion if you have any doubts.


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## Djg24 (Jul 7, 2011)

I just finished recovering from a type 3 AC separation. It happened at the end of April. The ortho said it was up to me if I wanted surgery or not. He demanded that I go for PT though. I was pretty lucky as I am in good shape and pretty flexible. I did go to the PT after about a week and a half of rest. By the time I started PT I already was at 99% range of motion. Strength was way down with pushing motion (couldnt do a push up for a month!) but after 3 weeks of PT I started to ride my road bike. Once a good 30 mile ride or 2 hours in the saddle didnt cause an ache in my shoulder I ventured back into the woods and started back on my routine work out. Glad to say I can do everything I did before without any problems. I do have the dreaded bump and it looks awkward but it really doesnt bother me.

My advice would be, do the physical therapy and SLOWLY work up to a shoulder strengthening routine and you'll be just fine!


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## pipes10 (Mar 11, 2007)

I currently have a complete grade 3 ac joint separation that I suffered on May 21st. From what my surgeon has said, grade 1 and 2 don't require any surgical intervention, while grade 4 and 5 require surgery. Unfortunately, with grade 3 separations, there is no best practice for surgery vs no surgery, or which type of surgery is best for that matter. I have opted for no surgery at the moment but to rehab it and see where I stand in 12 months in terms of range of motion, strength, and pain.

My timeline thus far:

Injured May 21st
Crushed gravel ride June 12th
First trail ride June 14th (took it relatively easy)
First DH ride June 16th (again took it easy)

It wasn't until about June 22nd that I was able to ride at close to my normal pace. I'm pretty much back up to speed now. I still have pain when I move my arm across my chest, lift something heavy, or have to give a decent push on my handlebar. ROM is very good at about 90%, some pain remains and I was told it would until about the end of summer, endurance in the shoulder is half decent.

I am wearing a shoulder brace when I ride now. It's an EVS SB03 and I find it helps stabilize it a little.


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## ngarfield (Jun 2, 2012)

I had a level 3 AC separation, and got the same advice from my ortho. I opted for no surgery, and have been happy with the outcome. I was out about 6 weeks, and then some more time to rebuild strength. I don't have any pain, but it does click/ pop frequently, especially while driving one handed. I have excellent range of motion, and little pain, although I don't sleep on that side anymore. I work as a ski patroller, a bike ranger, and fill in with carpentry, and haven't had any problems. I was nervous about falling on that shoulder again, but took a good fall on it the other day with no problem. 

I am curious about the long term implications of surgery vs. no surgery for AC separations. Arthritis, loss of motion, chronic pain?

P.S. Do as much PT as you can. It hurts at the start but definitely pays off. Let your pain be a judge for how much you can do.


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## genemk (Sep 15, 2009)

Thanks for all the input guys. Gonna try the no surgery option first. Pain is already subsiding and range of motion is starting to increase. Doing a couple basic ROM exercises already. 

One thing I was wondering is if there's a way to help the collar bone heal so it's closer to the shoulder. I feel like moving my shoulder and taking arm out of the sling early is good for rehab, but it seems like the collar bone frequently ends up sticking pretty high above the shoulder (like it's trying to poke through the skin). I'm wondering if keeping it in the sling longer can help the scar tissue build up with the bone closer to the shoulder thus potentially resulting in fewer issues down the line. I tried contacting my ortho doc, but his assistant just kinda blew me off saying there's nothing I can do but wait. Anyone hear anything useful on this front? It's hard to imagine that what I do now doesn't impact where the bone sits in the long run. I'd be willing to lose a week of rehab time if it helps the bone stay in the right place in the end.

Thanks again.


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## HelloMyNameIsSean (Sep 14, 2011)

Glad to hear your doing better. 

Did all of you guys who had these injuries get them from riding DH?


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## Swell Guy (Jan 20, 2005)

genemk said:


> Thanks for all the input guys. Gonna try the no surgery option first. Pain is already subsiding and range of motion is starting to increase. Doing a couple basic ROM exercises already.
> 
> One thing I was wondering is if there's a way to help the collar bone heal so it's closer to the shoulder. I feel like moving my shoulder and taking arm out of the sling early is good for rehab, but it seems like the collar bone frequently ends up sticking pretty high above the shoulder (like it's trying to poke through the skin). I'm wondering if keeping it in the sling longer can help the scar tissue build up with the bone closer to the shoulder thus potentially resulting in fewer issues down the line. I tried contacting my ortho doc, but his assistant just kinda blew me off saying there's nothing I can do but wait. Anyone hear anything useful on this front? It's hard to imagine that what I do now doesn't impact where the bone sits in the long run. I'd be willing to lose a week of rehab time if it helps the bone stay in the right place in the end.
> 
> Thanks again.


Not sure what it looks like, but that's probably the "Piano Key." I have a bump, but it's not that bad. It's mostly an aesthetic, not a functional issue, but I guess if it's really bad it can become a functional issue. This is what it looks like File:Luxation acromioclaviculaire.jpeg - Wikipedia, the free encyclopedia

Of course, your doc needs to weigh in tell you whether it is or not.

To answer another poster, yes, mine from going OTB on a downhill run and sticking my hand out to break the fall. This is known as a FOOSH (Fall On Out Stretched Hand) injury.


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## man w/ one hand (Dec 29, 2003)

thesacrifice said:


> Shoulder surgery is imo always a last option. There is almost always a loss of range in motion after surgery.
> 
> Go see a physical therapist


Surgery may or maynot help as I was told. I have seperated both of mine, the left one has had multiple injuries and i haven't had surgery on either shoulder. It will take time to heal, but you'll be waay better off if you get therapy for it during th healing process. Processing a torn ACL presently.... sux getting old. *Don't get th surgery unless you have to have it*


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## genemk (Sep 15, 2009)

Both of mine were from DH.

The photo in the link you posted would be totally fine with me. Right now it's sticking out a solid inch above the shoulder at times. I'm hoping it gets sucked in as it heals, which I'm sure it will. Don't see doc again for 5 weeks so prob too late by then. Guess I won't worry and will see how it pans out.


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