AC Separation

[summit]

Hmmm Whistler strikes again. ED docs said "minor... like grade 1.5" radiology called it grade 3. I looked at it and called it a grade 2 but I don't know shit. Ortho called it "high grade 3" and thinks I probably need surgery... another doc says "grade 1 or 2"...


Yeesh.

[summit]

Another ortho says "grade 2, no operation, do PT." Going with that plan for now.

It's a very frustrating injury.

[bodywhomper]

Ortho called it "high grade 3" and thinks I probably need surgery...

Fuck that guy.

I’ve experienced a similar ortho, “well the MRI was pretty inconclusive, but I bet I can find something if I ‘go in.’”

[GoldMember]

Another ortho says "grade 2, no operation, do PT." Going with that plan for now.

It's a very frustrating injury.

Without question, try PT first and see where it goes. Give it some time. Surgery avoided is good surgery.

[splitlit]

Two fully separated shoulders for me, going on 15 years now. Both are a complete non-issue nowadays. My non-MD opinion, avoid surgery at all costs.

Eventually you'll get enough scar tissue buildup that it stops bothering you. The biggest thing I would recommend is exercising your shoulders on a consistent basis. Thorough warm up, lots of hanging exercises, weight training, and resistance bands. Periodically you will "re-separate" the shoulder but its basically the scar tissue tearing again, and in a few days you're back to normal.

[FortySixMac]

Two fully separated shoulders for me, going on 15 years now. Both are a complete non-issue nowadays. My non-MD opinion, avoid surgery at all costs.

Eventually you'll get enough scar tissue buildup that it stops bothering you. The biggest thing I would recommend is exercising your shoulders on a consistent basis. Thorough warm up, lots of hanging exercises, weight training, and resistance bands. Periodically you will "re-separate" the shoulder but its basically the scar tissue tearing again, and in a few days you're back to normal.

Complete opposite experience here — had surgery to correct and have been 98% for 10 years now. Guess everyone’s situation is different.


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[DumbIdeasOnly]

Hey, just bumping this thread about weird shoulder bumps. I got a grade 3 a bit over a month ago (late Sept) and have been doing PT and returned to lifting and biking.

My biggest lingering issue is hikes that last a few hours, my pack makes it get bad faster but not hugely so. I’m thinking/hoping I can ski the full season this year (starting in Dec).

Any feedback from others on whether skiing bugged their shoulders? I think the issue with hikes (especially over rugged terrain) is that there is more arm movement than there is in a comparably long bike ride and my trap and other stabilizing muscles eventually fatigue out. Not sure whether I’d expect skiing to be more like hiking or biking in this way.

[summit]

I'm mostly normal other than it continues to mess up my sleep

[Dantheman]

Any feedback from others on whether skiing bugged their shoulders?

No, but mine was only Grade 2. You're 6 weeks out from a Grade 3. It sounds like you're doing pretty well really. Give it time and keep up the PT and you should be all good for most of the season.

[GoldMember]

My latest was a 2 and bothered me some for probably 6 months. Didn't stop me from skiing, biking or golf. After that initial time, no issues except for the bump. Keep using PT and keep up strength condioning in the shoulders. Avoid surgery except as a very last option.

[summit]

The only thing I noticed with skiing was actually buckling a hard to buckle boot buckle could cause some strain on the AC unless you are careful about angles.

[TWINS]

Grade 2 separation in June.
Put 2 days of skiing on it last weekend.
No issues with that at all.
Sleeping on it still is not happening.
It still pops when I move it a certain way.
Go ski and have fun.

[MagnificentUnicorn]

You won’t really start to notice problems until several years out when the joint becomes arthritic. Both my AC joints are terribly arthritic, two separations on the left, two separations and a dislocation on the right with SC joint disruption. It sucks getting old


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[DumbIdeasOnly]

Thanks all, just as an update in case the information is useful to anyone I figured I'd share some stuff about my recovery process and injury.

First, on the injury - there are 6 grades of shoulder separation. Grades 1 and 2 are not ruptures of the ac and cc ligaments, they typically recover without a lot of intervention beyond rest. Grade 3 is a complete rupture of the ac and cc ligament without a lot of displacement of the clavicle. Grades 4, 5 and 6 are different directions and extents of displacement of the clavicle in the event of complete rupture.

Grades 4, 5 and 6 are "usually" treated surgically, in some cases urgently, because the displacement can damage blood supply or lead to limb numbness. Grade 3 can be treated surgically, but isn't always. The rest of this note concerns grade 3 shoulder separation treatment.

I am not a physician, much less your physician, and you should see a physician to come up with a treatment plan for a Grade 3 shoulder separation. With that out of the way, I said earlier grade 3 shoulder separations can be treated surgically. Based on a review of a few meta-analyses and consultation with a surgeon that contributed to some of the research, it seems that the bulk of available evidence at present favors a "wait and see" approach to recovery for a grade 3 injury. What this means in practice is a fairly intense course of physical therapy for 6-12 weeks and checking in with your physician on the level of function you have regained. Assuming you achieve acceptable to you function from the therapy, then there is no need to do a corrective surgery.

If you know you place a lot of demand on your shoulder (say you are an MLB pitcher or a maybe a serious climber or something), it is possible to skip the PT and go straight to surgery. That said, surgery provides no guarantee of complete recovery of function. I think unless you know you place a lot of demand on your shoulder to do something you love, it's unlikely you should rush into the surgery and, if you have a doctor pushing it, I would personally advise a second opinion pretty strongly.

My own approach has been the PT and I'm just shy of 8 weeks in. At this point, I have basically zero discomfort on daily living stuff. Biking is fine. Longer hikes and skiing are still TBD, but even when it's uncomfortable it's less uncomfortable than it once was and I am optimistic, per a very long thread on MTBR, things will keep getting better albeit at a reduced pace for another ~3-9 months.

[summit]

First, on the injury - there are 6 grades of shoulder separation. Grades 1 and 2 are not ruptures of the ac and cc ligaments, they typically recover without a lot of intervention beyond rest. Grade 3 is a complete rupture of the ac and cc ligament without a lot of displacement of the clavicle. Grades 4, 5 and 6 are different directions and extents of displacement of the clavicle in the event of complete rupture.

Just to clarify:
Grade I is a partial rupture (sprain) of the AC while a
Grade II is generally a full rupture of the AC with usually a partial for the CCs.

Generally the definition of the grades varies because of differences in human anatomy which some relying on the CC distance increase relative to the other side either in raw mm distances or percentages (assuming it is not otherwise injured) and/or the displacement of the base of the distal clavicle relative to the "top" of the acromion process for II v III v V. The CC distance vs the anatomical clavicle-AC line is a useful consideration for people with naturally "compact" CC distances. These variations in "how to grade" vs human anatomical are how I was diagnosed with everything from a I+ to a V-.

Grade IV is a posterior dislocation awfulness usually where the clavicle has been driven through the trap muscle and is stuck - OW!
Grade VI is super rare where the clavicle gets "stuck under" (inferior dislocation) one the processes.

I'm at 12 weeks and am 95% normal with some missing strength I need to rebuild. Crawl stroke is fine but breaststroke is "clicking" at the AC though not painful. I can do pullups.

[DumbIdeasOnly]

Just to clarify:
Grade I is a partial rupture (sprain) of the AC while a
Grade II is generally a full rupture of the AC with usually a partial for the CCs.

Generally the definition of the grades varies because of differences in human anatomy which some relying on the CC distance increase relative to the other side either in raw mm distances or percentages (assuming it is not otherwise injured) and/or the displacement of the base of the distal clavicle relative to the "top" of the acromion process for II v III v V. The CC distance vs the anatomical clavicle-AC line is a useful consideration for people with naturally "compact" CC distances. These variations in "how to grade" vs human anatomical are how I was diagnosed with everything from a I+ to a V-.

Thank you for the corrections and amplifications. I was trying to gloss over the grading issues because I had seen contradictory things in different sources. I had a ton of “clavicle splay” on radiograph, but I also happen to have big shoulders.

The smartest doc I saw was confident in a grade III in my case because I had a pretty pronounced bump on exam (not grade II) which fully reduced if I did a trap flex (not grade V). I don’t think that either of those are textbook definitions but at some level the functionality is probably more important.

Re: movements - I am not trying to do Olympic bar bench press anymore. Otherwise biceps, lats, shoulder press (light for now) are ok. Also, still have some instability trying to front rack a kettlebell on that side kind of weirdly.

[skirub]

…

[DumbIdeasOnly]

Update: zero issues skiing, only kind of painful towards the end of one day on a weeklong trip. For better or worse no falls on that side so crash resilience untested.

No skinning or meaningful boot packs this time so can’t comment on that stuff.