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View Full Version : shoulder seperation, grade 3, what does it mean?


cmg
05-09-2013, 10:17 PM
took a tumble yesterday resulting in a shoulder seperation (Acromio Clavicular Seperation) grade 3. from the exam report, No fracture is seen however there is approx. 13 mm of cephaled displacement of the lateral head of the clavicle in relation to the acromion articulating process. this is concerning for a grade 3 shoulder seperation. will be seeing an orthepedic surgeon tomorrow. so how likely i will be going under the knife? when i googled type 3 it's on the fence between surgery and physicle theropy. don't mine going under the knife if long term prospects are better. So what does all this mean? they tried to explain it last night but i couldn't focus.

thwart
05-09-2013, 10:25 PM
Had to refresh my memory...

From a reputable internet resource:

Grades I - III are usually treated non-operatively. The vast majority of patients will have a period of discomfort. Once this discomfort disappears, the shoulder is usually fully functional, although the patient may still have a minor cosmetic defect at the injury site.

Some patients with grade III AC separations may be candidates for early surgical reconstruction. A discussion between the physician and patient should focus on the patient's expectations and possible return to sports. Many surgeons prefer to first treat the AC separation conservatively. If grade III patients develop problems or do not heal properly surgical reconstruction is an option. (Conservative and surgical treatment for grades I - III have essentially the same results after 1 year.)

There are some physicians who offer early surgery for a select group of Grade III AC separations based upon the activities and demands these patients place upon the shoulder.
These patients include:
1. young, active individuals (over the age of 13).
2. laborers whose jobs require heavy overhead work.
3. athletes in non-contact sports whose overhead movements are stressful and frequent.

So, in your situation it's a judgment call. Suspect the ortho doc may ask you what your preference is...

FlashUNC
05-09-2013, 10:26 PM
Sounds like fancy verbiage for hurts like hell.

Sorry you're going through it. Heal up soon.

gone
05-09-2013, 10:34 PM
Well, as it happens I have personal experience in this area. My options were the same as yours: have a fully restorative surgical procedure or let it heal. The orthopod I saw strongly recommended the latter. I decided to go with his recommendation so I wouldn't miss the time riding while I healed and did physical therapy.

I wish more than anything I'd had the surgery. Absolutely no strength in my right arm. Just for the sake of torturing myself I periodically work up to two sets of 20 pushups and am pretty much in agony for 24 hours after doing them. Bone on bone between the clavicle and its joint. Rotating my arm (doing a "windmill") results in more cracking than stepping on a bag of walnuts. Can't sleep on my right side for more than about 15 minutes.

Surgery might not have been a better outcome but unless I died on the table it sure as hell couldn't have been worse.

I'm going to end up going under the knife anyway just to deal with the bone on bone.

Sorry to hear about your accident and hope you heal well no matter which course you choose.

cmg
05-09-2013, 10:34 PM
1. young, active individuals (over the age of 13). No i'm 54

2. laborers whose jobs require heavy overhead work. No, construction manager, no heavy lifting but plenty of stress.

3. athletes in non-contact sports whose overhead movements are stressful and frequent. No, not athletic, cyclist, slow, old, heavy. The crash happened when i was going 20+mph on the bike, putting bottle in cage hit a bump, lost control. hit the ground with a beautiful thud and watched the bike fly over me.

thanks

christian
05-09-2013, 10:37 PM
I think a 54 year-old frequent cyclist counts as a young, active individual.

gone
05-09-2013, 10:38 PM
1. young, active individuals (over the age of 13). No i'm 54

2. laborers whose jobs require heavy overhead work. No, construction manager, no heavy lifting but plenty of stress.

3. athletes in non-contact sports whose overhead movements are stressful and frequent. No, not athletic, cyclist, slow, old, heavy. The crash happened when i was going 20+mph on the bike, putting bottle in cage hit a bump, lost control. hit the ground with a beautiful thud and watched the bike fly over me.

thanks

Yep, I got exactly the same verbiage. They must read it from the same menu. I especially like (2). No, I'm not a laborer. Let me ask you this: do you ever lift anything that weighs more than 15 pounds (like, for instance, a bicycle) above shoulder height? I do all the time when I put mine on the wall mounted storage. Hurts like hell.

If you want to call that "labor" then yes, I'm a laborer.

thwart
05-09-2013, 10:40 PM
I think a 54 year-old frequent cyclist counts as a young, active individual.

And much more likely to make it to 94 years old than the average... :banana:

texbike
05-09-2013, 10:42 PM
Sorry to hear about your spill CMG. One of our regular riding partners took a spill recently (actually a truck hit him) and he's been undergoing physical therapy for his shoulder injury. Not fun, but he is getting better...

Texbike

spamjoshua
05-09-2013, 10:47 PM
I am sorry for your injury.

The first thing your "grade III", the pain, and the lack of focus means, is that you need to rest, heal, and be patient. Dont stress now. Heal. You are likely under the influence of some serious drugs as well, dont fight them, you dont need to make decisions tonight, likely not even tomorrow or the next day.

I suggest between now and your next appointment, that you treat it like a broken clavicle: keep that arm immobilized, keep on the prescribed anti-inflammatories, and be sure to ice religiously.

The second thing your grade III means, is that you have torn the two ligaments that anchor the end of your clavicle to your shoulder joint. Your clavicle has separated from your shoulder joint, and thus the end of the clavicle has "popped up", giving the tell tale bump.

In my little mountain town, there are an awful lot of snowboarders with that bump. It is a very common injury in the snowboarding world.

The need for surgery can range from being purely cosmetic, to being wholly necessary in order to manage pain and joint stability. It is generally not a "threatening" repair... people usually return to 100% of where they were before the injury, they generally do not lose range of motion or strength.

My experience is that most heal completely from the injury and the surgery.

You are likely on the path to total recovery. Lets hope so.

It is also my experience that many folks find themselves back to 100% range of motion, 100% joint stability, and pain free, all without surgery, but still with the telltale bump. The bump may matter to you, or to a loved one. That is a different choice.

I hope you did not do significant damage to the shoulder joint itself, and I suspect there is a good chance you did not.

I am sure you are in a great deal of pain.

Rest, get your shoulder evaluated as a whole, and make a decision from there.

I have needed surgery on both of my shoulders to address recurring dislocations, so am familiar with the options, but lets hope that surgeries of that type are unrelated to anything you need to ponder right now.

Joshua

zmudshark
05-09-2013, 10:47 PM
thwart is who you want to listen to, even if this isn't his exact field of expertise.

Even if he isn't an expert in this field, his advice will be better than most, and will do no harm.

Get well soon!

thwart
05-09-2013, 10:51 PM
thwart is who you want to listen to, even if this isn't his exact field of expertise.

Even if he isn't an expert in this field, his advice will be better than most, and will do no harm.

Ah... would you like the $20 by PayPal, or are you doing the Dwolla thing?

eippo1
05-09-2013, 10:52 PM
Sorry to hear about this. One thing to note is that if you have surgery, this joint and in particular does not have the best track record. If I were you, I would try to rehab it through pt first rather than get a surgery that may not help, and you'll be back where you started, but with extra crap in your shoulder.

I am actually getting my second surgery to put my shoulder back together after a failed slap tear surgery, which is actually a more successful surgery than the one you'd be getting. A separated shoulder can often be recovered through diligent pt, so try that first and you can always get surgery later if things don't work out.

FlashUNC
05-09-2013, 11:26 PM
Fwiw, I'd echo that sentiment. Surgery, for me, was necessary if I wanted to have a usable arm for the rest of my life. But man, it kicked my butt.

rice rocket
05-09-2013, 11:30 PM
Unsolicited advice here, but GO TO PHYSICAL THERAPY!!!!

I didn't, and mine was only the mildest grade. My shoulder still "clicks" 15 years later when I lift heavy things. Biggest regret of my childhood. Okay, maybe I have some others too...:rolleyes:

stackie
05-10-2013, 01:04 AM
Been there, done that, got the scar.

OK, I've got the hookup. When I was a resident at UCSD, I took a nice little flight off my bike on the way to work. Made it to work on time, but went to ER instead of OR. Saw first ortho who was a trauma ortho and said it was grade III AC separation. He said either way, surgery or rehab. Leaned toward rehab. But, he said go see his colleague who was more sports ortho. This ortho said it was grade V and he really recommended repair as I was young and athletic. The shoulder specialist was out of town, which was fine with me since I did not really like him anyway.

So, I went ahead with surgery. Turns out it was way worse when they got inside. The clavicle had pushed through the deltoid. Anyway, he repaired the deltoid and put a Rockwood screw through the clavicle to hold it down. Of course, I'm an idiot and probably did too much with the hand despite it being in a sling. (of course, it'll be ok to make an espresso). Anyway, screw loosened. So, back to OR for tightening. Loosened again. Out at 10 weeks. Still a little separation, but overall pretty good. I'm very happy with the function of the shoulder. I did rehab it like a mo-effer, though. I loved that pain. I really loved that pain. Seriously, make love to the pain.

It's been 13 years now. I have full range of motion and no discernible deficit compared to the other shoulder. I may need a distal clavicle resection when I get even older than I am now. But, so far, so good.

I work with a bunch of really good orthos now. They all say now that Weaver-Dunn is the procedure to do. Tie the clavicle down. No worries about the screw loosening.

That's my story.

Here's my recommendation. See several orthos. Make sure you see a real shoulder guy. Look for a guy with a sports medicine fellowship. Ask how many shoulder surgeries he does a year. You want a guy who is doing at least a 100 shoulders a year. Like I said, I work with a bunch of orthos now. Almost all of them do shoulder work. They will all tell you they can do it. But, there are only two that do enough to be good. And really there is only one that I recommend. I wish I could help you find the one guy in your area who should do your surgery. If you have a friend who is an anesthesiologist, OR nurse, or OR scrub tech, they could tell you. Maybe ask a physical therapist. They will also know whose patients do well after surgery.

Feel free to PM if you have any more questions.

Good luck.

Jon

shovelhd
05-10-2013, 08:31 AM
Funny you should mention this now. I had the same injury last weekend on lap 3 of my race. I tore three of the tendons/ligaments in my shoulder and have the bump. I had x-rays and an MRI and was seen by my orthopedic surgeon who has been racing his bike for decades. We are taking the rehab approach first. If the joint isn't up to snuff by the fall then we'll consider surgery. He says that there is no penalty for waiting.

gone
05-10-2013, 08:44 AM
He says that there is no penalty for waiting.

I was told the exact same thing. My separation happened in early November and there was an event I wanted to do in mid-March so I decided to wait since there was "no penalty". When I went back at the end of March he said I'd waited too long and restorative surgery was no longer an option.

Not saying your guy is lying or even wrong but that's what mine said and he was one of the best sports related shoulder guys in a large metro area.

shovelhd
05-10-2013, 08:56 AM
Point taken. I could travel to NYC to see a "shoulder guy" but I am going to take this route first. It's not like I see my doctor and we never talk again. If we don't like where it is headed then we change course.

oldpotatoe
05-10-2013, 09:09 AM
took a tumble yesterday resulting in a shoulder seperation (Acromio Clavicular Seperation) grade 3. from the exam report, No fracture is seen however there is approx. 13 mm of cephaled displacement of the lateral head of the clavicle in relation to the acromion articulating process. this is concerning for a grade 3 shoulder seperation. will be seeing an orthepedic surgeon tomorrow. so how likely i will be going under the knife? when i googled type 3 it's on the fence between surgery and physicle theropy. don't mine going under the knife if long term prospects are better. So what does all this mean? they tried to explain it last night but i couldn't focus.

means it fookin hurts.

cmg
05-10-2013, 11:48 AM
appreciate all the comments. You guys rock. the ortho i'm seeing is listed as sport medicine guy and he's younger than me so i hope that helps. yea, more than one opinion is the way i'm going to go. thanks

kaze
05-10-2013, 12:39 PM
I have a grade 3 separation in my right shoulder (of course since I'm right handed !). I made the rounds of the emergency room, an orthopedic surgeon (shoulder specialist), and physical therapy. The doc said that they always used to do surgery but typically only do it now if the bone is protruding through the skin or there are other complications. He recommended the no-surgery route for me. The recovery was long and gradual, but my arm is back to at least 95%, both in strength and range of motion. I went through PT and continued a weight strengthening program on my own afterwards (I asked the PT for specific home-exercises). Although I belonged to a gym, it gave me a good excuse to buy a nice home gym to make recovery more convenient. The "bump" in my shoulder did subside over time and you can't really notice it now. The only long-term issue that I've had is an occasional shoulder ache (usually with inclement weather), which may be partially due to the fact that I've slacked off the weight strengthening program or perhaps I'm just getting old (arthritis). BTW, I'm 50 now and the injury happened maybe 7-8 years ago. Hang in there, it does get better.

hnovack
05-10-2013, 12:57 PM
I also had a fall off the bike with a right shoulder separation Grade 3. Saw a colleague who was a shoulder specialist who also told me to try physical therapy first. Took a month off the bike and did the exercises. Still a funny feeling at times, however no trouble biking or lifting up to 50 lbs. Full range of motion. He felt that surgery was only for young active individuals. Everyone is different. I agree find a specialist who does the surgery on a routine if the surgery is planned. Interestingly all the orthopedists have stopped biking: they feel there is too high a risk of shoulder and hand injury!!!

rnhood
05-10-2013, 02:02 PM
I had one (separation), and still have the bump 20 years later. No surgery, just pain meds and care, and it eventually got well. I have 100% mobility but the bump (and slight click at times) will always be there. Not a big deal really because it feels and works perfectly.

bironi
05-11-2013, 09:02 AM
My clavicle separation was grade 3. The doctor told me Troy Aikman had the same condition and went on to Super Bowls. No operation, full functionality, a noticeable drop at the shoulder. My right arm reach is a little longer than my left. I've adjusted my break hoods accordingly, and my climbing out of the saddle is less symmetrical than previously. Good luck and have a quick recovery.