OT: Surgery to repair Grade V AC joint separation.

[sfscott]

After nearly five decades of (essentially) injury-free skiing, I somehow fell skiing and managed to separate the AC joint on my left shoulder 10 days ago.

I took the first two days off and then skied three of the next five, resorting to ice and advil. Things were sore, and I had some range of motion issues but figured it was a bad bruise, etc. A week later, I got some x-rays at the mountainside clinic, and those revealed a grade V AC joint separation.

Today, I went to an orthopedic surgeon back home who classified it as a grade V while noting the difference is more semantics these days than anything else.

The three options are do nothing and go to PT and see how things shape up in eight to 10 weeks; get surgery; or do the PT now and decide down the road if U want surgery.

Surgery is no joke. Open procedure, hardware, soft tissue grafts and potentially some bone shaving. 10 days in a sling and 4-6 months rehab. But it has a good success rate and would keep me from having a drooping arm/pectoral for the rest of my days.

I'm getting a second opinion from a shoulder specialist but was wondering if anyone has had the procedure and what comments you might have.

FWIW, it's my non-dominant side and other than sports, I don't need my arm as I sit at a desk vs. swinging a hammer, etc.

[lavi]

Bummer. I feel your pain. Literally. 10 years ago I blew my shoulder apart. Grade 3, full loss of all ligaments. I know the 4 and 5 are rare. Can't imagine something worse than what I experienced. I literally cried like a child it hurt so bad.

Thankfully, I had/have a very good doc. He has taken care of two pro sports teams (NBA and MLS)...so he knows his stuff when it comes to this sort of thing. His take was that one year out from injury, the outcome is the same. Meaning surgery or not, a person ends up in about the same place. Yes, without surgery you'd have the nice lump (which I have). However, aside from aesthetics and cosmetic appearance, your "performance" will be very similar. Doc did say if I was a baseball pitcher or football quarterback, then the surgery may be good as accuracy throwing would be different without going under the knife. My doc is one that avoids surgery, pain meds, and test (MRI, etc) unless there's a real need. I'm also married to a doctor...and I can tell you there are more docs out there than you'd like to know of that will suggest surgery or whatever as that how they derive there income. So there's that. I'm not saying that's the general rule, but let's not be naive about docs and their intentions at times. Those Maseratis don't pay for themselves. No. I'm not exaggerating.

I chose to not have the surgery for a variety of reasons. I took the pain meds at first and then just lived with it. For me, it was the worst injury of my life. My damn shoulder hurt for a very long time (over a year). The pain wasn't excruciating, but it was very noticeable. I was very uncomfortable sleeping due to whatever positions I slept in.

I think the 2nd opinion is a good idea. In the end it's up to you. A year out or so, you'll wind up in relatively the same place. With surgery, you'll be lighter in the wallet too.

Sorry bub...these things aren't easy.

[sfscott]

Thanks. What's confusing is the doc at the mountain called it a III, which is borderline for surgery. Today's guy, who has pro sports experience, called it a V which I understood to be surgery mandatory. He said the difference was more semantics than reality and definitely did not advocate surgery.

Mine doesn't hurt that bad and I can use my arm. Worse on some days more than others.

The second opinion will be from my #1 choice. Went to see someone in the same group in a desire to overcome my impatience. Was surprised to hear that waiting for surgery does not make things harder or rehab longer.

[robt57]

Not the simplest of joints, make sure the guy works with folks on sports teams, tennis players etc.

In fact the furthest thing from the simplest of joints. Get a few opinions, and don't just listen to the guy who sez what you think you wanna hear would be my 2 cent. Maybe worth a dime.

And remember, the guy that graduates bottom of his DR. classes is still called Doctor.

[nortx-Dave]

OUCH! I feel your pain and understand exactly what you're going through.

In August 2017 I t-boned a dog, flipped over the bars on a road ride and landed on my left (non-dominant) shoulder. Luckily I was only a few miles from home and rode home holding my arm to my side best I could. I could feel a bump on top of my shoulder and assumed I had fractured my collar bone. Xrays showed a Grade V left AC separation.

The ER doc gave me a sling and an appointment to see a sports medicine guy who recommended surgery. Immediately after surgery in the sling my shoulder looked normal.

About 3 months post op the "bump" on my shoulder returned. I saw the Orthopod again and he wasn't surprised! He told me that it was common for the surgical fix to fail!! Wish he had told me that PRIOR to surgery!

So now I'm about 2 1/2 years out from ligament repair and even though I still have the bump (and a separated shoulder on xray), I can do anything I want to do without pain. I can lift and stack 100+ pound bales of hay for my wife's horses...I use a chain saw and move around big pieces of wood without issue .....of course I can ride my bike pain free.....the ONLY thing I feel is a very very slight feeling of instability with very certain motions. And if I sleep on my injured side, in the morning it's a little sore. But I've got no pain and no limitations with activity.

So in hind sight, the operation cost me time and co-pay on my health insurance to the tune of several hundred dollars but no benefit at all. I can say without hesitation that I wish I had NOT done the surgery.

[lavi]

I should add that, aside from the lump, I'm 100% back to "normal". It takes a little getting used to feeling that bone float un-tethered. Aside from that, I'm good.

Just was a bit of a journey. I'm glad to hear your pain isn't that severe! That's a blessing. Mine hurt and hurt and then hurt some more.

[glepore]

I've had one for close to 30 years. It's not been an issue. Folks that do repetitive lifting overhead can get arthritic but I didn't. Does hurt to put a 260 lb squat bar on the shoulder without pads, but I don't do that anymore.

[mdeth1313]

Interesting. When crashed on my bike a couple of years ago I was told I had a grade 2 separation. That was the on call doctor at my ortho's walk in. I went back the next week to see my orthopedist - who is a knee, hip, shoulder guy and he classified it as between a 2 and a 3. I guess it is semantics as surgery never came up (and I have the lump).

[robt57]

Boy, everybody I know is chiming in on this one.

You all need to learn how to stay 'on' the bike/skis/MCs etc.





Lump is common. FYI: wife is a 20+ year veteran SurgTech, mostly Ortho.

[doomridesout]

I went without when I did a Grade III in 2013. Did PT seriously, did my homework. Overall pretty glad I went the way I did. I’m a bit asymmetric and you can get sore in weird places in your neck as your body adjusts. But overall, given the likelihood of a minimal benefit from surgery I’m happy I played it conservative.

[jamesdak]

Yep, add me to the list. Grade 3 of my dominant right side AC joint. No surgery and now at just under two years I really don't notice it. Except for the bone sticking out big time.

[merlinmurph]

Ouch, that sounds ugly.

Do some digging to find good docs and get 3 opinions. Ask friends, friends of friends, bike forums - anybody - to find doctors, and narrow it down to three.

I've had rotator cuff surgery (doesn't sound nearly as bad as your injury) and a ruptured achiiles. For each case, I saw three doctors and in both cases, the opinions were all over the place.

Good luck!

[DeBike]

I did not have the injury you are speaking of. However, I did have 3 tears in my right shoulder(dominant); rotator cuff, bicep, and the muscle that runs along the clavicle. I had the shoulder arthroscopically repaired in 2011. The end result is that my shoulder is pretty good, but it took a long time getting there. The post-surgery pain is excruciating, nearly impossible to get a good nights sleep, 6 weeks in a sling with no driving and very little activity other than walking. It took 6 months of PT, and then nearly another 1 and 1/2 years before the shoulder was feeling really good, at least as good as it could get.

My left shoulder has a couple of small tears and surgery has been suggested in the past. That is not going to happen unless, and until, it gets to the point that I basically cannot use it, or the pain becomes constant and severe.

I have had 4 spinal surgeries, including fusion and total disc replacement, but the shoulder was by far worse than any of them.

[DeBike]

Originally Posted by robt57

Boy, everybody I know is chiming in on this one.

You all need to learn how to stay 'on' the bike/skis/MCs etc.





Lump is common. FYI: wife is a 20+ year veteran SurgTech, mostly Ortho.

None of my spinal surgeries, nor the shoulder surgery, were due to specific accidents or mishaps. I certainly did injure those areas, in one way or another, and more than once, through the years. It really was the cumulative effects of wear and tear through the years.

[robt57]

Originally Posted by DeBike

None of my spinal surgeries, nor the shoulder surgery, were due to specific accidents or mishaps. I certainly did injure those areas, in one way or another, and more than once, through the years. It really was the cumulative effects of wear and tear through the years.

Most folks over the years I know with separated shoulders was ski related. I spared my shoulder skiing, my tibial Plateau and Fibula fractures not spared from skiing personally.