shoulder seperation, grade 3, what does it mean?

[cmg]

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]

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]

Sounds like fancy verbiage for hurts like hell.

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

[gone]

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]

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]

I think a 54 year-old frequent cyclist counts as a young, active individual.

[gone]

Originally Posted by cmg

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]

Originally Posted by christian

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...

[texbike]

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]

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]

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]

Originally Posted by zmudshark

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]

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]

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]

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...