Separated shoulder, grade 3/4. Surgery?

Just saw the specialist. Got all the info, now onto the mulling. 50/50 decision on surgery.

The collar bone is free at the shoulder end from all 3 ligament attachments, so it’s floating about and the broken ends may/will be pulled apart as they try to bond, those ligaments will keep being stretched as they heal.

Surgery would be “lockdown”: essentially a zip tie holding the collar bone in place so the ligaments can heal without being disrupted.

Surgery is never risk free, and there’ll be no way of knowing in 12 months’ time whether I was significantly further on due to the surgery. I could wait 3 or 4 months and see how I get on, but given that I want to do a lot with it (biking, rock climbing, swimming, surfing) there’s a very high chance I’d be back in 3/4 months asking for the surgery then.

❓ ❓ 😐

I had it done back in 1997. Same injury as yours by the sounds of it. My shoulder was much improved afterwards.

Weaver & Dunn?

https://en.wikipedia.org/wiki/Weaver%E2%80%93Dunn_procedure

You sure you don’t mean ACJ separation, as it sounds like what I had, although with mine my collarbone was totally dislocated and not going anywhere, so healing was never going to happen, upper end of grade 4 apparently, any worse would be ‘a mess’ to quote the consultant.

I had the surgery, ACJ stabilisation/lockdown and it’s now fixed and as good as it was before, as long as I don’t think about it, as then I can ‘feel’ the screw and surgilig, and now I’m thinking about it, gah!!!!

The rehab hurt more than the injury, but was worth it, as I couldn’t move my right arm above should height before.

2 votes for! Cheers guys. sobriety – yes, same thing, different names. Mine’s mostly 3, but occasionally 4: if I get up wrong, it pops up.

HTS:

https://www.youtube.com/watch?v=LerMY0XpKE4

There are videos of actual operations on there too. Course there are. Might need to work up to those… bleurgh.

Edit. flipping heck, actual operation autoplayed after the animation finished. I think I prefer the cartoon.

I had a III or IV (can’t remember which) a few years back. No surgery but oodles of physio.

No problems since.

I’m 6 months in to a grade 2-3 separation – i feel your pain. can’t ride without kinesiology tape, can’t touch my opposite shoulder without pain, can’t climb, £400 of physio so far.

I’d been told 6 weeks heal time at the time of the accident, had i known it would be 6 months and counting i’d have been pressing for more care options (operation, had it been appropriate). I’m currently on an 18 week waiting list for an ultrasound guided cortisol injection. seems recovery for even a more mild separation is a long old wait 🙁

Well, data the other direction here. I separated mine maybe 15 years ago, grade 4, and never had surgery. I was told they only operated on professional athletes who used that arm and even then it wasn’t guaranteed to do anything. And there was the possibility of messing things up more if they went in. I was living in the US at the time, going to Stanford Medical Centre, and insurance would have paid, so that wasn’t a factor. But, surgical procedures have no doubt changed.

It’s not particularly bothered me since, once the initial healing and physio was done. My collarbone sticks up in the air, that’s the only downside. I’ve also damaged rotator cuffs in different accidents and they’ve been much more of a problem.

J.

I detatched my clavical from the acromion 2010, getting sideswiped by a kid on a BMX bike at a French campsite when returning from a ride. The French surgeon wanted to operate but was reluctant as I was returning home in two days. On getting home I visited the surgeon at the local General Hospital (Mr. Limb) and he laid out the pros and cons (infection, loss of mobility, recuperation, Physio etcs.) and I decided against. I went straght back to work and although the two cracked ribs slowed me down a bit, two months later I was riding a 14k red run at Superbagneres in the Pyrennes. The shoulder aches now and again but on the whole, I’m ok with it.

Very similar experience to Stavro, including the surgeon.

Having discussed operating on my grade IV separation with Mr. Limb I decided the cons (particularly the risk of arthritis in the joint) outweighed the pros and didn’t have the operation. I also get occasional aches, but it hasn’t stopped me doing anything.

Worth knowing that there’s no time limit on the operation either, so if you don’t get on with rehab then you can opt to have the operation much later..

I’ve got some meccano and a few odd screws in teh garage.
That’s basically what they do anyway to hold the bits (technical term) together.

Pop on over, I’ll do it for you…

DrP

+1 for a Weaver-Dunn here. I ended up with a Grade III after going over the bars back in 2011. My shoulder was left wobbling around all over the shop and killed swimming for me.

A year later I had the op – some surgical nylon, a titanium screw and several months off the saddle and some local numbness and occasional twinges aside, all is good.

If you live in the South East, seek out Chris Brooks. He did a very good job on my shoulder.

I was given surgery for a grade v separation (Weaver-Dunn). Unfortunately it lasted for six months and then failed.

Was referred to a very good upper limb specialist who repeated the operation with a modified Weaver-Dunn using a section of hamstring as a replacement ligament to reattach the coracoid process. This worked out great for a couple of years, but that too eventually failed, leaving me with a usable arm, albeit still with a grade iii/iv.
It still causes problems and has a slightly limited range of movement, but it works!

The biggest downside to having the surgery is that they left a screw fixed through the top of my clavicle which is a massive problem for me (can’t wear some backpacks, internal abrasion, ect) but if it is removed, I am back to the start.

So, Probably be wary of surgery until you feel that your shoulder is causing problems, but be aware that it carries a quite high risk of failure, and may leave you with other problems too!

Good luck with it, whatever you choose.

Thanks all, I’ve got private cover through work, so I could be under in 2 or 3 weeks. I’ve seen a chap called Mark Flannery, who’s apparently “Mr Shoulders” round these parts, but if there’s any problems, I look up Mr “Chris” Brooks or Dr “Lego” P.

Would you have to revert to MrP, if you start surgering, DrP, or does it not count if you do it in your garage?

At the moment (i.e. since 10 minutes ago) I’m erring towards waiting. I tend to pick up new things quite quickly, maybe mending ligaments will be one of those things.

Thanks cdoc, just saw yours. hadn’t thought about backpacks! 😕

How long ago did you have your ops? Chap this morning said 15/20 years ago there weren’t really any good options, and a lot failed, but the more modern options, like the plastic lockdown strap, have a much greater success rate.

Mechano you say? 😀

Level 4 here, so all the ligaments snapped (level 5 is apparently where you’ve snapped all the ligaments and managed to get the collar bone underneath the shoulder blade, nice!)

Had the surgery as soon as the swelling had gone down enough recovery wasn’t that bad, did the physio and was on a spin bike in about 3 weeks, turbo a couple of weeks after that.

Should add, i’m back to full strength again now, no niggles or issues other than a fundamental fear of that big kicker in Philips Park

Other thing of note, i think the consultant told me that they use ligaments recovered from cadavers as the new ligament tissue regrows over them better? 😀

+1 for abrasion being sore – I find it painful to carry anything on my right shoulder, shouldering a bike frame is completely out.

But it’s a minor issue compared to having stability in my shoulder again.

My op was back in 2012.

First op was 2006, second in 2008. Things may have changed since then, but my second surgeon (Professor Lennard Funk in Manchester) had the option of strap, surgilig artificial ligament and harvested ligament.

He chose my hamstrings, which after years of cycling he said were quite impressive and should be tougher then all the other options!

Fair enough!

Did the fact that it was Professor Funk operating on you help at all?

I couldn’t say, but he is a great guy who is quite well known in the field and has a good turnout of papers, so I guess that he knows his stuff!

All that I can say for certain is that he is in a very different league to the chap who performed the first op!

And everybody loves a bit of Funk 🙂

Another edit: In must say, the first op was VERY invasive, leaving a huge sabre scar and considerable bruising which really slowed recovery in the first few days in a hospital bed..

In contrast, the trip to see Mr Funk was a day surgery, in and out in four hours. No damage, no pain and an incredibly quick recovery.

Not being able to wear a backpack is a pretty serious counter to surgery. Half my holidays for the last nearly 20 years have been snowboarding, almost all of it recently being off piste/backcountry with a pack…

****.

Yeah, nobody mentioned that the position might be a problem in the future and I just did not think about it, to be honest.

I still find that some are fine to wear, particularly Osprey stuff as the straps just clear it, but my first climbing trip after the last op resulted in the screw wearing through the skin on my shoulder and bleeding everywhere! I did not notice because of nerve damage in the area, but the sensation has come back a bit since then. With a bit of careful pack choice it is not too bad. Sometimes a ghetto fix of a bit of padding taped over it helps, too..

You might be able to request a different fixing position or technique, that might avoid this issue, though.

separated my AC joint in 2012. I think the ligaments etc weren’t totally separated so doesn’t sound as bad as yours. The surgeon in Bristol Royal said it would be best to just leave it and see what happens. The prognosis for do nothing or surgery was about the same. I just had a lot of physio (make sure you do the exercises!!) and it has been fine ever since. Got a bit of a lop sided shoulder though!

I had a different injury to you OP but ‘Gold’ fast track NHS service wanted to saw bone off at 3 points around my shoulder. I was shocked. I asked for a second opinion. The person who gave the second opinion was the head of Limbs, he agreed with me to hold off surgery. That was in Feb. I started doing pressups last week.

(Original injury June2016).

Have you had a Arthagram? I really would recommend pushing back (pardon the pun). I did.

I had that – no surgery but lots of physio and it’s fine. Then I went to a physio for something else. She noticed it and reckoned it was dramatic enough that I should look again at surgery to prevent future issues.

The surgeon checked it over and said that he could operate if it ever became a problem. So I thought I’d leave it for now and carry on riding my bike. I have exercises to keep in strengthening it (3 years on).

cheers hora. not much point having MRI – for it to be floating as it is, all 3 ligaments must be snapped through, no pain or displacement anywhere else.

clover – does it ever bother you? do any swimming/climbing?

Did mine about may last year, grade 3/4. Surgeon said it was 50/50 to have the op or not, decided to go without as I could always have surgery later on if required.
Took a while to get it 100% (about 3 months) but it doesn’t hinder me one bit now. No problems biking, I don’t climb but do pull ups and strength wise it’s no issue.
One thing I would say is, if you do decide not to have an op get physio asap. I started basic movement / exercises after about a week. Slowly but surely I had a bigger range of movements and I’m certain it’s the way it is now due to the early physio and keeping at it.

cheers gav. good to know. I’d take 3 months to 100%, that sounds like an amazing result! Is that to 100% strength, pull ups, swimming as hard as you fancy, or just back on the bike etc without it bothering you too much?

Some more questions I’ve got below, putting them down here is as good as anywhere else, but if anyone can chip in with any thoughts, hints, tips, facts, that would be great.

What I’m not sure about is how/whether the ligaments heal. Is the lockdown operation to replace the tethering job of the ligaments, or to tether it in place to allow the ligament ends to stay in the correct relation to each other so that they can bond and heal at the pre-injury length?

If it’s the latter, how does sawing the end of the clavicle help that?

If I decide not to have the surgery, how do the ligaments bond and heal, when they’re occasionally being pulled out of position?

Is successful recovery building up the muscles so the lack of ligament attachment is less of a problem, or full bonding and healing of the ligaments?

If I don’t go for surgery now, what does injury +4 months unsuccessful recovery through physio alone look like? Unable to build muscles and cope well withoutligameents, or ligaments healing, but they’re baggy and stringy and not doing what they need to?

I am unsure on some points and am happy to be corrected, but..

1: Both. The ligament may regrow and mesh at the sutured point, may regrow and secure a surgilig tether, or may be too damaged for use in reattachment. An artificial tether is often used in conjunction with the sutures in order to relieve the load on the healing tissue (or used to completely replace the tissue in cases where required). This is often a dynamic decision made by the surgeon, as sometimes a scan may show tissue to work with, but on inspection it may be deemed unsuitable.

2: The excision of bone is cited as ‘to prevent the distal head of the clavicle from abrading against the acromion’. This is because the clavicle will exhibit increased fore and aft movement as there is not reliable method of fixing the distal end in position due it being a naturally flexible connection.

3: The few weeks post injury are often enough to help the (now slightly longer due to the stretch and tear) ligaments to mesh and heal slightly. With the clavicle now offering much less of a supportive role, these ligaments are generally under less load than they used to be.

4: That was my choice. With increased muscle mass comes much greater stability.

5: My initial surgery was a few months after the accident and I had made little progress. This was due to the complete detachment of the clavicle and having to deal with a good amount of soft tissue damage and other injuries at the same time, limiting rehabilitation. In cases where there is still a good, albeit stretched and damaged attachment, (as I have ended up with after surgical failure, effectively leaving me with a grade 3/4) then rehabilitation was fairly quick.

Even if you go back in a few months and the ligaments are past it, you are just back in the same position as many start in. There are a good few options for these cases, both artificial and natural harvested.

A great source of info run by my surgeon: https://www.shoulderdoc.co.uk/

I’ve had this injury twice on the same shoulder. The second time was as severe as yours, if not worse. I probably should have had surgery at the time but, due to location, my options were limited and I didn’t have much faith in the surgeon so decided against. 12 years down the line I get some fairly significant pain but functionally my shoulder is fine. I have to keep it strong with weight training or the pain worsens. Funnily enough the worst pain occurs if I have to stand for long periods. In that situation the weight of my arm causes a nasty ache across the trapezius. Even without surgery backpacks cause me an issue. I did a four day hike recently but doubt I could tolerate anything more (light packs for riding etc are fine). As you know already, there isn’t a time limit on the surgery, so given the same choice again I would probably avoid the knife in the first instance. I think I’ll need something done in the next few years but it works well currently so I’m in no rush. To answer your question about trimming the end of the clavicle – that’s done to stop it rubbing on the acromion and causing arthritic pain. Best of luck with your recovery.

Thanks both, really appreciate you taking the time to reply as you did. Very helpful. Lots to think about…

I had a grade 3/4
Insisted on surgery (important it is done quickly)
I had a band put in between the shoulder blade and the clavicle Tightrope
Key hole surgery and ould have the same again
You will probably recover fine with out it but there is a chance that you will have a level of displacement

Hi ned, a very good snowboarder friend of mine (who you may also know!) separated his a few years back (grade 5, which I didn’t think even existed – means something like all the ligaments are bust, it’s out of place and the ends of the bones are damaged).

As he makes his living from snowboarding, he ended up paying privately to have it fixed in the UK by the afore-mentioned Dr. Funk using an artificial ligament. As I understand it, this was strongly recommended as the best option, but the French won’t do it due to expense.

He seems to have had a very good result, back snowboarding, riding bikes and climbing – depiste falling off a skateboard 3 months or so in and displacing it again!

Cheers Mike, I haven’t seen the tightrope before, looks interesting. glad it’s working for you.

Stevo, it’d be really interesting to talk to your friend if you’re happy passing my details on. Just pinged you a mail. Ta!

And the scale goes to six. Which looks like it takes some doing. Some sort of awful rag-doll fall, probably. bleargh!

Yeah, mine was a grade 5 with a fractured clavicle and torn rotor cuff + a standard dislocated humeral head too.,
I was told that grade 6 generally happens when the clavicle is broken in the same incident, allowing the impact to force the tip down towards the scapula 😯
Seems to be seen in motorbike accidents most often. Nasty.

Same experience as MikeWW here. Grade 4 and had surgery within 3 weeks of injury thanks to physio knowing the local shoulder specialist. I was told it was important to get the op done soon as possible.

Did mine in November 2013, off work for 4 weeks. Weekly physio plus home exercises and was back on bike in the May.

Other thing to consider is that you may have done other damage also, I had a torn bicep which the surgeon didn’t see until he was in doing the shoulder repair.

The new stabilisation techniques have very good success rates. Given the advice I was told at the time I would go for surgery again.

No issues at all now apart from slight tightness but that’s down to the bicep tear. No issues with backpacks, used osprey, camelbak and deuter. I don’t like touching the bump though.

Best of luck whatever you decide.

Well, its been 6 weeks and I’m effing bored of not being able to do anything. Turbo trainer is boring. Got some high rise bars and high rise stem for the commuter bike, but that still hurt like buggery. Got loads to do round the house and the garden, and I can’t do much of that.

No increase in stability from day one. More movement and less pain, but it’s still rattling about.

Got a date penciled in for the op on the 31st of August. Feels like the right thing to do.

I had a 3/4 separation last April (along with a lot of other injuries). Went private but was advised to wait for the shoulder operatin. A year in I have the characteristic notch, occasional crepitus, but no real discomfort. I reasoned that cyclists fall on shoulders all the the, and surgery can only do so much. It would fail again.

If you carry bricks or play the violin for a job, have surgery was my advice. And anyway, it helps the TT position 😉

Arg. Every time I think I’ve made a decision… !

I want to go climbing and swimming. I want to be able to work in the garden. That seems a long way off at the moment, and the shoulder doesn’t seem to be stabilising at all.

How long did it take for you to feel more comfortable, for the shoulder to feel more stable?

And how long before you were mountain biking pain-free?

No going back now!