[Closed] AC Joint shoulder separation. Advice please. Your experience.

What grade?

Mine was "only" a grade one, but I've got the bump to prove it!

Recovery took a long time, not aided by the NHS physio giving me swinging exercises to do aimed at improving mobility (despite being fully mobile with it).

Private physio said not to do them and had me slowly building up strengthening and stability exercises instead.

My advice would be to see a private sports physio that you trust.
My research suggested considering the operation as a very last resort although I believe there is some sort of lazer therapy for it that people say has worked well.

Onzadog

What grade?

I think he said grade 2.

Did your doctor tell you what Grade of separation you had done?
RM.
Edit: What Onzadog has said.

I had an anterior dislocation about 5 years ago that had to be reduced under general anaesthetic (riding round a car park....don't ask) and a couple of separations consequently (tree,bridge,fence).
I was back on the bike in a week and I just did strengthening exercises (no proper physio or surgery).It aches and feels a bit 'loose' from time to time but nothing that stops me getting stoopid.

I did it a couple of years ago, not sure of the grade but had some bone floating too.

Hospital advised to take it easy and slowly build back up. For a couple of weeks sleeping was difficult due to wanting to lie on that side. Back on the bike after 4 weeks and probably 2-3 months before fully comfortable.

I did mine (Grade 2/3) 5 years ago. It was painful for a couple of days and then calmed down. I was road riding within 4 weeks. I have the lump now and it sometimes aches if it's cold/damp, but it's not really a problem. Had to give up my career as an underwear model though.

Thanks guys, that helps to hear.

I also did mine about 4 years ago. +1 private physio, worth every penny. If you dont have one already, try to find out who your local rugby team use

Private physio said not to do them and had me slowly building up strengthening and stability exercises instead

+1

strength ball, kettlebell halo's etc

Did my AC in 2012. Not sure of the grade but the physio said it was to the more severe side of it. The initial injury ( and associated muscle damage) was bloody painful. At the A&E they told me it was likely they would operate. When I went to see the consultant he just said it would be best to give it 6 weeks and see how it repairs. It was fine. Took a good few weeks in a sling being very painful before I could use it much....did a couple - few months of physio (NHS which was good), and now as right as rain.
I did quite a bit of research on it and I think if the injury had happened in France / Italy / Spain, they would have operated as soon as they could....however the results aren't any better statistically. Therefore I reckon that I was better off just seeing how it healed itself rather than go through the surgery that might not be a success. My consultant did offer me the option of getting surgery done if I wasn't happy 3-6 months after the injury.

Ive got a lumpy shoulder now with the collar bone stuck up!

Holds up hand. Was the same side that I'd broken my collar bone on so I was very lop-sided anyway.

Had metalwork put in followed by intensive private physio then ended up with a frozen shoulder. Jeez, was that painful and had to go back under anaesthetic for manipulation. More physio followed.

Wasn't pain free so got a recommendation for a physio when I moved. She was brilliant with soft tissue work and also used acupuncture.

Trouble is, these things never really go away when you're old like me. 😐

Edit: did I mention the scar??

Did mine Grade 2/3 (I think, can't really remember, was certainly 2) and it was bloody painful and very debilitating for a week but I managed to do Passportes du Soleil 3 weeks after. TBH it was more painful off the bike than on. I did have it strapped up very heavily to try and support the joint.

It's not too bad now but has been getting increasingly crunchy this year and i have the standard bump plus my collar bone floats around a bit. I had a very good NHS physio (Exeter and at local doc's) but not sure that at my age (49 at the time) it will mend fully.

I separated my shoulder about 20 years ago and then broke my collar bone on same side 10 years ago. No operation but my shoulder has never properly recovered and I haven't ben able to sleep on my side since. A friend who had the op recovered very quickly. It would have helped if I had gone to the gym more as in true cyclist fashion I have bugger all upper body muscle to support the injury.

Has anyone tried Oxygen therapy ? There's a hyperbaric oxygen thingyamebob not far from me.

No, because it's bollocks.

Anyway:

Grade 2 ACJ injury, [i]should[/i] heal on it's own without the necessity for surgery. Very common injury (as we can see from above). Basically you just need to be careful initially to allow the torn ligaments to heal back together again, and then slowly and gradually build up the strenght in your shoulder again, to get it all working tickety boo. You will end up with a bit of a lump, but then so have loads of other folks and it shouldn't cause you any bother, just looks a bit odd.

As above, a decent sports specific physio will be your friend/enemy to get this all sorted properly. Someone up there ^^^ made a good shout about finding out who physios for your local rugby team. Most professional rugby players do this on one or both sides during their career so their physios will be top drawer at fixing it. Where are you based?

Steven

I'm in Belfast Steven, cheers.

I've been lucky enough to do this both sides!
The left side about 20 years ago (mtb OTB), grade 2 I think, got the lump, rested for a few days then active - just moving to it's limit to start with then more as things improved. Only aches now if it's pretty cold.
The right side 15 years ago (brought down by fxxkwit pedestrian stepping off the kerb). Not as bad as the other side but I wasn't anywhere near active enough with it afterwards and it aches every bloody day without fail

Hmm, grade V here in 2004, four bouts of surgery to get it somewhere near usable. It still aches pretty much constantly but the real discomfort comes after exercise or in the cold.
Abduction is still limited to about 80 degrees, so makes climbing a bit awkward, but it is largely OK for cycling..
The biggest issue post surgery is the metalwork that was left behind.. It is all in just the wrong position for a rucksack, so modifications are needed to the strap to stop the top screw head wearing through the skin on my shoulder and becoming visible!

All I can recommend is sticking to the physio schedule as the joint will stiffen up considerably over a few weeks of inactivity, making speedy rehabilitation difficult.

Good luck with it!

I grade 4'ed my right acj when I got hit by a car earlier this year, the doc looked at it in the shoulder clinic and said 'come back in 4 weeks for surgery'

So I now have a bionic acj with a titamium screw and false ligaments, they do the op under a local nerve block, so your awake as it happens, the awesome painkillers they give you turn the drilling of a hole in your collar bone to put the screw in into an allover warm body sensation (which I suspect was every nerve in me screaming!) The rehab was more painful than the crash that caused the injury!

Surgery+rehab and it's pretty much back to normal, other than mild discomfort carrying rucksacks on that shoulder.

I turns out that I did my left one (probably only a grade 1/2) years ago falling of some north shore and didn't even realise!

My AC broke and I didn't really know at the time - all symptoms were there, like the sharp, sickening ache inside shoulder blade, which then (miraculously) disappears (because the ligament had totally snapped) - because I am pig headed and didn't get checked.

then I had a very big break of the same collar bone and it was complicated by there being no AC ligament.

My advice would be to get it fixed. That is the advice on consultants both here and in France where I had the break & semi-emergency surgery. It won;t fix itself and can only 'tend' to get worse.

I was told of a procedure called 'Surgilig' by UK consultant. This is commonly and successfully used for rugby players (both Lee Halfpenny and Sam Warburton have had this) where the injury is common. Non-specialists and A&E are not always very pro-active with pushing this solution, but it really does work.

Good point, digga. The only surgery I had that did not fail within three months was the Surgilig replacement as it allows tissue to grow though it and reinforce the connection.
Great stuff!

I was told of a procedure called 'Surgilig' by UK consultant.

That's what I've got, as advised by Mr. Gooding, the consultant at Nottingham City Hospital where I had my Op. The only fortunate thing about my crash was that it was on the same day as the Shoulder Clinic!

I did a grade 1-2 (doctor didn't define which but mentioned both) last year when I was out in new zealand. 2 days of not riding at all, a further 5 taking easy smooth trails and then back to normal after that pretty much. I still have an odd lump on my shoulder but no problem apart from that.

here is mine from the start of this year...

[url= http://singletrackworld.com/forum/topic/whatz-is-going-on-with-my-shoulder-diagnosis-please/page/2 ]my shoulder[/url]

turns out the collar bone was broken right at the end... the last inch was broken/shattered. exactly the bit that the first doc did not xray (pic i posted). he thought i had torn the ligaments and would be ok to return to work after a fortnight or so....

after three weeks i ended up seeing a specialist and getting an MRI scan. this showed that it was a bit more fudged than previously thought.
think it was a 3.

as well as the bone eing shattered the tendons/ligaments were also stretched and torn. stupidly it was then too late to operate. the bone and stretchy stuff had already begun the healing process meaning that they couldn't screw down the collar bone allowing the tendons to regrow at a shorted length... (the screw would have been removed letting the collar bone sripng back up meaning there was some tension in the tendons.)

as it wasa, i had to sit it out. it took a total of 3.5-4 months after the accident before i could return to work proper, but i was able to wash and dress myself after two months and ride my bike (well, the GF's bike with funny handle bars) after three.

i have a friend who happens to be a physio. he looked after me and gave me exercises to do with helped greatly. i had one of those stretchy band things and would sit there watching tv whilst waving my arm about.

i was very lucky and don't seem to have any adverse effects (exactly 11 months tomorrow). had a bit of a problem on cold mornings for a while, but fine now.

being strong prior to the crash i think helped as did taking it slowly and building up the exercise afterwards. however the exercise was necessary as i gained 5kg due to sitting on the sofa, watching crap, smoing weed, eating shite and being a slob.... through no choice of my own...

good luck! at least it is the winter you'll have to sit out rather than the summer...

oh.. [i][b]part of the game[/b][/i], too.

Have a Grade 3 ACJ injury on my left side, I've been seeing a very good sports physio (ex-olympic cycling team physio), I've been of the bike for 3 weeks and I am looking at 3 - 6 weeks more.

Sadly my injury has come just as I was recovering from knee surgery so I'm now seriously grumpy.

Some interesting stuff [url= http://thesteadmanclinic.com/shoulder_acseperation/overview.asp ]here[/url]. Be careful where it says 'rest' though- this can mean different things to different people and completely immobilizing after a trauma can (and also cannot) lead to complications down the line. Your physio will be able to advise..

It hurt
Two weeks to ride on turbo
Three on a bike
Never been right since

jimjam - Member

...jumped

There's no learnin for some people 😀

Think i may have done mine a couple of years ago. Didn't think i'd broken anything so didn't go to the doc. Was off the bike a few weeks and it was a bit uncomfortable on the bike for a few weeks after that. Healed up ok-ish on it's own (with some home brew physio). Ok-ish as in i've a slightly deformed shoulder, a little bit of pain now and again and a lot less movement than before.

After reading that, i don't imagine anyone would take my advice, but i'd pay for private physio (rubgy guy is a great shout) rather than rely, and wait, for the nhs stuff.

Heel up well buddy.

My son did this on his 15th birthday. Was told by NHS he would never compete in contact sports again and would have a weakness for rest of life. It was left arm and he is left handed. I took him to see a specialist sports otho surgeon. He said:
- build up muscles to compensate using physio
- bump is there for rest of life but it's a common rugby and football injury. Plenty of pro players have the bump if you look for it
- it can be pinned but there is a very high instance of the plate migrating to other parts or body so risk outweighs benefits for someone who continues to be active

4 weeks after he did, he played football in a tournament in Holland. Won the tournament, was top goal scorer, then won the league and was also top goal scorer. Still plays football and has no issues with it other than slight che when it's cold.

Thanks guys, I appreciate all the comments and feel a lot more optimistic about the process now. Now for some serious placebo action.

jimjam - Member

...jumped

Euro - Member

There's no learnin for some people

I know. My secret shame.

I had a grade 3 separation to my right shoulder back in June. You need to balance resting it with a bit of light exercise and keeping it mobile. I gave it 5 weeks before getting back on the bike and doing gentle road rides, i was back mountain biking in 7 weeks.

After 9 weeks the Doctor said it had healed really well and was back doing all the drops/jumps etc i was doing before i did it. It aches a bit now and again and the Doctor i originally saw in A&E when i first did it had the same injury and said you probably won't be sleeping on that side for a year or so!

Did mine almost exactly a year ago. Grade 2/3.

Nhs said physio and no op. Luckily I was going to a good sports physio for groin strain and he reccomended I see a private consultant who specializes in shoulders in Scotland. And I had insurance throughout the work.

Operated 2 weeks later, they also found I had ruptured the bicep tendon. Was bloody painful doing physio. 6months after op, I was back riding, now 12 months and 95% movement and still strengthening all the time.

Op I had was a relatively new procedure where they use Kevlar wires and a "dogbone" they called it to secure the collar bone to the clavical which stabilizes the joint and repaired the ac ligament.

Make sure you get a good physio to look at it as its better to operate soon as possible after the crash before the muscles start scarring over.

Oh and stick to the exercise regime for rehab. Hard work but only way to get it back. Glad I went for the op in the end. Shoulder looks normal apart from the scars.

Rather embarrassingly did mine coming home from work on my wife's hybrid in march this year. Bloody hurt at the time and thought i had broken something. A and E told me it was my rotator cuff (which would have been far worse), turned out it was a grade 3 ac injury.
I have to say even though I was in a sling for a couple of weeks and did a few months of painful exercise, I was gritting my teeth through turbo sessions after a month, riding carefully after about 10 weeks. Not so sure surgery is of any more benefit unless you have a 4 plus injury.

Shoulder is very complex - this is why you will get lots of different stories.
Have a look at the shoulderdoc.co.uk site patient tab to get some info
Pay very careful attention to what you are told to do in terms of rehab
above all see a consultant

look here http://www.shoulderdoc.co.uk/article.asp?section=3

No affiliation to the site , but an ex was secretary to a shoulder surgeon that happened to write the book on the subject that happens to be online on the web site above.

I did mine nine years ago and had surgery within a week of doing it with something similar to the surgilig procedure. Same surgeon as Steve Peat had to do his, keyhole surgery and I have a little 'button' on my collar bone not a surgical screw.
[img] [/img]
I had two weeks of immobile rest post-op then started physio and was back working in quite a physical job two months later.

There's several threads I read at the time on MTBR you can find [url= http://forums.mtbr.com/rider-down-injuries-recovery/separated-ac-rehab-exercises-pull-all-together-730975-post8342833.html#post8342833 ]HERE[/url], [url= http://forums.mtbr.com/rider-down-injuries-recovery/looking-feedback-ac-surgery-686820.html ]HERE[/url] and [url= http://forums.mtbr.com/rider-down-injuries-recovery/ac-separation-shoulder-separation-300318.html ]HERE[/url]

I used to get a bit of pain as the weather turned cold and damp but it hasn't given me any problems since the surgery but I never found out what the procedure was called unfortunately.

Did mine boarding a about 5 years ago. Grade 2/3. A&E visit confirmed what I'd done. Booked lots of private physio and after 6 weeks pain had gone, so felt fine again. So stupidly helped friend move house, cue more pain and more physio. Didn't fully stop periodically aching for another 2 years but now fine and back to 100% again. Good luck and if anyone asks you to lift anything heavy just after you think it's right, tell them to bu**er off for another couple of months.

I borked mine about five years ago (Grade III or IV, can't remember-narrowly avoided surgery) and with access to lots of physio I was painfully on a road bike at three weeks and very nervously on an MTB in six.

I get the impression if you can avoid surgery then that's best.

I can't lie on my right still and feel discomfort with some stiff shirt collars but otherwise it's business as usual with a slightly deformed collar bone!!!

Just max the physio. Hope you recover swiftly.

Im having a very similar time of it at the minute with a grade 3 seperation. I did mine 2 weeks ago and trying to do lots of research on line to try and find info. There seems to be such a range of people who have different experiences, some who have been back riding within weeks, and other having years of problems and surgery. A lad I ride with had 18 months out and surgery following bad advise from NHS and having to go private.

Mines happened just as Ive started to get some real pace and getting to a decent level on the DH bike. Out til at least the new year now following the advise of the Specialist.

Front wheel blasted through a loose berm at Llangollen on a steep but one of the slowest sections, so quick I didnt get chance to get my hands off the bars and an arm out.

Full edit
[URL]

Crash edit (what you are all only really interested in)
[URL]

And my xray
[IMG] ?oh=65944cc23969765bf9c6e3db4f6f2bb9&oe=54E4CDBB&__gda__=1424976849_a1b29e50dbe86aa0a75c4f602ceca164[/IMG]

After doing some searching online I came across this image which is a good at explaining what the injury actually is
[IMG] ?w=705[/IMG]

This weekend is my 1st time not using the sling during the day, I have a follow up appointment next week, but going to ask for a referal to BUPA as I have it with work. I've got a constant deep ache within the joint of the shoulder, and keep getting shape stabbing pains when it move certain ways etc.

Still have no strength at all in it, but have about 90% range of motion back, although the extremes are painful.

Plus Im right handed and its my right shoulder so thats been fun.

Been a shit year for me for a number of other reasons as well so will be glad to see the end to 2014 now.

Hi
If it's a Gd 2 seperation then there's no need to consider surgery - just relative rest, followed by ROM and then strengthening exercises.
It would be good to see a Physio for some advice and exercises.
I'm a Physio myself - and when I did mine (Gd 3 after exiting the bike at speed) - I still needed a colleague to slap me around and get me going.
Best of luck.

we should have a self help facebook group.... with badges or something.

Looking at those pictures, it seems the doctor described a grade 3 to me. Still resting, a bit of mobility has come back, but urgh.

I went over the bars in April 2011 and wound up with a Grade 3 separation. When I went for x-rays I was simply told to rest and take painkillers, which I did for a couple of weeks and then got back on the bike again. I managed a couple of miles before the pain in my shoulder became unbearable!

Fast forward a few weeks and my GP referred me to a consultant and in February 2012 I had a Modified Weaver-Dunn procedure. I was out of hospital the next day and spent the next week and a half off work - thankfully, I have an office job - and wore a support for a month before commencing physiotherapy.

The post-op pain was easily managed, TBH I didn't really require much beyond ibuprofen and I've regained 90% of the stability in the joint. My consultant did a fantastic job.

PJM1974 - Member
I went over the bars in April 2011 and wound up with a Grade 3 separation. When I went for x-rays I was simply told to rest and take painkillers, which I did for a couple of weeks and then got back on the bike again...

IMHO stage 3 is never 'fixing itself' and the risk of carrying on, as I (unkowingly in my case did) and then having an even more complex collar bone break are obvious.

The main advice I'd always give is to insist on early surgery, because these days -with modern techniques - it is swift and far less complex or painful.

[URL= http://i1245.photobucket.com/albums/gg594/Headangle/IMG_0053_zps9d7376a8.jp g" target="_blank">http://i1245.photobucket.com/albums/gg594/Headangle/IMG_0053_zps9d7376a8.jp g"/> [/IMG][/URL]

The first one I did was a simple Grade 1. Flippin' painful at the time. I did some NHS physio, but rather quickly realised I needed more if I wanted to be riding anytime soon. I was due to be racing the Mega 7 weeks later, so that was my incentive. I did 1-2 sessions of private physio per week, and stuck to all the prescribed exercises. After about 4 weeks I was able to ride a road bike very carefully, and I did race the Mega!

Decided to do the other shoulder in order to have matching lumps, so tried to shoulder charge a spruce at Innerleithen on a race run and that sorted that one out.

Digga,

I've found exactly the same. very little Advice or care given from when I did mine over 2 weeks ago, all the information I've got has been from my own research and talking to friend who have had similar experiences.

stage 3 is never 'fixing itself' and the risk of carrying on, as I (unkowingly in my case did) and then having an even more complex collar bone break are obvious.

mine was a 3er... stupidly the first doc didn't pick up on it and when i did finally approach a specialist he said it was too late to operate as the bones and ligaments had started to fix themselves. i ended up sitting it out for a few months and waiting. fortunately i've no ill side affects and have full movement in my shoulder and can happily carry 25kg with that arm.

supposedly, according to the doc, they don't always operate nowadays, anyway. this is in Germany, the UK medical approach may differ.

These are the translated version of my (French) medical notes. The last line always makes me s****.

The radiological shows the fracture as previously described, and a disjunction acromo-clavicular state III of Rockwood.
We decided to operate in semi-emergency

I am firmly of the belief early surgery is better, but it sounds as though in Germany, as well as the UK, the health service try to defer it. This baffles me because a.) ligaments can't heal themselves and b.) the cost of later surgery is higher. I guess they rely on attrition.