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Grade 3 AC Joint Dislocation (Separated Shoulder)


scottah

2-Sep-2009
11:02:37 PM

Hi Guys/Gals,

2 weeks ago I had a cycling accident in Sydney, was 'car doored' (ie parked car opened
driver side door). I went over the handle bars and onto my right shoulder and head.

Helmet did it's job (may it rest in peace) and my head is fine.

My shoulder however, has had the clavical (collar bone) torn from it, and it is now trying
to poke through my shoulder skin!

I'm told this is a fairly common injury, so was surprised to see no search results for it on
chockstone (albeit plenty of other shoulder injuries!).

Keen to hear what the recovery is like from a climber's perspective, and of course, the all
important question of whether surgery is a good idea.... (Am seeing an orthopaedic
surgeon tomorrow).

Thanks,
Scott


Andrew_M

3-Sep-2009
1:12:15 AM

Hey Scott,

Sydney isn't a great place to ride a bike. I had a very similar accident and injury (gr3 AC separation) about 3 years ago. The recovery has ultimately been pretty successful without surgery. It took a solid 3-4 months of physio before getting back to climbing (I some other complications in the recovery - chipped bones in one wrist and broken head of radius on other arm which caused some delays) but then it was pretty much straight back into it.

The AC joint doesn't seem to be activated in many climbing situations... its main function is to rotate the shoulder blade when you are lifting a weight above your head (someone with better anatomy than correct if I'm wrong), which you don't really do very often. The only real time it causes me problems is in strenuous underclings, which seem to have a similar action. Mind you I don't climb very hard, so if you're used to doing strenuous athletic routes you might have a different experience...

re surgery: at the time I did my shoulder I reviewed the published medical literature (I do this sort of thing for my job). My memory is a bit hazy, but the long and short of it is that despite the fact that surgeons like to do the procedure, there really wasn't much evidence that it did any better than standard rehab. So, as well as going to the surgeon, consider going to either a good sports medico or sports physio for a non-surgical opinion.

good luck with the recovery.

Andrew

mikl law

3-Sep-2009
8:18:42 AM

I've done three AC pops (motorbike racing) with no great issues resulting, just remember, surgury is a last resort, I didn't have any treatment apart from strapping initially

Edit- an ex of mine poitned out that "older shoulders" are tighter and may have a better outcome than younger shoulders

Older shoulders are rarely bolder

Hugh

3-Sep-2009
9:02:11 AM

re; on the function of the AC joint. One must point out that there is only one connection of the upper limb with the 'axial' skeleton; the axial includes the core. With the core being the most important part of ALL functional movements. This joint is the sternoclavicular joint, funnily enough and as the name suggests is opposite the AC (AC being acromioclavicular). Hence, any disfunction in you're AC will have repercussions for all upper limb movement. Be very careful with your rehab program. Find a good physio and do everything they say. Do not climb just because you're 'feeling better' and if surgery is required get them to bind that baby tight! Haha


scottah

5-Sep-2009
10:58:26 PM

Thanks for the info Andrew, I guess climbing wise it just has to be strong enough to lift
your arm up, and then it's pulling rather than pushing...

I'm no hardcore climber, just love it recreationally! So sounds like I should be OK.

Had my X rays, I've got 1.5cm of superior displacement. Surgeon says he would love to
operate on me if I was concerned about the bump, but unless I was a manual labourer or javelin thrower, or baseball pitcher, (ie above head work) he wouldn't recommend the
surgery.

I haven't seen a physio yet, Doc says there's no real point in the early stage and I
should focus on my range of movement, then use physio for strength gain.

It has been just over 2 weeks and I have seen some good progress, I can move my arm
almost any which way, but above head is indeed painful, delicate and very very weak.
My trapezoid (or whatever it's called) muscle though is getting very sore when walking,
not sure what the story is there... maybe it's getting used to my shoulder's new position
(lower and slightly further forward.) A good massage sorts that out.

Mike, not sure what you mean by 'pops', I'm guessing you've strained your AC joint
ligaments???

Hugh, yeah it's a wonder how the body will get on with 1 less joint.... and how forces
from the arm will translate through to the core now that it's gone...

Hugh

6-Sep-2009
11:58:45 AM

scottah.. Not sure if you were being sarcastic there mate but if you are, then you really have no idea what you're talking about..

mikl law

7-Sep-2009
12:28:43 PM

On 5/09/2009 scottah wrote:
>Mike, not sure what you mean by 'pops', I'm guessing you've strained your
>AC joint
>ligaments???

Big crash then it sat up about 20 mm above my shoulder, and slowly pulled down oer about 1 year, when I did it again. i think it was termed an AC joint dislocation


scottah

7-Sep-2009
2:20:17 PM

Hugh, No sarcasm at all (perhaps it's my overuse of dotdotdot throwing you off :) , and for
the record I have only a very faint idea of what I'm talking about after madly googling for AC
Joint + Axial Skeleton as a result of your post. (Thanks btw)

You're right though, essentially I have no skeletal connection from my core to my arm any
more, the clavical was IT. So I suppose I wouldn't be able to just 'hang from my bones' as
easily anymore...

Mike, wow 20mm sounds big enough to be a complete rupture. Do you have the 'bump' now
after the second fall?

mikl law

7-Sep-2009
5:25:04 PM

On my right (where i did it twice) it's about 8mm now (after 14 years) and the left side is now pretty indiscernable (it was more minor).

I did all the stretching and walking fingers up the wall etc

Hugh

7-Sep-2009
6:47:49 PM

haha all good mate. Yeah was the dot dot dot. If you need any help just shoot me a message and i'll see what i can come up with haha

jgoding

7-Sep-2009
11:26:29 PM

Hi - I've had a grade 3 AC joint injury - also from a riding accident.

I elected not to have surgery and got a fairly full on strap brace thing. Given that Melbourne is home to the AFL there are tons of shoulder injuries and hence good treatment options.

So in my case the strap has turned out pretty well. I've been diligent with the rehab and now have no issues with range or strength, however I've been advised that due to the increased movement in the joint I may well see some arthritis as the joint is, and will continue to be less stable (versus having the surgery).

I went and saw a family friend who is an orthopedic surgeon and he said it was not such a clear cut choice.

Anyway I guess my point is that you can get back to full strength and motion if you choose not to go the surgery option - but it will take quite a while. When I had the brace/strap thing on (for a few months from memory) I eneded up getting some lower and mid back pains as the lack of movement turned into muscle imbalance. With a bit of time and exercise (I found swimming pretty good) this has sorted itself out.

I've found pilates to be excellent, and if you have access to a good CLINICAL pilates (i.e. people who know what they are doing - not someone in a gym who's done a 2 week course on teaching pilates) I'd strongly suggest you go along. One of the great things about Pilates (versus lots of other rehab options) is that the exercises are very tailorable and are ideal for injury recovery.

Posture will also be important - i.e. keep the shoulder back rather than let it slump forward. Also try and keep it down rather than letting your shoulders lift up. The bone that still sticks up (only a little bit now) in not at all noticeable if the shoulder is in it's correct position (i.e. low and back) but does look bad if I let my shoulder rise up and roll forward. Hope that makes sense.

If you need a clinical pilates referral in Sydney I can suggest you ask Nick Allan (who runs a great clinic in Richmond, Melbourne). http://dynamicstability.com.au/

or you could try Naomi Gibbs, Bruce or Megan at Balance Control Pilates
http://www.balancecontrolpilates.com/

PS if the pilates place you go to has never heard of a "reformer" or "Cadillac" then keep looking. These are fantastic rehab tools that will greatly assist you in your recovery.

Well good luck with your recovery. Stay strong and well balanced and you should be right.

Josef

rightarmbad

8-Sep-2009
10:45:45 PM

My ac ligament is totally separated, I suffer pretty much a 25% loss of power compared to the other side.
This is quite obvious when pushing weights in the gym and is across the board for almost any movement concerned with climbing.
For some movements like trying to pull myself closer to the wall with my hand directly in front of my shoulder, there is an incredible loss of power that just makes even some seemingly easy moves impossible. There is a grade 17 climb at Girraween that is simply impossible for me to do now, the first move is slightly over vertical and is 'that' movement, combined with me being tall and having to bunch myself up onto the only feet available, I simply do not have enough power to do it. Highly frustrating.
Without surgically reattaching it, that's just what you gotta live with.

Hugh

9-Sep-2009
7:33:01 AM

i know this is somewhat of a hijacking.. But why is it that so many people are hesitant to have surgery? Just interested in thoughts..


ajfclark

9-Sep-2009
8:36:52 AM

Surgery = being stabbed... It may be in a very precise way but it's still being stabbed.

rightarmbad

9-Sep-2009
9:24:50 AM

6 months recovery doing nothing but silly exercises. Only 20% of cases have a really good outcome.
Expensive, especially if it stops you working..........


dougal

9-Sep-2009
9:40:34 AM

On 9/09/2009 Hugh wrote:
>i know this is somewhat of a hijacking.. But why is it that so many people
>are hesitant to have surgery? Just interested in thoughts..

Any responsible surgeon will say something like "I'm the port of last call." A collegue of mine estimated that 97% of people refered to him shouldn't have been in his office ie 3% warranted a surgical approach. (figures will vary - his practice handles quite specific problems with poor outcomes) so generally people leave a surgeons office without a booking. Surgery is still astoundingly overprescribed in health care and poorly researched but it's what our western system does well (ie a lot of) along with CT scans, MRI and chemotherapy for metastatic tumors.

The vast proportion of complaints not only do not require surgery but surgery (and medication) is actually contraindicated. This doesn't stop many people from performing thousands of proceedures with little or no evidence base (if you think surgery is wholly based on science/evidence you are mistaken - it is largely an art form like all the other health fields based mostly on empiricism (let's see what works and pass that on to the next student). Good outcomes are more to do with picking and choosing. Through experience you learn that one approach has good out comes and another doesn't (at least that's the idea). Mostly we keep doing what someone taught us with little or no real evidence base. Again that's accross the board in health care.

This question could and has generated volumes in health care lit.

Having said that - I'm curious as to why the surgeon advised against the proceedure - why the athlete and the tradesman and not you? I suspect he assumes you don't want to use your arm. This proceedure (reattaching the ac jt) can be very effective. You need to push him with questions. Be blunt. Also try calling Julian Saunders in Blackheath for advice. He's seen plenty of these in athletes and has a very good understanding of the pros and cons of having/not having it done taking into account how dysfunctional it is.


scottah

9-Sep-2009
1:05:39 PM

yikes 25% loss doesn't sound good. I suppose it's luck of the draw. I'm 26, and AFAIK
in full health, so hopefully that will assist in recovery.

Josef, thanks for the referrals, I'll keep clincal pilates in mind.
Interested to hear you mention keeping the shoulder DOWN, did you mean the other
way? The injury (from what I've read and feel) usually means your shoulder naturally
drops, giving the illusion that your clavical pops UP.

I was rushing on Monday night in the rain and held a heavyish bag out with my bad
shoulder and felt very sharp pain in the injury, I'm paranoid I've moved the clavical on top
of my acromion now, it kinda feels different, higher, and further back.... In any case it is
now sore again, so back into the sling it goes *smacks forehead*

I'm seeing the doc again Monday (who hasn't recommended physio thus far since it's
really just ROM I should be concentrating on). I think I'll go see Julian next week to see
what he thinks.

On another note, the car doorer has reported to police that I cycled into the back of her
parked car and she didn't open the door *sigh*, the world we live in huh.

re:Surgery, I'd put money on getting osteoarthritis in the joint down the track, in which
case a surgical fix would probably be required...

I must say it feels odd to do nothing about this injury other than rest it, I certainly feel
the impulsive need that it needs to be treated somehow someway, cut something, move
something!

I think the jist of it was, if my line of work involved heavy use of the joint, then the pros of
surgery outway the cons. (And there are real cons involved in surgery!)
As much as I love climbing, it's not my job and I'm not doing it everyday, so wear and
tear wise it will be better than the manual labourer or overhead athlete. I'm in IT and sit at
a desk all day. (A friend of a friend who is a tradie, not labourer, was advised against the
surgery)

In any case, if things don't work out, there is always the option of surgery down the
track, although a slightly different procedure, but just as successful as far as I know.

- Scott

jgoding

9-Sep-2009
10:51:58 PM

Hi Scottah,

I just meant that the position of your shoulder is important to reduce the wear and tear on the joint. If it's in the correct position then the wear and tear should be minimal. My tendancy was to have the shoulder lift up (i.e. like you're shrugging) and also to roll forward (i.e. poor posture).

If it's rolling forward, or you're lifting the wrong way you could over stress the joint and cause more wear and tear.

It's also from a posture point of view (learnt this doing pilates) that doing exercises with your shoulders in the correct position keeps things in balance, and helps you to stay injury free.

I have 100% strength and range of motion in both shoulders now - but it's taken a lot of work to get here. You will definitely need a prolonged physio program to get you back to where you were (or better than where you were). You may well experience other discomforts such as sore back etc which are to do with the muscle imbalance caused by inaction. In short once you've been through the rest stage and get to physio don't stop. Staying strong and well balanced is going to be essential for you to stay injury free.

anyway good luck with it. don't take my advice anyway - go see a pro who can explain the mechanics of the joint (and suitable rehab programs) based on sound understanding - not one experience.

lacto

10-Sep-2009
12:53:53 PM

>On another note, the car doorer has reported to police that I cycled into
>the back of her
>parked car and she didn't open the door *sigh*, the world we live in huh.
>
my son basically demolished a door on a bmw when opened infront of him , wrote his bike of but just scratches , she claimed he deliberately rammed her and wanted him to pay for her repairs , cops ended up charging her but no luck in collecting money from her . Rumor had it that a couple of his less civically minded mates offered to do a bit of "loss adjustment " on her street parked car


scottah

15-Sep-2009
4:24:16 PM

Am seeing Julian on Saturday.

For anyone interested in my x ray and new shoulder bump
http://picasaweb.google.com/scottah/BikeAccident#5379333782018970738

Submitted my CTP claim with the driver's insurance today, fingers crossed.

Had a checkup with the doc on Monday, I'm certainly missing some of the range in my
arm, even though it FEELS like it's all the way up, it's not! I think continued exercises
will sort that out though.

lacto, hope your Son's OK? sounds terrible.

There are 22 messages in this topic.