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You can live with Type III AC joint separation, but I want more

It’s been three weeks or so since the AC joint and supporting ligaments in my left shoulder were completely torn apart.

My recent visit to the orthopedics doc left me kind of annoyed. I waited for about an hour and when the doc finally came in, the first thing he asked me was what I did for a living. I replied with my typical “I’m an IT guy”, to which he replied “Well, you can have surgery, but you’ll be fine without it.”

At that point he was ready to wrap up the visit only 60 seconds in. I asked if the ligaments would ever grow back, and was told they wouldn’t unless I got the surgery. He went on to explain that the muscles in the shoulder would grow to compensate for the lack of support, and unless I was a pro tennis player or something like that, then I shouldn’t worry about it. I asked him if there were any limitations or loss of structural integrity and was told “nothing significant.”

Well I’m sorry, but it seemed to me that a proper shoulder should be supported by the very ligaments I tore. Yes, being an IT guy, the likelihood of me taking up a pro tennis career is practically nil. However, I still felt that any loss of structural support like that couldn’t be good, especially when I get older. After getting my hands on some orthopedics texts while visiting a doctor friend of mine today, I found that indeed a 5% to 10% loss of strength can be expected with a type III separation. What bothers me most isn’t the permanent bump on my left shoulder, or the fact that the ortho doc I saw was basically saying “you’re a fat IT guy, you won’t miss what you don’t use”… what really bothers me is the thought of being broken, especially when I have the option to fix it.

As of today, amazingly I can move my left arm around pretty good and I’m gaining some strength back. I still can’t lift my arm up to raise my hand or anything, and I have no hope of doing things like reaching around to scratch my back. The pain in the AC joint itself is still very real, and it lets me know when I go too far, but all in all I’m impressed with my body’s ability to cope. All the muscles around my scapula still cramp up like nobody’s business, and I have to take frequent rests to help calm those puppies down… but things are progressing.

So with all this progress and not much in the way of lost function to look forward to, why am I considering surgery? Aside from the fixer in me that is bothered as hell that one thing that is supposed to be connected to another just isn’t, and will never be without surgery… the fact is I have an opportunity to take a small risk to fix the problem while I’m young enough to recover as quickly and as thoroughly as possible. No amount of muscle building or physical therapy can get my body to a state as structurally sound as how I’m naturally supposed to be put together.

Still, the argument for just letting it recover without surgery and live with the separated shoulder is a good one, particularly when my physical activity level is currently so low and the foreseeable future doesn’t assume any increase. The real bottom line is; I want my limitations to be entirely of my choosing. I know that sounds kind of funny, but let me explain it this way; When I was a kid growing up, I liked keys. I began collecting them because I knew they would let me into something or somewhere. Eventually that collection became known as “the forbidden key chain”, and held such gems as the mater key to all the doors in my high school, the key to a mountain top communications relay station, and several others. I never used any of these keys… well, ok rarely did I ever use only a couple keys from the forbidden key chain a couple times, but my point is I had the option to use them, but chose not to. The important thing was that I had the choice… and really that’s all anyone wants. I see it all the time.

Let’s say a someone is looking over a clearance table in a local store. They stand and look over the items with other people. As they look over the various things, they are making judgments about usefulness, value, etc. but ultimately nothing from the table interests them. Then this casual browser overhears a couple standing on the other side of the table talking about an item sitting next to the casual browser. Immediately the mind races… the browser instantly becomes an aggressive shopper, rechecking the table, reassessing the item in question. The browser may even be prodded into action by pretending they didn’t hear the couple talking as they pick the item up… staking a claim to it by simply holding it, and at the same time reserving the option, the choice, to purchase it. Whether or not the casual browser decides to buy the item or not is irrelevant. Action was taken because of the pressure generated by the knowledge that soon, if they didn’t act fast, the choice to buy it would be gone. The knowledge that the item itself would be gone is not the affecting issue, the browser had already determined that it was of no interest. Action was taken due to the potential loss of choice.

So here I sit with my broken shoulder. No matter what the doc told me, I know there will be limitations. For example, with my shoulder the way it is I don’t have the choice to take up professional tennis. I know I’ve had and will have a lot more situations come up in my life where I have no choices at all, but in this case I do have one. I can choose to get the surgery.

I’ll give it a month, let things settle down with my shoulder and my day job projects, then I will revisit this decision. Luckily, the doc told me this is a choice that can wait.

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457 Responses to “You can live with Type III AC joint separation, but I want more”

  1. Fitz says:

    Hi all,

    As alot of you understand an AC shoulder seperation is a very uncomfortable and painful injury. Mine was sustained 16 days ago today when tackled playing football where all my weight landed on my left shoulder. After the game I went straight to hospital where they xrayed the shoulder and determined it was a grade 2 type injury, the nurse taped the shoulder across the scapula towards the acromio part of the shoulder which hurt like hell but I suppose eased the pain in the long run and applied a sling. Up until 10 days I could not sleep comfortably in bed so slept on the setee, could not move the arm without a lot of pain and had to have the wife help dress me pmsl, not to mention the painkillers I was taking (8x per day)…

    After 10 days the sling was taken off with instruction from the expert so to speak and so far have had no problems. The pain has died down a lot but does still hurt with certain movements and still can not lift any heavy objects for example. I have been researching on the internet like alot of you guys for physio excersises and strengthening excercises which may help speed up my recovery as the football season is nearly underway for the new season and want to play ASAP. From alot of information I have read on this type of injury a grade 2 injury can be fully healed within 6 weeks as this is how long the ligaments normally take to repair, it can be longer depending on each circumstance and also the person, daily activities and diets etc.

    I have been pleasantly surprised with my recovery so far as I thought I could be off work for upto 12 weeks after reading some forums but at this rate I hope to be back playing football no later than 8 weeks and back to work after 6 weeks. I am an electrician therefor need my shoulders for alot of my work so fingers crossed.

    I hope some of you will find this comment helpful as I did with others above as it can be depressing not being able to do the things you love ie sports.

    One thing I would say is that everyone is different so some people will heal quicker than others but be optomistic and start stretching your shoulder as soon as you can, where a shoulder support with either ice or heat packs when doing this and also use rubber stretch bands. If you feel alot of pain you should rest the shoulder until the pain has gone although from what I have read even this will not cause additional damage.

    —-Take care all and watch the shoulders !!—-

  2. Mason says:

    Reading all these blogs and knowing my own experience, what is clear is the psychology of facing the injury is no small thing! I have a server type III injury with an inch fall from the clavicle, which is very confronting to look at, sickening even. I am in the 6th week and have little direct pain and good range of motion. After being up and about for a few hours of constant work or walking; if its not taped; it aches and is irritated. I can’t live with it taped all the time. But I must admit, my main concern is I can’t stand the thought of being permanently disfigured like this. I think many people who have this injury are frustrated by a feeling of a stupid moment in time that can’t be undone, resulting a permanent disfigurement. Mine was a snowboarding injury on was a great holiday, however the holiday ended; for the lack of a better brief description; with a falling-out with my closest friend; thus I have a mental association with the injury and this event. I don’t want to look at the bump and remember all the trauma associated with it; I’d prefer a scar, which would be a better symbolic representation… But on the other hand; given I am not insured; and the operation is $10000 AU ($5000 for the prosthesis alone) this is disincentive for the op. That, and the onset of arthritis from an op which again, I don’t want to remind me of the associated trauma of the injury, and all that could have been avoided in the ‘what if?’ world. I change my mind back-and-forth hour by hour.

  3. Mason says:

    Reading all these blogs and knowing my own experience, what is clear is the psychology of facing the injury is no small thing! I have a server type III injury with an inch fall from the clavicle, which is very confronting to look at, sickening even. I am in the 6th week and have little direct pain and good range of motion. After being up and about for a few hours of constant work or walking; if its not taped; it aches and is irritated. I can’t live with it taped all the time. But I must admit, my main concern is I can’t stand the thought of being permanently disfigured like this. I think many people who have this injury are frustrated by a feeling of a stupid moment in time that can’t be undone, resulting a permanent disfigurement. Mine was a snowboarding injury on was a great holiday, however the holiday ended; for the lack of a better brief description; with a falling out with my closest friend; thus I have a mental association with the injury and this event. I don’t want to look at the bump and remember all the trauma associated with it; I’d prefer a scar, which would be a better symbolic representation… But on the other hand; given I am not insured; and the operation is $10000 AU ($5000 for the prosthesis alone) this is disincentive for the op. That, and the onset of arthritis from an op which again, I don’t want to remind me of the associated trauma of the injury, and all that could have been avoided in the ‘what if?’ world. I change my mind back-and-forth hour by hour.

  4. Sam says:

    Hello all,

    Progressive Grade 2 ACJ separation here from weight training/bodybuilding.

    Initially I had a Grade 1 ACJ separation when I was 17 from trying to snatch and clean around 70kg. Left shoulder sustained the injury. The joys of being uneducated in training at a young age. 4 weeks after that I was back in the gym and playing rugby – everything was fine.

    After the age of 18, I stopped playing rugby but continued training at least 4 days a week and got into natural bodybuilding. My left shoulder since the injury has always fatigued before the uninjured right.

    This year, aged 24, with plenty of knowledge on form when training and warming up correctly, I re-injured the shoulder doing bicep curls of all exercises. This was with only 12kg dumbells too and with strict form! At the time though, I wasn’t getting good sleep, was stressed with exams and I was training for a show – my body fat percentage was around 6%. But my diet was on point. This was 4 months ago.

    I wore a sling for a few weeks – maybe not enough, kept a strict diet, rested it, had an MRI and seen two orthopaedic surgeons who have advised not to have surgery and that it will heal back fine. Since I am back in gym doing all the mobility and rehab exercises working the scapula, deltoid, teres, rhomboid and trapezius muscles. The shoulder is still not right though. Theres a lot of clicking and popping still where the clavicle meets the acromion and if I grab something quickly from a counter at a 45 degree angle it will “dislocate”. Even carrying shopping bags can cause this to happen and it is very painful. This amount of movement is going to lead to osteoarthritis undoubtedly. I cannot bench press or do any over head shoulder work. No dips either! The fact that this is preventing my from exercising like I used to, competing in bodybuilding or ever playing rugby again is depressing! This is a truly awful injury with unpromising surgical solutions.

    Anyone else have a grade 2 and been completely fine after?

  5. Kurt says:

    After talking to a few surgeons I discovered that my type 3 separation was really a type 5 that should have had immediate surgery. But I was uninsured so my quack doc said it was a type 3 that didn’t need surgery.

  6. John says:

    I fell while running. Hospital Xrayed and said I had a bad sprain. I could not sleep for two nights and when i did i woke up in terrible agony. But, I never took any pain meds or even ibuprofen because i wanted to understand the pain. In late Oct i finally got to an orthopedic doctor. After an x-ray, She told me they don’t do surgery for people like me and I would get only physical therapy. people like me are 50, but they are also very active and regularly run, lift, and play vigorous sports. I was bench-pressing 125% of my own body weight prior and regularly did should exercises with weights. What more, exactly, am I to build up now?

    Now I favor my good side all the time. I am afraid to put the same kind of strain I used to put on my shoulder, so I have reduced all exercise dramatically. It is very discouraging. If the tires on my car go out of allignment, then i get them fixed. I do not just reduce my speed to 50 mph and rationalize that it’s still ‘kinda fast’. No doubt, the insurance companies we all pay for so dearly have decided that they can save money.

    I will go through the PT program, and I am sure I will see improvement from my current state, but I was improving before the injury as well since I was gaining strength, so I am not sure what a physical therapist is going to do for torn ligaments. According to one study ( http://ajs.sagepub.com/content/29/6/699.short ), people overall do not get back their pre-injury strength. In fact the median strength loss was something like 17%. I will go through the therapy, but I will also fight to get myself re-assembled. Sure, I am 50, but that means what? That I should accept having a hugely misshapen shoulder for the next 50 years because I am not an athlete? That I should live with the effect of misaligned bones in my shoulder and learn to just deal with pain in my exercise for the rest of my life? I expect to be lifting weights in my 90s. I expect that if I take care of myself, my care provider should be willing to do likewise and not tell me to accept non-age related limitations.

  7. allen says:

    I really don’t know how to work this but i have a few questions i landed on my shoulder about a year ago in October and the doctors didn’t even tell me what it was they said it was a possible ac joint separation and gave me a sling a year later i have a big knot on my shoulder that pops when i move it I’m a football player and i can’t lift weights i can curl but when i bench it feels like my shoulder is tearing any advice?

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