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Seperated Shoulder
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By Evan Riley
From San Francisco, CA
May 31, 2014
A lovely chimney
Grade III separated shoulder?

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By jake marlow
From laramie
May 31, 2014
Mount Maunganui, Tauranga, New Zealand
There are many schools of thought on this and I tend to favor the conservative approach. The outcome of conservative versus surgical treatments are pretty much the same for grades I and II . As you know, grade III's can go either way but if you have a good surgeon he/she will tell you to try conservative treatment first.

Were I in your position (I have a grade II AC separation so I kind of am) I would say go buy an arm sling and a bottle of your favorite NSAID and rest it for a 2 weeks or so. This would include icing for 20-30 minutes a few times a day and NOT USING IT. If your clavicle reduces by itself, go ahead and start doing some light resistance training with an emphasis on deltoids, pec minor, rotator cuff, rhomboids, and traps. If active movements cause pain try some isometric exercises in a doorway.

If the clavicle doesn't reduce on its own then surgery may unfortunately be your only option. Try and find a shoulder specialist. A regular orthopedic surgeon may be able to successfully fix it but having worked with a good number of shoulder patients, I can tell you the outcomes of the surgeries done by a shoulder specialist are much better.

Happy rehabing!

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By Mac Lupton
May 31, 2014
Tangerine Dream
I had a Grade 3 from a snowboarding accident back in december. It was pretty severe, all three ligaments were shredded. I ended up having the surgery about 9 days after the accident. Had a screw holding my Clavicle down for 9 weeks and the day after the screw came out I was doing pull ups (not per doctors request LOL). But anyways I would recommend you get a doctors opinion on if surgery is necessary. I was told It would be at least 4-6 months until I would be able to START climbing again from the date of the surgery. However I was back climbing at my pre injury level about 2 1/2 months from my surgery. Basically I got hurt December 14 and was climbing on February 28, So there is hope!

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By Tradster
From Phoenix, AZ
May 31, 2014
I had a grade 3 separation. Dr said we can screw the collarbone back in place and you get chronic pain, or you can live with a lump. I choose the lump. Surgery may well give you chronic pain. Got my sep shoulder from flying ten feet up and over the mtn bike and crashing right onto my shoulder: sep shoulder & three cracked ribs.

My wife calls me Quisimodo...HA HA..she has a sick sense of humor. You will need to do some weights for your shoulder at the gym, or it will start to deteriorate and 'stove' up on you. Good luck, Bro. AVOID the surgery!

Of course, I was 55 when I messed it up. Do what the Dr says. Mine was conservative and didn't believe in cutting flesh unless necessary. I can do everything I could do before.

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By Price
From SLC, UT
May 31, 2014
Grade 3 separation here (motocross).

I'm 9 months in. Still have the lump. Can't throw a baseball to save my life, but after the initial recovery, it hasn't seemed to affect my climbing too much. I'm not quite back to the grade I was before the accident, but that's more about work and time management than the injury.

Watch those gastones.

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By Tradster
From Phoenix, AZ
May 31, 2014
I must qualify my last comment. Swimming feels weird as my clavical just seems to float when I swim. It feels like it catches sometimes.

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By the schmuck
From Albuquerque, NM
May 31, 2014
I got a grade III complete separation in a bike crash in 2009. Orthopedic surgeon informed me that because I was a cyclist, and likely to suffer the same injury in another crash, that he strongly recommends not fixing it. I started physical therapy with a shoulder specialist one week after the accident, got on the trainer the same week, started riding at three weeks, and raced in nationals 30 days post accident. I started climbing at 3 months out, and today my separated shoulder is more stable than my non-injured shoulder. I have a hump, and my range of motion is not what it used to be, but I have no issues otherwise.

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By JP Rohde
From seattle, washington
May 31, 2014
uintas
Sorry to hear about your shoulder, injuries are never fun. I also had a grade 3 separation from snowboarding, still have a pretty pronounced lump. I was told by a couple specialist and by a few friends who had done the same thing to try and not go through the surgery. I was told that recovery time would be longer but worth it in the long run. I chose to go without the surgery. It took me about a year until I had full range of motion back and no pain while climbing or surfing. Point of all the bullshit is that I am very glad that I chose to not go through with the surgery. Every injury is different and ultimately I would do what the specialist suggests, second options are always worth it.

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By B.S. Luther
From Walnut, CA
May 31, 2014
Separated my shoulder snowboarding as well, a year or more before I started climbing. I can't remember the grade, sadly, maybe 2? I have a big lump. When I started climbing I was worried it might be an issue, but after 6 years of climbing and many other minor injuries, the separated shoulder has never been a problem, knock on wood. It was definitely fully recovered before I started climbing, which was good, but yeah - no problemo. That's doing everything from bouldering to sport to trad.

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By the schmuck
From Albuquerque, NM
Jun 3, 2014
I would suggest a second opinion. My separation was complete, and I had no surgery. The orthopedic surgeon, who runs the local university's sports medicine clinic, advised against surgery unless I played baseball and it was my throwing arm. My recovery is not full, as my range of motion is somewhat decreased and my hand goes numb in certain positions, but I am climbing as hard or harder than I ever have (which is not terribly hard). The surgeon recommended PT, and the therapist, a shoulder specialist, started me on passive range of motion immediately. This was followed by a program of exercises involving weights and therabands, which I still follow five years later. The danger associated with not getting the surgery is that if you do not strengthen the shoulder, the whole joint can drop down, but if you are vigilant about a good shoulder program, you should have no issues. I would say that without surgery, you should be able to climb moderately within one to two months of injury.

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By Chris Clarke
From La Paz, BO
Jun 3, 2014
I had a similar experience as the shmuck about 15 years ago. I had a mountain bike accident and returned to racing on the road very quickly (mtb was a lot slower coming around due to the need to lift upon the handlebars) with climbing following a month or two later gradually getting back to normal levels over a few more months. I have a big lump but no other ill effects yet. I've been able to climb a lot of 12s since then and even a few overrated 13a routes.

Just offered for encouragement and not advice one way or the other on surgery.

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By damienp
From Montana
Jun 3, 2014
blodgett canyon, mt
+1 for a second, or even third opinion. Sure, you may indeed need surgery, but once you go under the knife there is no going back.

quick UpToDate search...
" Type III For the large majority of type III injuries, initial treatment is nonoperative, consisting of rest, ice, immobilization with a sling, and analgesics [10-12]. A sling is helpful for two to three weeks, depending on patient symptoms, to aid healing and relieve pain [13-15]. The patient begins range of motion and strengthening exercises as soon as the pain is tolerable. The intensity of these rehabilitation exercises is increased gradually and as tolerated based primarily on pain.

Patients may return to normal activity between six and twelve weeks following injury, depending on the demands of the activity. Athletes may return to competition once full range of motion and strength is regained [10]. High level athletes and workers that place extreme loads on their shoulder should undergo early orthopedic evaluation. Otherwise, orthopedic consultation should be pursued if pain persists beyond 12 weeks, or returns when the patient increases activity.

This nonoperative approach to type III AC injuries is supported by a review of 24 studies comparing operative and nonoperative treatment [12]. Studies included in the meta-analysis were of variable quality and included two randomized controlled trials [16,17]. This review, which included 1172 patients with type III AC injuries, found no significant difference in functional outcome between the operative and nonoperative groups (88 versus 87 percent satisfactory outcome respectively), but found significantly higher complication rates among surgical patients. Operative care led to a greater need for further surgery (59 versus 6 percent) and a higher rate of infection (6 versus 1 percent). Greater cosmetic deformity was present among conservatively (ie, nonoperatively) treated patients (37 versus 3 percent). A subsequent review with more limited inclusion criteria reached similar conclusions [11]. Both reviews are limited by the dearth of high quality studies on management of intermediate type AC injuries.

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By Antonio Caligiuri
From Pittsburgh, Pennsylvania
Jun 4, 2014
Approaching the anchors on Eclipse (5.6) at Breakneck Rocks in Connellsville, PA.
Not speaking from experience but if it were me, I'd take the conservative approach. The human body is built to heal itself. That being said, throw the NSAIDS in the trash and leave the ice in your tea. These approaches are good for pain reduction but hamper recovery. Yes, they reduce swelling but why is that good? Do you really want to impede your body's natural reaction to heal itself? Swelling causes discomfort and immobility but it is a necessary step in the healing process. Good luck!

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By the schmuck
From Albuquerque, NM
Jun 4, 2014
Swelling is bad...generally. It causes irritation and slows healing. Initially, inflammation is good to promote stabilization of the injury, but you do want to get it down. As for the body healing itself, that is not the case with an AC injury, as the tendons are severed, and they cannot reattach themselves without surgical intervention. However, the damage is largely cosmetic, and from my experience will not limit you much.

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By jake marlow
From laramie
Jun 10, 2014
Mount Maunganui, Tauranga, New Zealand
Antonio Caligiuri, you are absolutely correct that the body is built to rebuild and heal itself. The Schmuck is also right that when ligaments are severed, it is difficult for them to reattach without help. In the instance of a grade III AC separation, it is likely that the scapula will rotate down and depress causing the acromion to translate inferior to the distal end of the clavicle. Once this happens the body may be able to heal, that is to say create new connective tissue, but there will be permanent deformity called a step-off deformity.

I do agree with you that conservative treatment should always be the first but sometimes the body just needs a nudge in the right direction. Swelling is an inflammatory mechanism the body has to stabilize and protect an injury. Since the injury is controlled and no longer needs the swelling, ice may be used to manage it. The NSAIDS are indeed a matter of preference but I would argue that they do not hamper recovery. It is in the acute stage of an injury that bad habits are learned due to pain and limited range of motion. I can't tell you how often a patient will present a limp but have little to no pain during ambulation. The limp is due to a learned compensatory measure the body creates to reduce pain. If there is a way to reduce pain in the beginning and never give the body cause to form a bad habit I think it should be done.

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By marty funkhouser
Jun 11, 2014
Antonio Caligiuri wrote:
Not speaking from experience but if it were me, I'd take the conservative approach. The human body is built to heal itself. That being said, throw the NSAIDS in the trash and leave the ice in your tea. These approaches are good for pain reduction but hamper recovery. Yes, they reduce swelling but why is that good? Do you really want to impede your body's natural reaction to heal itself? Swelling causes discomfort and immobility but it is a necessary step in the healing process. Good luck!


The no NSAID / no ice approach could be dangerous advice depending on the particular injury. I hear this advice most commonly from folks like cross training coaches when discussing things like mild muscle strains or ligament sprains. I would be very surprised to hear this advice coming from a medical professional concerning a grade III ac tear. The altered motor programs from prolonged inflammation are one negative. The possibility of the development of soft tissue restrictions are another. There are more. Bottom line, listen to your doctor.

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By jake marlow
From laramie
Jun 12, 2014
Mount Maunganui, Tauranga, New Zealand
jeff lebowski wrote:
The altered motor programs from prolonged inflammation are one negative. The possibility of the development of soft tissue restrictions are another.



BINGO!

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By caribouman1052
Jul 21, 2014
I got a mid-grade separation at age 21. I'm now 50. I'm calling it a mid-grade, because, back then, there were only three grades, and mine wasn't the type that resulted in automatic surgery. Back in the 80's, the clavicle was screwed to the acromion. Ten years later, a PT told me about a surgery that used a figure-8 of rubber band material to hold the two together, the ligament grows back (sort of) and then the rubber band is removed during an office visit (like getting a very large stitch pulled). Another 10 years down the road, and Boston University was doing an experimental surgery where they would scrape the bad ends off the ligaments, inject cultured ligament (stem cell scrapings from your nose), and essentially re-grow your ligaments. If you wait long enough, the medical crowd will come up with something better. If you wait too long, as I have, other problem crop up.

The never-to-be removed screw option I didn't go for, since it would limit range of motion. I've never had any surgery... all the stress from activity like push-ups now has the clavicle grinding on the sternum. Trust me, this is not ok. Strangely, bench press doesn't bother me nearly as much. Nothing like getting through 20 push ups and wanting to puke because your body feels WRONG. I have to recommend surgery earlier rather than later, so that inordinate stress is not thrown onto one end of a joint rather than the other.

As far as recovery time, it took me a good two years before I could nail overhead right handed again. Pulling down or back doesn't seem to be the issue nearly as much as pushing or raising your arm overhead, with this particular injury. I came back too fast, and blew out my shoulder during a bench press (it had been dislocated during the accident). All I can say is don't over do the PT, and don't under do it. I would ask for three opinions about the PT, and each form of surgery, for your particular injury.

Bon Chance

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By lynchdogger
Aug 22, 2014
Grade III separated left shoulder 24 years ago from high speed mtb crash. Most painful injury that I have had. No surgery, immobilization for a month (something like that) and rehab. No broken bones. Has not slowed me down and full range of motion and strength. Father in law is a sports medice ortho surgeon and was my second opinion. Both docs agreed no surgery. And the reason was that very unlikely that you'd get a congruent joint repair and arthritis is a bitch! Good luck.

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By caribouman1052
Aug 23, 2014
Lynchdogger,

Curious to know if your father in law ever mentioned a repair using stem cells. At one point I was told about a surgery being pioneered by Boston U med school: The docs would get some of your stem cells, culture them, open the AC joint, pop in the stem cells, and close it up. Somehow they would stabilize the joint, with open ended rubber banding. Once it's healed, they pull the banding. In the mid 90's that was supposed to be the cutting edge of AC repair, but I haven't heard about it since.

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By lynchdogger
Aug 24, 2014
No never mentioned stem cells. Not sure if it was because of the nature of my injury or his predisposition. At the time I could not have afforded such treatments. I would consider such now if the research backed it and minimal downside/risk. Hope that helps.

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By bking7
Aug 26, 2014
I'm sitting in the same boat, grade 3. Now exactly one week post injury. For those of you who had nice non surgical recoveries, when about did you stop needing the sling, or begin basic very light exercises?
I'm sitting about with rubber bands and a squeeze toy doing finger strength.
My regular hanging core workout is shot, so I'm looking at anything that places zero stress on the shoulder, leg lifts, superman, crunchs. Any other suggestions?

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By caribouman1052
Aug 27, 2014
initially, no suggestions. About 3 or 4 weeks in, I was doing a shared bench press with a guy who separated his left shoulder. A few months in, and I was benching more than my own weight for the first time - and blew my shoulder joint out backwards. I don't suggest overdoing the recovery. My memory is very small increments in what I could do pain free, that came very rapidly. At first, the slightest twist of my torso hurt my shoulder, and it pretty rapidly narrowed down to pain in the AC joint. But that recovery was literally a couple of years, to get to full function. Note that I split my scapula, cracked the clavicle, and dislocated my shoulder, in addition to the AC separation.

Isolate the joints (curls on a preacher bench) to avoid any strain on the AC joint, it will recover faster. Avoid sharp pain, that's a pain you don't want to work through. Dull ache is fine.

keep the compression sling on A LOT. The connective tissue will grow to whatever length it needs to, to bridge the gap... Less distance is better. If I remember, it's partly ligamentous, so it takes a lot longer to heal than a muscle/ tendon injury.

Eventually, you'll want to be doing Crazy 8's, but again, if the AC is loose, it could make things worse, rather than better.

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