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2012-12-27 9:00 AM

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Subject: Separated Shoulder

My IMLP training plan is supposed to start on 1/1/2013 but a drunken buffoon tackled me an separated my shoulder this past Saturday night.  I have a type 3 separation of the AC joint.  The shoulder at the time looked pretty gruesome and still look somewhat off 5 days later.  The Dr's have told me it will be a few weeks before I can raise my arm again and 2 months or more before normal use of the shoulder.  Has anyone experienced this before?  The main thing that concerns me is that they said will will stay out of symmetry with the other one.  Having never injured my shoulder before I'm concerned I won't be able to do the same things with it I did before.  Obviously swimming is out for awhile but I did break a rib on the same day while training for IMCDA in 2011 and I managed to adjust the training plan for that injury.  It just seems odd to me that these ligaments get torn, they don't heal, and that's somehow ok later on.



2012-12-27 3:13 PM
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Subject: RE: Separated Shoulder
Yes...they usually heal and it does not affect the function of your shoulder.  If you have surgery you will trade a bump for a scar.  The thing about this injury is we don't have a great way to fix it.  There are a lot of ways it can be done and we are getting closer but we don't have the best way yet and most of what we can do is not terribly predictable.  The torn ligaments are extra-articular (outside the shoulder joint itself)  The bump will probably get smaller than it is now but will always be there. If you saw a suregeon who does nothing but shoulder surgery they might be able to offer you something.  If I had this injury I would not have it fixed unless it became debilitating and I don't think it would.
2012-12-28 10:53 AM
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Subject: RE: Separated Shoulder
Thanks.  Assuming I heal about the same as the average person and don't suffer any complications, how long will it be before I'll be able to swim again?
2012-12-28 2:12 PM
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Subject: RE: Separated Shoulder
Tracker09 - 2012-12-27 10:00 AM

It just seems odd to me that these ligaments get torn, they don't heal, and that's somehow ok later on.

 

This is because the function of the shoulder is driven by the muscles in the shoulder. The ligaments simply hold the three bones in there in the vicinity of each other, so as long as all of them aren't completely torn, when the muscles recover and adapt to the new positions, then things will continue on.

 

I had a type 2 AC separation in a bike crash this past summer. It was accompanied by a broken clavicle and a shattered wrist.... and I was lifting heavy weights within 8 weeks, but my shoulders were already pretty strong pre-accident.  The current condition of your shoulder muscles will go a long way toward determining how quickly you can return to normal activity.  There is no reason that you cannot do everything you could pre-injury... you're just going to have to rehab the muscles a bit to get there.  As for swimming, I was attempting to swim within 4 weeks of my accident and only waited longer due to discomfort with my clavicle.  If you have full range of motion and strength in the shoulder, then give the pool a shot as soon as your PT says you can... or, just give it a shot anyway if you feel up to it.

2013-01-01 8:03 PM
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Subject: RE: Separated Shoulder

Complete AC separation Feb 2008 while training for IMAZ in April.   Accident was on 2/5, by the end of the month i was back to swimming 4K workouts (got sore, iced afterwards).  I was diligent about rehab and ROM exercises.  Most important thing is to strengthen the complementary muscles, planks, etc.   THing that bothered me the most longer term was my shoulder blade, would sag on longer runs as it was not being supported by the AC joint anymore.

No current complaints, no surgery, just have a gnarly bump.



Edited by ChrisM 2013-01-01 8:03 PM
2013-01-02 7:00 PM
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Subject: RE: Separated Shoulder
Thanks for laying it out for me. Did you notice the shoulder had a lot of play in it after you started moving it again.  My arm is just now starting to move again but it seems like some things are rattling around more than they used to.  Also, I have pain behind my shoulder blade. Was that present also?


2013-01-03 12:14 PM
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Subject: RE: Separated Shoulder

I get the occasional bumping and grinding, but not much.  I do recall pain in a lot of areas, including behind the shoulder blade. 

I should add that my progression with swimming started simply with kicking with fins and a board, and getting my right arm out in front of me.  From there, went to swimming very easily with most of the propulsion coming from fins, and some from my left arm, but only going thru the motions with my right.  Took a few weeks before I could generate any power in the right arm.  Ironically, a swimmer friend told me my stroke improved, as I used to bring my right arm too high, and the only way it didn't hurt during the recovery phase was to bring it down a little.

Doc said since it was completely torn, I could do whatever I liked training wise, so long as I could handle the pain.  Couldn't make it any worse

I cannot stress enough the importance of PT and core/complementary muscular work.  It will really help.

I also had my PT used kinesio tape during daily activities, to hold the shoulder up in place of the ligaments.

My only long term noticable effects are if I try a pulling motion with my right arm, i.e. pulling a cork out of a bottle.  Sometimes it feels as if everything in there just starts stretching apart.

 

BTW, I'd echo socks above - my ortho said there are several different methods of surgical repair, all with varying degress of success.  If completely torn, doesn't matter when you have surgery (if you do), but that will require 8-12 weeks of recovery, trade a bump for a scar, and it may not last.... 



Edited by ChrisM 2013-01-03 12:16 PM
2013-01-03 12:22 PM
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Subject: RE: Separated Shoulder
The shoulder blade stuff is typical.  Your shoulder is considered to have 4 joints.  Collar bone to sternum, collar bone to acromion (Which is actually part of the scapula or shoulder blade) Humerus (Upper arm bone) to glenoid (Also part of the scapula) and then scapula to thorax (chest wall)  Because you had an AC joint injury and the 'A' is actually part of your shoulder blade getting pain in that area is typical of most shoulder injuries.  Every time a commercial comes on the TV squeeze your should blades together 5-10 times to activate all those muscles back there.  It might be sore and feel like its pulling in the front at first.
2013-01-03 12:47 PM
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Subject: RE: Separated Shoulder
Thanks again for all the great advice and making me feel better about all of this.  I'll follow all your recommendations and check back in later to update on progress so this thread could be helpful to others in the same boat.
2013-01-03 2:03 PM
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Subject: RE: Separated Shoulder
Good luck to you.  I'd say you'll be fine for a July race if you are diligent
2013-02-04 9:40 AM
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Subject: RE: Separated Shoulder
Here's an update on how this is all going.  I did my first swim post injury last Thursday which was 5 weeks post injury.  I only did 25 laps and it was a bit sore during and afterwards but nothing I couldn't handle.   I was planning on swimming the week before but I was sick.   This Sunday I decided to try and push it to see how far I could go without stopping.   I made it 4000M before I decided that was enough.  I guess you can still swim after this injury.  I still can't do a pullup because of pain in that arm but things are coming around for me.  The bump on my shoulder though looks like a golf ball is suck under the skin but I can live with that as long as everything works properly.


2013-03-28 1:20 PM
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Subject: RE: Separated Shoulder
I'm now 3 months post shoulder separation and things were going well.  I'm coming along with IM training but something bad happened today.   Since the weather has finally warmed up I was out on my second ride outside of the year and second since the grade 3 AC separation and I hit a bump in the road both literally and figuratively.   While on the trainer I don't really experience any bumpy roads but I hit a particularly jarring crack today that send a reverberation though my collar bone which lead to an intense shooting pain.   Most of the pain subsided quickly but it is still a bit sore.  At the moment of impact that pain was intense.  My speculation is that my shoulder was absorbing the impact of the bump and the end of my shoulder blade crashed into my collarbone where it used to be attached.  Is that a possibility?  This is a bit worrying because of how intense the pain was and the fact that will be more likely to happen when I get on the tri bike due to the body positioning and weight distribution.  I am a decent rider but I'm also relatively heavy and riding in New England after the winter we had it's going to be impossible to avoid bumps.   Any suggestions, should I start thinking reconstruction surgery.
2013-03-30 1:27 PM
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Subject: RE: Separated Shoulder

I also had a Grade 3 AC separation from rugby. The options, no surgery and be left with a large bump on the top of my shoulder, but be back on the pitch in a couple months. Other option was surgery leaving no bump, but many more months rehab. The surgery would have meant 8 weeks in a sling, no shoulder activities.

I chose no surgery with 0 loss of function or strength long term. I returned to the pitch after 2 months, but had residual intermittent aches for 9 months. Sleeping was the worst. Riding in the aerobars and hooks was also difficult. Activities supporting weight on the shoulder or laying on my shoulder gave me deep bone aches. I am a critical care nurse and have always believed in the power of the human body. I avoided pain killers so that the pain/discomfort was my guide. Masking the pain with pain killers can lead to additional injury.

My advice, work on strength and ROM but most importantly listen to your body and be patient. It will be awhile before you feel 100%, but this doesnt mean you can't train and race. Just be smart about it.

2013-04-02 7:46 PM
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Subject: RE: Separated Shoulder
If you decide on surgery Training for your July IM will be out for several months.  You may be talented enough to get thru it But depends on your abilities.  Probably no IM this year and 3 months out of training.    Doesn't surprise me that you had pain with the bad bump.  If you really want to do the IM do the rehab and see how you do.   The surgery is not an instant fix.  AND I would highly recommend you see someone who ONLY does shoulder surgery
2013-04-03 7:48 AM
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Subject: RE: Separated Shoulder
I'm going to get through this season as is.  There's no time for me to start messing around with it.  I was thinking more long term though.  If I'm still having problems at the end of the summer, that's when I would consider having something done.  Hopefully, it will right itself completely by then though that's asking a lot.
2013-04-03 7:26 PM
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Subject: RE: Separated Shoulder
My gut instinct is by the time you get thru placid you will be fine. 


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