I’m writing about my experience with a type V/grade 5 AC shoulder separation to help other active people who have suffered the same,  by detailing what it was like for me to recover without surgery. This is info I wished I’d had in the beginning.

Well, At Least I’ve Got A Good Story…

In late September, 2007, seven days before the end of a two-month mountain bike tour down the Great Divide Mountain Bike Route, I went over the handlebars in the middle of nowhere, New Mexico. I landed on my shoulder and felt an almost instant body-numbing pain and within minutes had a huge bulge growing on the top of my shoulder where the collar bone hooks into the shoulder joint. This was the most painful and severe injury I’ve ever had.

I went to the E.R. (quite an adventure in itself) and they took x-rays and determined the shoulder was dislocated and separated. They gave me pain medication of some sort (I can’t remember now) and set the shoulder back in its socket. They placed my arm in a sling and said they couldn’t do anything about the dislocation and that I should see an orthopedic surgeon within a week.

I saw an orthopedic surgeon in about three or four days and he had a new set of x-rays taken. He concluded that I had a Type-V AC separation that was reducible–meaning that the collar bone could be pushed back down to meet the shoulder joint (though it would pop back up when released), something not always possible with a Type-V. I got lucky, since surgery would be a must if it was not reducible. Upon further research, I’ve found that this kind of type-V separation is like a very severe type-III separation.

[Good illustrations & diagrams]
[A good explanation of the types of AC separations ]

My surgeon said that 90% of surgeons would recommend surgery, but a few on the cutting edge of shoulder work are now advising some (highly motivated) patients to see how successful they can be in rehabilitating the shoulder without surgery. I was highly motivated to see what I could do to rehab my shoulder without surgery. He said that surgery would be a possibility later if I could not get my shoulder to function the way I needed it to.

I had been able to bring back my right shoulder (the same one now separated) from a pretty severe rotator cuff tear with physical therapy alone five years previously. I have been a pretty consistent weight lifter since I was 19, doing things like pull ups, squats, bench press and other major lifts at a high intensity. I knew my body, and if it was possible at all, I felt like I could do it. My other motivation to do it on my own was that I had major-medical coverage only, and I’d end up paying for surgery mostly out of pocket. I also get incredibly queasy just thinking of being cut open, and the recovery from this kind of surgery would be long and painful.

0-4 Months: Rest & Rehab

The first week I felt pain all the time, sometimes so sharp and severe it made me wince. I kept my arm in the sling day and night, and took Percacet at night just to be able to sleep a little. I had to sit nearly upright, and even leaning back on the softest pillow hurt more than sitting up. I spent more of the night awake than asleep.

In the second week I started taking off the sling for a half-hour, once or twice a day and felt a huge sense of relief. My back and arm was cramping up from being in the sling. Late in the second week I was able to go for walks, but would have to tighten the sling to keep my arm held up. The movement of walking would cause pain, but overall I had to do it to keep the rest of my back and body from knotting and cramping up. I quit taking Percacet some time in the second week. My arm hung down at least an inch from my shoulder joint without the sling. I had no muscular ability to lift or move it back up into place, I could only push it up from under my elbow with my good arm. The end of my collar bone stuck up and was very sharp, causing tension on the skin. It was tremendously sensitive and the weight of a t-shirt made it sore, so by the end of the day the tip of the collar bone was very irritated.

In week three I started taking off the sling for most of the day and all night, though working on the computer for even short bits of time would make it ache with some shooting pains radiating out from the joint. I started doing simple range-of-motion stretches and movements, though the range was limited to the front and side and nothing overhead or to the back. I was able to walk 3-4 miles a day up around the mesa, still needing the sling for walking. About mid-week I added some jogging now and then during the walks, stabilizing my arm in its sling with my good hand. I always kept the sling very tight and snug to keep from damaging my shoulder.

At the end of week three I started doing very light resistance exercises using the cable machine on its lightest setting and using 1-3 lb. mini weights. I ran through exercises that I had done to rehab my rotator cuff – basically what I read when researching rehab was that anything that didn’t make it hurt worse  was OK to do, and I had also discussed rehab dos and don’ts with my physical therapist that I worked with previously. I tried doing all the articulations possible using cable machines. Range of motion was very small, but what I could do I did.

Weeks 4-16 were all about making gains in range of motion using wall-walks and other stretching methods, plus weight resistance exercises three times a week. I continued running outside and spinning on the bike at the gym to keep fit. Range of motion was limited–I could lift my arm out to the side up to shoulder height, and out to the front about head height. I could not carry anything in my right hand that weighed more than 8-10 pounds because it would just hang down and hurt. There just wasn’t as much keeping my shoulder together, and letting my arm hang down without support for long periods of time really hurt. It was winter, and the cold made my shoulder ache down to the core, so I spent most of my time indoors and really enjoyed the hot sauna at the gym. During this time period I probably doubled the amount of weight on all rehab exercises, but at the end of 16 weeks I probably only had about 40-50% of my normal strength.

I would massage my shoulder with my good hand quite often. I would also roll around on a tennis ball while laying on the floor to get the knots out of the back of my shoulder – something my massage therapist had told me about. That helped tremendously. In fact, the knots would build up so quickly that I’d have to do it at least once a day sometimes or the pain from the knotted muscles would nearly bring me to tears. This is something I’d highly recommend, and something I still do sometimes still, 16 months out from the injury.

5-8 Months – Southeast Asia Bike Tour

I figured that by going to a warm climate and biking on the road would be a good choice for our next trip. I could spin on the bike at the gym for over an hour with no discomfort in my shoulder so I figured I was ready. Dave swapped out my handlebar stem for a shorter one so I’d be more upright and have less weight on my arms. We had a very loose schedule so that I could let my shoulder adjust slowly. So, we headed to Southeast Asia.

I was very happy with how it worked out. We cycled about four to five hours a day, and in the first two weeks I had some pretty good aches in my shoulder at the end of the day. But after about two weeks, it really adjusted and I had no problem at all. We spent some time on islands and along the coast so I had plenty of opportunities for swimming, which felt pretty good. I was even able to get open-water and advanced open-water certified for diving.

Even though I wasn’t doing any rehab exercises, my range of motion increased during this time. I think the ligaments and muscles needed time to rebuild. I continued to stretch and see progress throughout the tour. By the end, I could reach above my head and to the back, though I couldn’t touch my hands behind me.

9-11 Months – Paddling in Southeast Alaska

Dave and I paddled around Baranof Island, from Sitka to Sitka, with our friends Kris and Leslie. We had six weeks to make our way around, which was plenty of time for healthy people. Dave and I were in a tandem touring kayak, which was the only way that I could have made this trip at all, not just because of my shoulder, but also because I’d never kayaked before!

For the first three weeks or so I could paddle for a couple of hours with minimal pain, then aches and pains would start shooting from my shoulder and I’d have to take breaks (and let Dave paddle for both of us). After about three weeks, I had a good week where I could paddle a few hours and felt pretty strong. But then we had to wait eight days in Port Alexander for weather to calm enough to get around Cape Ommaney. Then we had to paddle hard for a couple of long days because there were few places we could land since much of that side was cliffs down to the water. This was too much for my shoulder, and for the rest of the trip back to Sitka I was in almost constant pain. It took just a week for my shoulder to feel solid again (to quit aching intermittently throughout the day). Then, just like that, it felt great again, though I wasn’t doing much with it.

12-15 Months – Back Home Doing Rehab

After we got back and settled, I got right into the gym, two to three times a week, to not only work my shoulder, but also do my regular lifting routine that I’ve enjoyed doing for many years before my injury. I started off fairly easy with the full rehab routine, but quickly found that my strength increase in all lifts. In addition, I noticed my flexibility was just about back to normal. I could interlock my fingers behind my back and straighten my arms and lift up. At the one-year mark, I estimated my strength was back to about 90%. Within a couple of weeks I could do two or three chin-ups and was really happy. After four months of solid training in the weight room, I think it’s back to 95%. I’ve even played some volleyball and felt great hitting and serving overhead. I’m incredibly happy to be at this point, and feel confident that I’ll be able to do nearly anything I want to physically in the future. But I want to stress that I think my personal success has to do with consistency and progressing very slowly with a long-term commitment to working my shoulder and keeping it healthy.

Day-to-Day: What it Feels Like

I’m happy to have my strength back, but my shoulder will never be the same. I still have a very weird-looking bump where my collar bone sticks up and my shoulder and arm still hang down lower than my other side. When I wear tank tops, sport tops or a swim suit, people notice that my shoulder looks weird and I can tell it bothers the sqeamish. I can now make it look much less obvious when I focus and pull my shoulder up and back with my muscles. But it’s something that definitely shows when I move around naturally and when I’m not thinking about it.

My shoulder also feels tight and unnatural when I simply hold my shoulders back, or even when I’m sitting or walking. I’ll notice and feel it randomly, and it’s not that big of a deal, just annoying at times. I try to stretch and hold good posture when I think about it so that I don’t start to look hunched forward in that side.

Another nagging thing is that my right shoulder is more prone to knotted muscles from neck to around the shoulder blade in the back. I also sometimes still have small aches in my shoulder, usually in the evening on days I’ve worked it hard in the gym. I can live with these things.

If you’ve suffered a severe AC separation and still have questions after reading this, please feel free to email me. I’m no expert, but I can let you know what my own experience has been like. This in no way should substitute for seeing a physician or physical therapist.

Resources:

Rehab Exercises for AC Separations from sportsinjuryclinic.net

Shoulder Articulations from ExRx.net

Shoulder Separation Rehabilitation from University of Pittsburg Medical Center