AC Joint dislocation (Surgery & Non-surgery) feedback.

[Jacques93]

I recently had a hefty crash on my beloved bike. I was diagnosed with a AC joint separation grade 3-4, it seems like a very common injury in the biking world.

People and doctors seem to be 50/50 split on surgery and non-surgery. 
 

Anyone who had this injury and what route did you opt for?

How is your recovery going and lastly any advice?

[bullet77]

I went the non surgery route.

No effect on my cycling at all.

The bone sticks out and is visible to me mostly. Sometimes it clicks but I don't have any pain anymore.

I can swim, paddle a surfboard and SUP but my right hand side does not have the same power/leverage as left side. 

This is a common injury but not the same for everyone.

Happened in 2018, I'm 55.

Hope that helps a bit.

[Frosty]

Good luck with the recovery.

The surgeon I saw preferred not to operate if there was a chance of recovery by isolating movement.

I spent 6 weeks in a sling, followed by physio; and no riding at all. I have a bump where the collarbone is higher than it should be. He (surgeon) said he could put a J-hook in to pull the bone done into place, but I’ve had no mobility from 6 weeks after to now. Happened in Feb 2013 for me.

My photo is in this post (page 2):

 

Edited July 9, 2022 by Frosty

[Mike Mac]

Hi

In Oct 2021 I came off my bike and landed on my right shoulder popping the AC Joint (level 3-4 As well). I saw a surgeon and a physio shortly thereafter. The surgeon also gave me the option of surgery immediately or alternatively, see what happens  over time. His opinion was that the studies show that the outcome 1yr down the road for those who elect surgery and those who don’t, is about the same. 
 

I elected not to have surgery (although it is still not off the table if things don’t work out). For the first month I could hardly use the arm (although it was never immobilised). The physio gave me some light exercises to do with a band.  From month 2-4 I could start using the arm, but still quite a bit of pain (I had cortisone injections into the joint to reduce inflammation). From about month 5 I started paddling (my main sport) which, surprisingly isn’t too painful, but couldn’t reach forward for a proper stroke. I also introduced some MTB from month 4, however, anything that has a drop off or hitting rocks/bumps hurts. This remains the case to today, so my riding is limited to jeep track/smooth single track. 
 

Seven months in now, there is still pain in the shoulder, but I pretty much have full range of motion.  I am trying to just get on with things as best as I can and take pain killers and anti inflammatory meds when necessary. 
 

I am hoping that over the next few month things will improve further and that surgery can be avoided. If not, then it will be a full AC joint reconstruction using tendons from other parts of the body which are screwed into the bone to pull the dislocated bone back into place. A less radical alternative would be to shave the bone where it rubs and causes pain, which apparently they do quite successfully with the rugby players. Regardless which way they go in terms of surgery, I understand that it will require 6 months of no paddling/riding which I want to avoid at all cost. In that regard I am working with a physio to try and strengthen the shoulder and develop “other” muscles to compensate and keep things in place. 
 

Apologies for the long reply, but hopefully there is something in there that helps you with your road ahead. 
 

all the best

M

 

[Tienie]

I went surgery route to tie it back down aligned . Perfect recovery and pain 💯 free movement. My opinion is that your shoulder alignment being out, it puts, stress on other ligaments, and joints, muscle groups. It will develop into problems in your later years. I suppose you can leave it for a party trick. In Cape Town I can recommend my shoulder Ortho for sure. 

 

[F@yino]

Hi Jacques, as a medical doctor and keen cyclist I would like to say the following:

1stly all of the above posts are completely correct. However judging by the pic of ur X-ray I would say that’s a grade 5 dislocation. If you are someone that is very active it will definitely bother you long term and also take a very long time to heal conservatively. 

You are more than welcome to drop me a msg if you’d like to chat a bit more and I can also recommend a few fantastic orthopaedic shoulder specialists.

[Jacques93]

Thank you for everyone’s input, I really appreciate it. I will put some thought to it and decide what to do.

Its a long term decision and I’m still young (28), so age is at-least on my side. I’m a relatively active person so to be fully functional again would be nice.

[nickelass]

Had sugery, after 7 months, of waiting to see if my situation and strength in my left arm would get better, but it did not, plus my riding ability , became such that I was so cautious of injury again on the same shoulder , that it was not enjoyable.

Very pleased with the result as I am left handed and have the strength back as before and the confidence.

[FirstV8]

I had a fall in the 1990's and had the same dislocation on my right shoulder . When i saw the surgeon the following day he was adamant about the surgery route  . It was a success as i have never had a days pain or further problems from the shoulder . The following weeks of physio and restraint are important to a successful op like that , i was told to treat it as a marathon and not a sprint to recovery .    I cycled and swam in those years and never regretted having the surgery . 

[taito]

I also had the surgery after I ripped all 3 tendons in the shoulder . Its been about 5 years and no problems at all. My xray looked very simular to yours.

The recover is not long.

[Sydd]

I dislocated my AC joint in July 2017, training for a major goal event. I was fortunate to see a wonderful orthopedic surgeon at Fourways Life and he completed a surgery to put a hook pin in - initially the doctor in casualty advised us to leave it. Because my husband dislocated his AC joint previously and his shoulder has never been the same since, and I was training for a major event, we searched for a number of opinions for the most pro-active treatment that would have the best long-term prognosis for an active person.

I was on the trainer within a week and was in a sling for 6 weeks. I was able to compete get back on track for the events I was aiming for. The hook pin must be removed within 3 months (it can be a little bit uncomfortable whilst it is in, I felt pressure on my sternum where it articulates with the clavicle).

I completed the physio (very very important!!)  and briefly worked with a biokineticist to get a strength programme going as well. I have previously broken the same humerus and still have a plate and screws the shoulder from that, so I have a good understanding of how important the rehab element is. I have no pain or problems 5 years later. I can race ultra marathon length MTB and gravel events with no problems, madison on the track and am able to carry out all of the movements required in CrossFit which can be heavy on the shoulders. I have about 95% of the mobility of the other shoulder so I have to work on lots of stretching and mobility exercises, but I think this is likely due to having also had previous surgery and still having the plate in (which can't be removed). 

My husband dislocated his AC joint about 10 years ago and it was treated by being immobilised for a while in a sling and then left. He is still very active and it gives him endless problems. Constantly seems to be subluxating and he has a lot of pain. There isn't much that can be done for him surgically now - he's had the joint and the area cleaned up and he is likely to battle more as he gets older. He often laments that he didn't know better at the time. 

[Dexter-morgan]

I had the same injury in 2019, went for surgery, they did the "wire" thing and it came loose(after another fall, I think), I have left it, the only issue I have is my right "shoulder bone" sit a bit higher and when I do technical mountain biking I feel stiff in my right shoulder, other than that, I am good.

Recovery is not too long but not nice for me being right handed, and the right hand side being immobilized.

Edited July 12, 2022 by Dexter-morgan

[Frosty]

6 weeks recovery feels like a lifetime, but in the overall scheme, time flies. Don’t skimp on recovery time; it will most likely cost you more in the long run.

[DJR]

I had it surgically repaired, but it was part of a much bigger repair because I also fractured the acromion process of the scapula. A few years previously I broke and had the clavicle repaired with a plate and screws. So, for me, surgery was without any doubt the way to go. The outcome is close to 100%, in fact, the other shoulder that I never broke, gives me more issues.  

What I want to add (like several people said above) is that the post-op physio is extremely important and essential to restore full function, both in range of movement and strength .

Edited July 13, 2022 by DJR

[Schuits]

I recently had a fall. X rays showed  no breaks. But now I have a pretty large protusion on my shoulder. Probably an AC dislocation  of some grade. It took about a month to settle down, but I'm cycling again. I notice some loss of strength in that arm, nothing major, just some weakness and stiffness after cycling. My only concern us it getting worse. Without spending $$$ on doctors is this something that can generally be left to nature to heal?

 

[Murrob]

1 hour ago, Schuits said:

I recently had a fall. X rays showed  no breaks. But now I have a pretty large protusion on my shoulder. Probably an AC dislocation  of some grade. It took about a month to settle down, but I'm cycling again. I notice some loss of strength in that arm, nothing major, just some weakness and stiffness after cycling. My only concern us it getting worse. Without spending $$$ on doctors is this something that can generally be left to nature to heal?

 

I had something very similar, ignored it initially which made it much worse over longer term. It’s now taken significant effort to rehab and get strength back. It’s worth a few visits to a good physio and get them to loosen whatever has tightened up to protect the shoulder. Then a combination of exercises and stretching has seen me make great progress, nothing crazy, couple of stretches daily after shower and some normal exercises after activating the shoulder with stretch bands.