A-C Separation

[MGRANT]

Six weeks ago I suffered a Type 3 AC separation in my left shoulder. I was treated in the ER. The ER doctor told me surgery was unnecessary, gave me a sling, and told me I should be healed in about six weeks. For the first four weeks I was very careful not to exert the shoulder. At the begining of the fifth week I began to give it very mild exercise, basically just moving it around. It's now been six weeks and though the shoulder is much better than it was in the begining, the ligaments still feel tight and get sore if I move my left arm around in a way that exerts them.

Does the tightness and soreness mean that the ligaments aren't healed and need more rest or is this normal and can I begin mild exertion to strengthen the shoulder and resume normal use?

I haven't seen a doctor since the original ER visit. Can't afford to.

Any advice is much appreciated. Thank you.

[Michael L Gross, MD]

I agree entirely with the above, except for thesecond to last sentence.  Most orthopedists agree that grade 3 AC injuries do not require operative treatment except in special circimstances such as an elite throwing athlete, or a overhead heavy laborer.  Even in those cases, there are no absolutes.

[ghengas248]

I am not a dr but a PT who had the exact same dx, type3 a/c joint separation. I did this snowboarding in 95'...had surgery because of persistent pain and yes..deformity..mine was pretty ugly. I am 41 (14 years post) I have most strength still but did suffer significant atrophy (muscle loss basically) in the deltoids. This is unavoidable because they have to remove the entire musculature off the clavicle. The fix is basically distal clavicle resection (they cut like an inch off collarbone) then drill a hole in the clavicle then insert a rigid fix (my case Mersilene tape) to take the place of your "vertical ligaments" called the corococlavicular ligament/trapezoid/conoid ligaments..these ligaments keep your clavicle down in place. .You probably shredded these along with you ac ligament.They then hook the tape under your coracoid process and voila! New stabilizers! It worked for me but its a painful surgery as far as recovery/rehab Its an involved surgery to and even without it...it take months to fully heal. So, I would give it 6-8 more weeks and if you are still having significant pain/loss of motion/weakness..then I would follow up with an Ortho definitely. I am having some pain now but Im guessing its scar tissue, maybe some deposits...maybe could use a clean-out but I would say my surgery was a success. Bottomline, if the pain lessens and you don't mind a trademark "bump" over you a/c joint....I would just rehab carefully and keep your deltoids/trap/etc.. intact. They are never the same once a surgeons has messed around with them. Sorry for the injury and i hope you make the right call for you. Good luck!