Forums: Climbing Information: Injury Treatment and Prevention:
AC separation, grade 2
RSS FeedRSS Feeds for Injury Treatment and Prevention

Premier Sponsor:

 


mojomonkey


Apr 28, 2012, 11:43 AM
Post #1 of 13 (4477 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

AC separation, grade 2
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

I went off the road on my bike on a steep curve with gravel. Orthopedic doc diagnosed main injury as grade 2 ac separation. The pain was never severe, though some motions hurt. I'm creeped out by the bump where my clavicle pokes up now, and am worried about future utility of my shoulder.

Anyone have a similar injury? How was your recovery, and how long did it take? Did you get back to full strength and range of motion? Are you more prone to re-injury?


(This post was edited by mojomonkey on Apr 30, 2012, 12:55 PM)


methuselah


Apr 30, 2012, 12:15 PM
Post #2 of 13 (4423 views)
Shortcut

Registered: Jul 23, 2006
Posts: 3

Re: [mojomonkey] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

I had a similar experience last August after colliding with a deer on my motorbike and landing hard on my shoulder (wearing protective gear fortunately).

Result was a grade 2 AC separation. My shoulder recovered most functions in about 2 months and is back to normal function now - except I still have that prominent bump.

A surgeon told me that it won't be going away, and that because the joint has been damaged, it will be susceptible to arthritis; also will put more strain on the rotator cuff, so strengthening exercises are recommended.

Best of luck with your recovery.
CW


mojomonkey


May 1, 2012, 6:05 AM
Post #3 of 13 (4383 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

Re: [methuselah] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Thanks for the info. Glad to hear your recovery has gone well. I won't be back to the orthopedic doctor for a week yet, The bump is distressing and feels weird when I move, but I guess I'll get used to it. My bigger concern was the strength/stability in a dynamic move onto that arm, for example. Sounds like that may be manageable with proper exercise to strengthen the area.

Anybody else have any info? I'll update as my recovery progresses in case someone else is looking in the future.


altelis


May 1, 2012, 3:20 PM
Post #4 of 13 (4359 views)
Shortcut

Registered: Nov 10, 2004
Posts: 2168

Re: [mojomonkey] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

i got hit by a van's front windshield post head on while biking to school in '09. Took the post square in the AC joint, sent me flying straight back off the bike. Thank god for the metric ton of books on my back- landed on my back, slid, and never once hit my head since it was so far off the ground!

Basically repeat methuselah here. Bump still present, full ROM in my shoulder, no problems/restrictions at all to any sports (riding road/mtn, skiing, climbing, etc). Mine was not quite a full grade 2, but worse than a 1.

The most important things, esp in the beginning, are the stretching exercises to help build then maintain your ROM. Very important.


onceahardman


May 1, 2012, 5:14 PM
Post #5 of 13 (4350 views)
Shortcut

Registered: Aug 3, 2007
Posts: 2468

Re: [altelis] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Hit a rock while over-aggressively tele-skiing early season powder several seasons ago. Took a header, suffered a high II/low III AC sprain. The bump will remain unless you have surgery. (I didn't). Feels a little rattly on things like bench presses, overheads, pushups, etc., but little functional deficit.

I rarely do this, but I disagree with altelis about early stretching. Mine was pretty painful to move early on, and I used a sling for about a week before I had enough scar tissue to start moving it. As with most shoulder issues, strengthen the tar out of your rotator cuffs.


altelis


May 1, 2012, 5:31 PM
Post #6 of 13 (4341 views)
Shortcut

Registered: Nov 10, 2004
Posts: 2168

Re: [onceahardman] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

We might not disagree as much as it seems, I was a little non-specific with "early". It took me probably about 1-2 weeks of babying the shoulder immediately after the injury before I could even imagine stretching it. Hell, shampooing was a one handed task for a bit.

By early I didn't mean to imply immediate. I would wait till overhead activity isn't impossible- till it's totally doable but maybe still a little stiff. I wouldn't imagine going straight into stretches the day after injury would be a good idea.


mojomonkey


May 1, 2012, 5:46 PM
Post #7 of 13 (4335 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

Re: [altelis] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Thanks for the info on stretching. My Dr recommended some rotation and movement exercises, but to use pain as a guide on how much to do. I hope I didn't push too far. The first couple of days I went with button down shirts since I couldn't move my arm enough to pull one over my head.

I haven't had too much pain, though some movements hurt. Trying to wash part of my back with that arm, for example, if I reach too far.

I took 500mg naproxen the first few days, but tapered off of it since it didn't hurt, and I didn't want to mask any pain and do too much. Though maybe I should continue if it there is still inflammation to worry about?


onceahardman


May 2, 2012, 7:15 AM
Post #8 of 13 (4305 views)
Shortcut

Registered: Aug 3, 2007
Posts: 2468

Re: [altelis] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Ok, we agree again. Smile

From the standpoint of general principles, remember this is a hypermobility injury. It is always easier to re-introduce motion to a hypo-mobile joint than to decrease mobility in a hyper-mobile joint.

Let the scar tissue form. Early on, don't move it too much. There seems to be a growing (but not yet fully realized) body of evidence that using anti-inflammatories can actually slow healing. Inflammation is the necessary first step in the healing process.

This seems to be best studied in bone, but there is no compelling reason why it should not also apply to other connective tissue.


mojomonkey


May 8, 2012, 8:33 AM
Post #9 of 13 (4200 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

Re: [onceahardman] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Some follow up in case someone ends up in a similar situation.

It has been about 2.5 weeks since I crashed (April 21st). I've mainly rested my shoulder, with light usage with pain as a guide to stop. I didn't have too much pain but was trying to err on the under- vs over-doing it side. I only took the naproxen a few days after crashing and stopped since it didn't normally hurt. I iced the first few days, then moist heat for a few days (and I kept that up longer at least once a day since it was easy).

I have pretty good range of motion. I can't, for example, reach my right arm (the right shoulder is the injured one) across my body to wash my left scapula. Reaching behind my back is even harder. I tend to sleep on my back anyway, but trying to sleep on either side (especially the injured side) hurts a little, or at least feels off.

I've mainly done walking for exercise, with a little light jogging after the doctor said it would be OK.

I had a follow up with the doctor this morning. He OK'd me to start easing back into activities with my shoulder, using pain as a guide, and that I may want to use the naproxen then. He said I won't hurt my shoulder now, but will be sore as I start using it. I should be wary of falling on or banging the area more than just using it. I had a climbing tripped planned for the end of the month and he wasn't sure if I'd be recovered enough for it, but thought I'd be good for a trip planned at the end of June.

Long term (5-10 years) he said I may had shoulder pain/issues and arthritis. A shot may be needed then, apparently.

As I was concerned about healing as best and quickly as possible, he recommended physical therapy 2-3 times per week for the next 4 weeks.

It sounds like some of you are pretty knowledgeable - does all of that sound right? Thoughts on the PT? Anything I should keep in mind when looking for a physical therapist?


altelis


May 9, 2012, 11:37 AM
Post #10 of 13 (4141 views)
Shortcut

Registered: Nov 10, 2004
Posts: 2168

Re: [mojomonkey] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

PT is pretty much voodoo and certainly has no place in an evidence based medicine treatment plan Tongue


mojomonkey


May 11, 2012, 7:09 AM
Post #11 of 13 (4085 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

Re: [altelis] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

altelis wrote:
PT is pretty much voodoo and certainly has no place in an evidence based medicine treatment plan Tongue

My first session went well, though the chicken sacrifice was a little off-putting.

I was there about 1.5 hours. Much of it was discussing the injuries and what I wanted to get out of the sessions, then some prodding of my shoulder and various strength and range of motion tests. Nothing hurt too bad and they (I had a student doing a clinical along with another therapist) reiterated the advice to use pain as a guide for use and not to fall or bang it. We discussed some activities I have planned and will likely skip a trip I had planned to New Hampshire for Memorial weekend, but should be good for a weeklong trip to the Gunks near the end of June.

The session ended with some exercises I'm supposed to do twice per day, then a corticosteroid patch on my shoulder hooked up do some battery powered device for maybe 20 minutes. Since that I seem to have better range of motion and can even wash my left shoulder with the right hand (though I can't reach as far as with my left). They said we'd review on Monday and decide whether I should get a prescription to keep up the patches. They were thinking I'd come in for around 4 weeks, maybe do the patches for the first two weeks.

I also climbed on Tuesday and took it really easy just to test out movement. Nothing hurt, though some things were a little uncomfortable and maybe my shoulder was stiff from less frequent use. I was a little sore after and took the naproxen.

So things are looking better than I initially feared :) My right shoulder/scapula is a little lower than the left at the moment but that should apparently move up as the inflammation goes down and the ligaments recuperate (at least that is my impression of what they said).


onceahardman


May 11, 2012, 3:07 PM
Post #12 of 13 (4041 views)
Shortcut

Registered: Aug 3, 2007
Posts: 2468

Re: [mojomonkey] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

Good news!

The steroid/battery thing is probably iontophoresis. It has mixed results in the research, and most insurances around here don't specifically reimburse for it, although some clinics get around that by billing it as e-stim.

Pretty remarkable that you were able to climb a little. Be careful. Let it heal, please.

You could go to New Hampshire if you limited your climbing to Whitehorse Ledge, or some of the other easy/moderate classics.

Most people carry the dominant-side scapula a little lower, and it may well have been that way before the injury. Keep that in mind, and don't worry about it too much.


mojomonkey


May 15, 2012, 8:44 PM
Post #13 of 13 (3908 views)
Shortcut

Registered: Aug 13, 2006
Posts: 841

Re: [onceahardman] AC separation, grade 2 [In reply to]
Report this Post
Average: avg_1 avg_2 avg_3 avg_4 avg_5 (0 ratings)  
Can't Post

onceahardman wrote:
The steroid/battery thing is probably iontophoresis.

Yes, that sounds about right. It seemed like it helped some with range of motion, but wasn't too drastic. I'm not normally in any pain, just certain movements hurt. Afterward I could reach further over my left shoulder or behind my back. I'd also done some exercises too.

I tested things out this weekend and was happy to feel pretty good after two short bike rides (around an hour) and jogging at an easy pace for 45 minutes. Both felt OK and I had no increased pain or soreness after.

I had another session on Monday and, since I didn't report a drastic improvement, they didn't do it again.

The (isometric) exercises they'd given me weren't too stressing, so they bumped up the difficulty*. The therapist also pressed/massaged the area where my clavicle pokes out, and pressed/worked out some really sore muscle knots in my shoulder. They used a device to apply pressure and ice after exercising, then taped up my shoulder. There are two strips. One runs front to back over the part of the clavicle that protrudes. She pushed it down before taping. The other runs from my upper arm over the shoulder to my neck. She lifted my arm up before taping it. It felt a little odd to have the weight of my shoulder transferred to my skin/neck, but it didn't take long to get used to it. The point is apparently to take the weight off of the muscle/ligament. I haven't had any new muscle knots in the area, and hopefully it is helping the ligament too :)

I went climbing again tonight. I'm still taking it slow, but I felt pretty good. I definitely can't reach as far and don't want to try and pull much on it, but nothing caused any pain.

* For those interested in the actual exercises:
Four were done with my arm bent 90 degrees at the elbow and pressing into a stationary object (forward/back/each side) and holding it for 8-10 seconds, repeating 10 times. I also used a towel to like I was drying my back with my good (left arm) above my shoulders pulling against my injured arm. I now work in a stretchy band for more resistance. They also added an exercise that is basically planting both arms (straightened) on the arms of a chair to support my weight (using legs to lighten the load) and shrug my shoulders. I do all of the exercises twice per day.


Forums : Climbing Information : Injury Treatment and Prevention

 


Search for (options)

Log In:

Username:
Password: Remember me:

Go Register
Go Lost Password?



Follow us on Twiter Become a Fan on Facebook