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lawse
24-09-2004, 08:27 AM
I separated my shoulder last saturday in a rugby match, I went to the orthopedic surgeon today at the hospital and she did not indicated what grade it was, I suspect it is a grade 3 as it has a very big lump sticking up.

The surgeon recommended surgery as the best option, she said that most people get it done. If i dont get surgery she said that it is very likely that i will develop arthiritis in the ac joint. If i dont get surgery iu can go back to playing rugby in about three weeks she said.
But Im not soo sure i can live with have a deformed shoulder, its very prominent, it can be seen even when im wearing a shirt.

She said she was going to pin the ac joint down for 4 weeks i think.

Is surgery the best option? the orthopedic has made it sound like it is, but would like to get others opinions.

cheers

injuryupdate
24-09-2004, 01:42 PM
It does sound like a grade 3 A/C joint injury.

The general view on A/C joint injuries at the moment is:

Grade 1-2: Don't operate in the first instance.
Grade 3+ (4, 5 and 6): Operate, although these are rare.
Grade 3: Choice of surgery versus non-operative.

First thing is to identify that you don't have a 3+ injury. These are A/C dislocations that are stuck way out of place that can't move back. They are all very rare. A grade 3 injury sits way higher than it should, but if you support the arm and relax as much as possible, you can feel the clavicle can still 'move'. The average grade 3 injury will move slightly back into place over time and the lump will be less prominent. If you have a grade 3, which is likely, over the next week you will see the lump slowly become less prominent.

The problems you can have after a grade 3 injury has healed are:

Chronic pain: most likely poor outcome, which can be treated by late surgery. Probably equally likely after conservative and surgical treatment, but most A/C injuries DON'T get this.
Chronic instability: a feeling that the A/C joint is still moving around when you do high intensity activities overhead. Surgery should prevent this from happening, it is still a possibility, but rare, after conservative (non-surgical management).
Deformity: Post surgery there would be much less lump, but instead you have a scar. Which is worse? I guess this is an individual preference.

Bottom line is around the world I would say that 95% of grade 3 A/C joint injuries DON'T get surgery, and this is what I would advise. If you are a pro-weightlifter, or gymnast, maybe surgery might be advised. Even pro-football players generally wouldn't get surgery.

injuryupdate
24-09-2004, 01:49 PM
Here is a good link:

http://www.physsportsmed.com/issues/2001/11_01/johnson.htm

lawse
25-09-2004, 03:28 AM
thanks for the reply.

The orthodpedic said that if I decide not to go with surgery then I have a very high chance of getting arthritis. She also said that most people decide to go with the surgery.

Ultimately what I want is for the lump to go away. I am young and i dont realyl want a lump on my shoulder for the rest of my life. Scars heal to an extent.

I just dont want surgery to make the injury worse.

It has been nearly a week since it happened, and it doesnt feel like it is going down at all.

lawse
29-09-2004, 03:14 PM
I have decided against surgery at this stage.

However down the track am i able to get surgery to make the lump go away. Because it is a fairly obvious lump when im wearing a singlet.


thanks
lawson