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Grade 4 AC Seperation, should i get surgery

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  • Grade 4 AC Seperation, should i get surgery

    Hi Guys,

    Just wondering if there is anyone who can give me any advice on wether to get a AC reconstruction. I did the injury around two & half years ago playing rugby and was told buy the reds doctor that i had a grade 4 AC Seperation. I'am back playing Rugby at the moment for the first time since doing the injury, but i don't know for how much longer as my shoulder is very painful after each game and doesnt allow me to do any training as the time between games i need to recover the best i can, but its starting to worry me now as i am starting to loose the strength in my arm and getting a lot of pinns and needles. The good thing is i only have two games left with two weeks in between both games then the season is over. What i suppose my real question is, should i get surgery by one of the top surgons in Sydney straight after the season is over or just give it time and work on it in the gym. My fear with being conservertive with this injury is that it is just going to be the same next year when i start playing again, and i can't afford it to happen next year as there is a good chance of rep rugby and then going to Scotland. So any advice would be apprciated. Thanks
    Last edited by Cameron; 15-08-2006, 04:46 PM.

  • #2
    I think you should


    • #3
      surgery or not

      I think if you've waited 2.5 years and are still in pain doing what you enjoy i.e. Rugby, then talk to a surgeon. If you find someone that can talk to you about at least a few options e.g. Weaver Dunn (not favoured by me) or artificial ligament AC reconstruction and how you are likely to improve with those procedures - then you lose nothing.

      I just had a 'Nottingham Surgilig' reconstruction 4 weeks ago and am just having physio. I expect to be playing district league badminton again in around 3-5 months (no idea how rapid the healing will be for a few weeks yet). Already the shoulder feels much better than following the Weaver Dunn operation I had 2 years ago which failed.

      Hope this helps, Keith


      • #4
        Hi Cameron,

        I'd suggest that you get it done at the end of the season since I have had success with the same operation and through it have I made it back to contact sport and training.

        As Keith mentions the modified weaver dunn is one of the procedures that can restore your shoulder. If you are in Australia I believe your only option will be the modified weaver dunn. This is from my experience from seeing shoulder specialists in Adelaide and Sydney. I believe it will not involve an aritifical ligament but part of your own ligaments (specialist will call it an autograft when you see him).

        I would not let Keith's negative remarks about the modified weaver dunn procedure get you worried for the following reasons.
        * Surgery can fail and a surgeon will give you their success rate. You have to accept that it can be a bit of a gamble though the odds are stacked in your favour.
        * The modified weaver dunn failed for Keith and he obviously has a negative opinion of it as a consequence.
        * I believe that the Australian health care professionals are better than those in the UK (google for the Nottingham Surgilig and you will see where it is performed). So when see a good shoulder specialist you can take heart that you are at least in as good hands or better than when Keith had the modified weaver dunn in the UK (my guess).

        Educate yourself on your injury and what can be done for it, and then go and see several reputable shoulder specialists that are listed on this site for the ultimate opinion. They are the experts and will tell you straight away what your options are.


        • #5
          Originally posted by mantisgb
          PLEASE TAKE NOTE I did not find out that my first surgeon actually works mostly on wrists - it is CRITICAL that you quiz your surgeon about the procedure, how many he has carried out, what his success rate is and what other surgeons do. I was more annoyed that the first surgeon did not tell me at the first referral appointment that another consultant in the same hospital would be much better placed to assist. :-(
          I'd like to further clear up why his operation failed with his quote from another thread.

          Before knocking a procedure please provide all the facts next time Keith. It does not help Cameron who is looking to have that very operation.

          Don't worry Cameron. In Australia you will get a large choice of shoulder specialists - only operate on shoulders, which are different from wrists - who have performed many thousands of shoulder operations. I doubt they had even bothered to ever looked at a wrist.


          • #6
            I spoke with my team physio last night at training, he seems to think that the pain i am having now shouldnt be from the separation as the ligaments have raptured which is true and that an AC recon will not help just get rid of the bumb which doesnt worry me and also said that they might just cut the joint out. So now i am really confused about what the AC reconstruction will do for me beside get rid of the bump


            • #7
              If you are unsure get an appointment with a shoulder specialist.


              • #8
                i agree too. any updates on the injury cameron?


                • #9
                  Originally posted by Cameron
                  I spoke with my team physio last night at training, he seems to think that the pain i am having now shouldnt be from the separation as the ligaments have raptured which is true and that an AC recon will not help just get rid of the bumb which doesnt worry me and also said that they might just cut the joint out. So now i am really confused about what the AC reconstruction will do for me beside get rid of the bump
                  With all due respect to the physio, he is not as qualified as a shoulder specialist to advise you on this matter. I would research this carefully and if possible, get more than 1 opinion.First, research the operation and try to find out what it consists of. Then, make a list of questions/concerns and bring them with you when you see the surgeon. I think the more informed you are, the better position you will be in to make tha decision about surgery.


                  • #10
                    Hi Cameron
                    The general feeling of specialists world wide towards any AC seperations grade 3 and above is that they are surgically reduced. Grade 3's are still a grey area, if to be reduced or not. I suffered a solid grade 5 and simply had no choice is the clavicle had pearced my trapezoid muscle and when the swelling was so subside, my shoulder would put pressure on the brachial plexxus (significant network of nerves converging at one point) = huge amount of discomfort. This could be some of the pain you are experiencing. I returned to normal mountainbiking activities after 6 weeks with no pain whatsoever and am competing after 10 weeks at full pace. Just please make sure you go to the best SHOULDER specialist available and not a general surgeon. VVVNB!!!


                    • #11
                      All textbooks point towards surgery for grade 4 separations. You can leave it unoperated on but forget rugby and expect other problems into the future. Even if you get an op, rugby will REALLY test it and there's still a good possibility of future probs. I recommend the surgery. Also, don't rubbish the physio, they and other professionals (I'm a Chiro), often see these conditions. I often treat a grade 4 that refused to have surgery. Structurally he will always be unstable, but functionally we get him going again and we understand the long term problems. I've treated this guy for 5 years whereas often the specialist doesn't consult for the longer term functional rehab. JUST DO IT. Good luck


                      • #12
                        hello, I am a 24 yr old male who was involved in a motorcycle accident 2 months ago. I felt like I broke my arm and my coller bone was sticking out through my shirt immediately after the accident. I went to a shoulder specialist and he diagnosed me with a level 5 ac joint seperation. Basically the tendons holding my shoulder into place were torn apart and would not grow back into place correctly unless I had surgery. Ive played football and baseball my whole life so surgery was def a must. My surgeon did the modified weaver dunn surgery on my shoulder and used cadaver tendons from someones hamstring to pull my shoulder back into place. I was in extreme constant pain for the first month after surgery and started slow physical therapy on my shoulder after 2 weeks. I am on my seventh week of post op now and I can now move my arm almost good as new. The next step is to build up my strength again but Im progressing so fast I can tell day by day differences. As long as you do what the pt say to do you should be back to normal within a few months. I would def recommend this surgey!