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  • shoulder separation and weight lifting

    Hi,

    I had grade III shoulder separation two weeks ago. As a hobby I lift weights actively. E.g. I have made 400 in bench press, 330 in incline bench press and 240 in military press. I think I try to rehabilitate the shoulder first without surgery.

    Does somebody have experiences of how well it is possible to recover the original strength level after this injury?

    How much time it is going to take to recover fully?

    Does the separation cause some kind of permanent unfunctionality to the shoulder so that it is not possible to gain the original strength level back?

    Should surgery help the recovery?

    I have read few studies of how recovery has gone after this injury and it seems that without the surgery the recovery process is faster and you are able to gain the original strength level quite well back. But I understood that those studies were made with patients that didn't lift weights actively.

  • #2
    If by shoulder separation you mean A/C joint then usually conservative treatment is recommended over surgery. If you have dislocated the entire shoulder, maybe surgery is required.

    Grade 1-2 A/C joint injuries should definitely be treated surgically and grade 3+ (or 4-6) where the clavicle has ended up way out of place should be treated surgically. Grade 3 injuries, where the clavicle part of the A/C is displaced a long way but upwards only (and not sideways or backwards) are controversial as to whether surgery or conservative is best. I will try to treat without surgery in football players. Probably trial of conservative is best as many recover well without surgery and also surgery can be performed later on with success.

    However, if you are obsessive about lifting PBs, perhaps getting an anatomic repair may be advisable. If I was treating an Olympic weightlifting I think I would advise repair after a grade 3 injury, perhaps same with pro tennis player or Olympic swimmer (who don't tend to suffer this injury anyway) but for most other athletes go conservative at first.
    The staff of injury update are not responsible for views of other users posted in this forum.

    Comment


    • #3
      Hi,

      Thanks for your reply. Yes, I meant A/C joint separation.

      Just to clarify... In your reply in the sentence:

      "Grade 1-2 A/C joint injuries should definitely be treated
      surgically..."

      you really meant "...treated nonsurgically...".

      My injury seems to be "Grade 3 injury, where the clavicle part of the A/C is displaced a long way but upwards only."

      I think I would be happy if I could rehabilitate my shoulder so that I could even lift weights with using more bodybuilding style. E.g. to make longer sets with 80% of 1RM. Of course the injured shoulder would be weaker also in this kind of training.

      In one study of conversatively treated grade 3 A/C joint injuries, it was mentioned that although in general strength recovered well to the injured shoulder, bench press caused problems. Non athletic patients had in average 17% weaker "bench press" strength in their injured shoulder compared to their uninjured shoulder.

      I haven't found any studies of how bench press results have been able to recover with surgical treatment of this kind of injury. Do you know any or do you know any real life examples?

      If the shoulder recovers to almost its original strength with conversative treatment, are there any exercises that should be avoided?

      Somewhere it was mentioned that heavy dips should be avoided. But what about dead lifts, pull ups etc.

      I understand that I must handle the actual rehabilitation with local orthopedist and physical therapist. They also recommended to try first conversative treatment. But it helps a lot to get a second opinion.

      Comment


      • #4
        You are right with this correction - should be non-surgical. Although general patterns can be followed, each A/C injury is different, so see how you pull up and if you are not too bad, avoid surgery, but if you have chronic pain or weakness, discuss it with an orthopaedic surgeon.

        Comment


        • #5
          shoulder separation

          Mikexxx, I am in the same position you are, I have a grade three separation and would like to return to doing heavy bench press, etc. I was wondering how your shoulder has been doing, did you get the surgery? I am currently considering an operation.

          Comment


          • #6
            weight lifting

            Hi, i too had a grade 3 shoulder seperation a year ago. I resumed weightlifting after 4 months but still had a problem with bench press and pull downs. Even simple movements such as bi cep curls were affected as the whole shoulder is unstable and moves out of symmetry when compared with the other.

            I had surgery a week ago and am waiting to see the results. Its a hard decision to make as my shoulder didn;t bother me during normal activities and it was only when lifting weights. I realise it could go either way but decided it was worth the risk.

            I'll keep u posted on my progress

            take it easy

            cookie

            Comment


            • #7
              Hi Cookie,

              I was in the same situation as you at one year post my grade 3 ac joint dislocation. Later in the second year is when I developed chronic pain. Chronic pain for me was pain in most days of the week at varying levels with the worst forcing me to not move my shoulder.

              I also had surgery, outer clavicle excision modified weaver dunn shoulder reconstruction on the 22 September 2005. I wish I had the surgery earlier so I believe you made the right decision.

              In terms of results you won't really know until you take your arm out of the sling in week 6. I would not stress too much before week 6 as your orthopaedic surgeon will have fixed the structural problems in your shoulder. It is easy to stress but you will be doing yourself no good. Just protect your shoulder and watch a lot of TV, DVDs, read and keep relaxed in the first 6 weeks.

              In week two you will get your stitches out. If your wound has not healed fully when the stitches come out make sure you pay careful attention to it. If the wound is not healing you should expect to visit your GP for advice and possibly antibiotics to clear up the wound. The immediate results of the operation will be a vertical scar running across the top of the end of your clavicle. It should be around 3.5 - 4 inches. Your clavicle will be better aligned so there will be a large reduction in any bump.
              In week 6 when you get your shoulder out of the sling there will be a lot of muscle wastage around your shoulder and bicep since you will not have moved your arm for 6 weeks. Your shoulder will not move very much as the shoulder becomes compartmentalised. You can compare this will the mobility you have in your good shoulder if you attempt to move it in the direction of the compass points. After week 6 your shoulder will improve daily but it will take a lot of work on your part to keep moving. You will need to find an experienced physio who has worked with similar repairs. Expect to work very hard on your rehab. You will initially focus of your range of movement and then strength.

              I wish you all the best mate. Just be sensible and remain positive.

              Originally posted by Cookie
              Hi, i too had a grade 3 shoulder seperation a year ago. I resumed weightlifting after 4 months but still had a problem with bench press and pull downs. Even simple movements such as bi cep curls were affected as the whole shoulder is unstable and moves out of symmetry when compared with the other.

              I had surgery a week ago and am waiting to see the results. Its a hard decision to make as my shoulder didn;t bother me during normal activities and it was only when lifting weights. I realise it could go either way but decided it was worth the risk.

              I'll keep u posted on my progress

              take it easy

              cookie

              Comment


              • #8
                Thaanks for the advice.
                The operation i had was to have the end of the collarbone removed and then plated into position with a wolter hook plate. This has to remain in for 16 weeks. Apparently during this time scare tissue will form and hold it all in place. The thing that worries me is that the torn ligaments were not repaired as in weaver-dunn. I'm now concerned that once the plate is removed it could just move out of place.

                Has anyone else heard of this type of surgery?

                I suppose it could be an option to get another surgeon to repair the ligaments whilst the plate is still in but this means another operation, which i'm not too keen on but could be worth getting a second opinion.

                This is all very annoying since i was originally told it was just a sprain and would heal to full strength by itself.

                Still have to soldier on!!

                Comment


                • #9
                  I will look into this further but i think the wolter hook operation and weaver dunn reconstruction differ in the suturing of the transferred ligaments. Weaver Dunn uses a bosworth screw whereas the wolter hook uses a hook plate. I don't know if it can be said that either technique is better at suturing the ligaments but the bosworth screw degrades away so does not need a second operation to remove it, whereas your plate will be removed in the 16th week. I'm sure you will be fine anyway since you got through the first open shoulder reconstruction.

                  16 weeks should be plenty of time for there to be sufficient scar tissue to form. My orthopaedic surgeon had a go at me in my 6th week telling me my shoulder is all healed and that I need to start moving and not protect it. Similarly the physio that is handling my rehab had to remind me in the 7th week to not be so protective of my shoulder since significant force like a car accident or a serious fall would be needed to disrupt the repair. Now your repair will be proteccted by a suture for 16 weeks so I can't see how the scar tissue will not be there since the scar tissue in my shoulder which will replace the bosworth screw was there in at least 6 weeks and left to its own in 8 weeks.

                  The sprain is the same bullshit I got from the hospital physicians and physios initially.

                  Good luck.

                  Originally posted by Cookie
                  Thaanks for the advice.
                  The operation i had was to have the end of the collarbone removed and then plated into position with a wolter hook plate. This has to remain in for 16 weeks. Apparently during this time scare tissue will form and hold it all in place. The thing that worries me is that the torn ligaments were not repaired as in weaver-dunn. I'm now concerned that once the plate is removed it could just move out of place.

                  Has anyone else heard of this type of surgery?

                  I suppose it could be an option to get another surgeon to repair the ligaments whilst the plate is still in but this means another operation, which i'm not too keen on but could be worth getting a second opinion.

                  This is all very annoying since i was originally told it was just a sprain and would heal to full strength by itself.

                  Still have to soldier on!!

                  Comment


                  • #10
                    Hi,

                    I am now at 3.5 months after surgery. My orthopaedic surgeon has told me I can return to Judo in another month. I have regained my range of movement. My external roatation strength on my operated shoulder is less than my uninjured shoulder otherwise my strength is satisfactory. My physio has told me that I can now return to the gym and start working on getting back my swimming stroke.

                    I told my physio about some discomfort and stiffness around my ac joint and in my deltoids if I do not move my operated shoulder for some time. He told me that it is due to swelling in the tissue as a consequence of the operation and will settle down over the next 3 months.

                    I am not in pain anymore and am looking forward to the future.

                    Comment


                    • #11
                      Hi plucs

                      I had a grade IV separation on 2nd June 2005 - I seem to go through phases of pain and none pain - the most annoying thing is sometimes when I move my shoulder it tends to grind/click (though not painful) and am wondering whether or not to have surgery.... how are you now? Also if the bump on your shoulder has gone with the surgery?

                      If anyone else is in a similar position it would be great to hear from you.... there is so much information on the internet about arthritis in the future etc... not sure what to do for the best???

                      Thanks
                      jlb

                      Originally posted by plucs
                      Hi,

                      I am now at 3.5 months after surgery. My orthopaedic surgeon has told me I can return to Judo in another month. I have regained my range of movement. My external roatation strength on my operated shoulder is less than my uninjured shoulder otherwise my strength is satisfactory. My physio has told me that I can now return to the gym and start working on getting back my swimming stroke.

                      I told my physio about some discomfort and stiffness around my ac joint and in my deltoids if I do not move my operated shoulder for some time. He told me that it is due to swelling in the tissue as a consequence of the operation and will settle down over the next 3 months.

                      I am not in pain anymore and am looking forward to the future.

                      Comment


                      • #12
                        My shoulder is getting towards where I want it slowly. I have full range of movement and no pain any more. I can even sleep on my side (no more pillow under my arm). I still have not regained my strength but I feel in much better shape after the operation. I'm swimming, weight training and training in judo. The difference pre and post surgery for me is massive. My regret is that I did not have the operation when the warning signs (onset of pain, crunching, moving the arm difficult) started at around 6 months after the injury.

                        The bump is gone and replaced by a thick 3 - 4 scar perpendicular to the ground across the AC joint. I also had the end of clavicle excised so it is a little shorter than the undamaged side.

                        My advice would be to see several orthopaedic surgeons who specialise in shoulders. This site has lists of very good orthopaedic surgeons specialising in shoulders. If your work or sports involve a lot of repetitive lifting above your head you would be certainly be a candidate for surgery.

                        You can email me if you want to talk further.

                        Comment


                        • #13
                          Hey guys,

                          Thanks for all the emails posted, I have had a simular operation to what some of you have had only I have had a false ligament pinned in between the joint which remains in, and is helpful to get you bac to sport quickly. I had a type III to IV injury playin rugby, and like most of you the docter told me it was a 'sprain' at first. Like some of you I like weight lifting and have got an addiction to bench press. Pre operation I had waited eight weeks to assess conservative treatment but bench press was impossible and I was so paranoid that my shoulder was not attached to my body. I had to have the op through depression as much as anything else as I had lost approximately half a stone of muscle in this time, that it took me about 18 months to gain. I had the op on my 20th birth now 2-3 weeks on still in a sling I am itching to see what it can do but after reading the forum I am going to wait till I have had about six to allow tissue to form etc. My doctor told me to do this anyway but I am now waiting to ensure the best recovery. The progress made by some of you really encouraging and really gives me confidence for my rehab.

                          Gareth

                          Comment


                          • #14
                            grade 3 separation

                            Hi,

                            I just separated my shoulder last week. I went through the whole dislocation thing on the other side a few years back but this seems way worse. Painful! And my whole arm is like hanging 2 inches lower than the other. Is this normal??? Will it go away???

                            My doc's on vacation and the fellow thought I was okay, only a 3-, but he didn't even look at my good shoulder for comparison. Am I being too paranoid about where my arm is? I feel like having the sling hold it up will help it heal in the right spot, but the fellow thought I should be without sling by this weekend. I can do it, but it starts to ache like crazy.

                            And man, I do NOT want to have surgery... I ride horses competitively and I can't take a long break. What is the rehab time if you do have surgery? Will it really hold up anyway? I have a tendancy to fall from height, at speed and land on my shoulders!

                            Charlene

                            Comment


                            • #15
                              Originally posted by Charlene
                              Hi,

                              I just separated my shoulder last week. I went through the whole dislocation thing on the other side a few years back but this seems way worse. Painful! And my whole arm is like hanging 2 inches lower than the other. Is this normal??? Will it go away???

                              My doc's on vacation and the fellow thought I was okay, only a 3-, but he didn't even look at my good shoulder for comparison. Am I being too paranoid about where my arm is? I feel like having the sling hold it up will help it heal in the right spot, but the fellow thought I should be without sling by this weekend. I can do it, but it starts to ache like crazy.

                              And man, I do NOT want to have surgery... I ride horses competitively and I can't take a long break. What is the rehab time if you do have surgery? Will it really hold up anyway? I have a tendancy to fall from height, at speed and land on my shoulders!

                              Charlene
                              The way your shoulder looks now will never change.

                              Go see a shoulder specialist - a good orthopaedic surgeon and no one else. You will get all your answers there. A GP and emergency room doctor know nothing about a shoulder separation, except the automatic sling for 2 to 4 weeks. Physios see a lot of shoulder separation and will recommend the conservative approach you say you want.

                              With surgery my rehab was 3 months with a return to contact sport at 4 months. My shoulder has held up in Judo which is very demanding on the shoulder with the standing throws and ground work.

                              Comment

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