# Shoulder Surgery vs Rehab



## UserName (Sep 7, 2007)

My 2 cents.... The question of surgery is a question of how active would you like to be the rest of your life. You can do fine without these ligaments, but you will be prone to more and more problems with it being involved in an active lifestyle. Kayaking in particular, but skiing, etc., etc... The biggest problem is continued problems will only exacerbate the current problem. My experience is that shoulder injuries are inordinately painful too. And reguardless of the injury, shoulders taske a Long time to heal.

Ligaments hold bone to bone. Without these this thing will pop out easier and easier each time. It will get less and less painful and be easier and easier to pop back in too. Not a good trade off though. 

These comments may be way out of line, not knowing the extent of injury, but as I said, my 2 cents. Not worth 3...


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## glcasson21 (Apr 16, 2009)

Hey,
I have had severe shoulder problems through my career. I've had two shoulder surgeries with excellent results. I paddle with no problems now. I'm no doctor, so i'm not sure how bad of an injury you have but rehab won't help a 100% tear at all. It will strengthen the other muscles though. that will help. Some tears may not affect your kayaking. my advice is to test it. keep boating and see if it dislocates. Make sure you won't be in a life threating situation if it does. give it some time to heal first. if it begins to dislocate on a regular basis, surgery is your only option from there. I hate to hear about these type of injuries. good luck and keep those elbows in!!! let me know if you got any questions about surgury or rehab. I got tons of info.


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## Nickdanger (Mar 30, 2004)

This resonates with my thinking at this point. Since I'm going to have to go through rehab and build this shoulder back up (which is probably going to be a painful process), I may as well address the fundamental integrity of the system first . I'm 44 and hope to be paddling when I'm 70! Thanks for sharing. Cheers, Nick


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## Nickdanger (Mar 30, 2004)

glcasson21, it's not actually a dislocation. It's the two main ligaments that attach to the scapula, which has resulted in my whole shoulder dropping an inch or two. I've been thinking about this all week and I think I've made up my mind to go get surgery. I have Kaiser insurance, so options for who to have do the surgery are limited unless I shell out big bucks, but given how important this is, I suppose I'd consider all options. Who did your reconstruction?


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## HINDS (Oct 14, 2003)

I had a 2nd degree shoulder separation that resulted in Bursitis (sp?) of the shoulder joint. Combined with years of paddling canoes and C-1 boats, it needed a good cleaning anyhow. But I did have my AC repaired and reattached after the cleaning. The removed the Bursa and did it all arthroscopically, no cutting. That is probably what they did for you. I tried rehab before the surgery and laid off boating for three months while it healed. But it still was killing me so I went in for the surgery. Since it has been much better and I have maybe 90% back but not 100. I would say go for it if you are worried about it being unstable. I had mine repaired in Steamboat Springs.


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## jennifer (Oct 14, 2003)

Wow, this happened on sunday and you are already testing it kayaking? After 5 days??? When I dislocated my shoulder kayaking (actually I was in a C-1), I was told I tore most ligaments and broke the socket of my shoulder (hill-sach deformity). I could not use my arm at all for over 3 months or my shoulder would pop out, and it took a year before I could kayak again, and almost 1.5 yrs before I could raise my arm above shoulder height. Never had surgery but I kayak regularly now without too many problems. Maybe this is just a different kind of injury though.


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## GAtoCSU (Apr 18, 2005)

Don't listen to anyone on here, unless they have a DO, MD, or DPT following their name (and I don't). With that said, it's my understanding that a full AC separation is a bitch to treat. I know several physicians, that are very active and are doing it with a full AC separation (it does haunt them sometimes).

Take your MRI or Xray to several ortho's and see what they suggest. Another option is doing a literature search on pubmed.

PubMed Home
-Hit this site up and enter "acromioclavicular and coracoclavicular separation", or any combination of the two. There are numerous articles discussing the outcomes of surgery in these patients (this is THE site for medical journals). If you see a journal that you can't access, send me a PM and I will download it and email the article to you (I have full access to these articles @ my school).

Good luck man. That's not one of the easiest to treat.

BTW, 

This injury isn't the same as a torn labrum or a rotator cuff (very common injuries for kayakers). Look for an orthopedic surgeon that has done a fellowship in sports medicine w/ a focus solely on the shoulders. There should be at least one of these in most major cities (Denver, Fort Collins, Colorado Springs, etc).

PS. This is the general consensus as of 2008 in the literature.

"Since there is not a preponderance of positive papers showing the benefits of a surgical technique over conservative therapy, the nonoperative treatment is still considered a valid procedure in the grade III acromioclavicular separation." - Grades 4-6 "require" surgery


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## Nickdanger (Mar 30, 2004)

jennifer said:


> Wow, this happened on sunday and you are already testing it kayaking? After 5 days???


No way! I can't pick up a jar of jelly with my right hand. Yeah... it's a very different injury. 

GAtoCSU... thanks for your input. I'll look at PubMed. Surgery is 90% successful according to a Steadman Hawkins sports med doc I saw yesterday. But rehab can work too. 

I'm grateful for all this input from all of y'all!! Cheers, Nick


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## aevanlloyd (Dec 23, 2007)

I dislocated my shoulder 4 weeks ago. After the MRI, I have decided to get surgery. With my lifestyle, I would never want to put myself or my friends in a situation where they would have to rescue me if it dislocated again. From my research, surgery is the only way to get it really strong again. Anything less could be rolling the dice. 

Like others have said, talk to your doctor. But be careful, it sounds like your trying to rush back into kayaking. The water will be there next year. A messed up shoulder can last forever. Take the time and let it heal. I hurt my shoulder on the first real run of the season. My season is done, but I'll be back next year. No river is worth ruining yourself for. Plus, if you were my friend, I wouldn't boat with you in this condition. You are putting everyone in danger. 

Good luck. I'm sorry if I came of preachy. I'm just trying to help.

Evan


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## KSC (Oct 22, 2003)

jennifer said:


> Never had surgery but I kayak regularly now without too many problems. Maybe this is just a different kind of injury though.


Wait Jennifer, aren't you worried about rolling because your shoulder might dislocate? I don't know if I'd call that kayaking without too many problems.


I'm not much help here, but my girlfriend had a shoulder separation, I think sim. to yours, but with only partial tears. Sorry, I don't know more details. She doesn't kayak, but swims regularly and sometimes has trouble with pain when swimming. Docs have told her it's tendinitis. Never had surgery. I don't think it was recommended for the extent of her injury.


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## Nickdanger (Mar 30, 2004)

Not sure where this idea came from that I'm back in a boat. I don't expect to paddle for 3 months minimum.


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## GAtoCSU (Apr 18, 2005)

Steadman-Hawkins is a great clinic. I hope to set up a clerkship there when I do my elective in surgery. There are a lot of very insightful articles on pubmed that talk about your injury. One in particular stood out while I was reading them a minute ago...
Am J Sports Med. 2001 Nov-Dec;29(6):699-703. Links
*A prospective evaluation of untreated acute grade III acromioclavicular separations.*

*Schlegel TF*, *Burks RT*, *Marcus RL*, *Dunn HK*.
Department of Orthopaedics, University of Utah Medical Center, Salt Lake City, USA.
We prospectively studied the natural history of untreated acute grade III acromioclavicular separations. Twenty-five patients were treated nonoperatively with a sling for comfort through progressive early range of motion as tolerated. Ten additional uninjured subjects underwent strength testing to evaluate the difference between the dominant and nondominant sides so that patient data could be standardized. The patients were examined at intervals of 6, 12, 24, 36, and 52 weeks after injury, at which time they completed a subjective questionnaire and underwent isometric dynamometer testing as well as military press and bench press strength testing. One patient underwent a surgical procedure at 2 weeks after injury because of cosmetic concerns. Twenty of the 25 patients completed the 1-year evaluation and strength-testing protocol. Subjectively, 4 of the 20 patients (20%) thought that their long-term outcome was suboptimal, although for 3 of them it was not enough to warrant surgery. Objective examination and strength testing of the 20 patients revealed no limitation of shoulder motion in the injured extremity and no difference between sides in rotational shoulder muscle strength. The bench press was the only strength test that showed a significant short-term difference, with the injured extremity being an average of 17% weaker. This study documents the natural history of patients with an untreated acute grade III acromioclavicular separation and provides a reference with which to judge all other proposed methods of treatment.


It's 7:30 on a Friday night and I'm reading about your injury... Lol.. I have to stay off Mtn buzz and get back to reading about patient interviewing & history/physical examinations.



Scott

Good luck with whatever path you decide to pursue.


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## glcasson21 (Apr 16, 2009)

hey man,
You asked who did my surgeries. I'm actually from tennessee and had both done there so that wouldn't be much help. It was at a center for sports medicine though. do some research and make your own desicion about open or arthoscopic (not sure about the spelling) surgery. I did the artho, and wish i would have went with open. While my shoulders are good, I still switched to handpaddles. I feel about ninety percent. and my surgeries were a couple years ago so i'm as good as i'm gonna get. open is a little more painful and leaves a scar, but is supposedly a little more effective. Recovery times are exactly the same. About six months.

Once again, this is only my humble opinion and I am no doctor. Best of luck to you!! you'll be back before you know it!!


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## GAtoCSU (Apr 18, 2005)

Most surgeons will tell you that the outcome of a surgery is never 100% predictable. Ideally, physicians hope to restore the joint/organ/etc to its "original" form, but they rarely are capable of this due to multiple limitations (technique, injury, therapy, strain, etc). 

When I had my labrum repaired, I read a lot of journals that compared the effectiveness of an open procedure vs. an arthroscopic procedure, and they all failed to established a significant difference, in the ultimate outcome, in a huge cohort of patients- that were standardized for age, type of injury, etc. What does all this mean? Both surgeries will yield the same result, and no one can predict which outcome a patient will have (100%, 95%, 90%, etc) with any certainty. Most older docs prefer an open procedure b/c that is what they were trained on and that is what they are most comfortable with. Also, there are a slew of advantages for an arthroscopic procedure (less bleeding, quicker recovery, decreased chance of infection, fewer complications). I would be surprised if any ortho's, under the age of 50, are routinely opting for an open procedure, over an arthroscopic one, for shoulders, wrists, and elbows that fall into the category of an "elective" surgery.

Statistics can't predict how one person will do... just how a large group of people will fare.

PS. We need more boaters in orthopedic surgery


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## raftus (Jul 20, 2005)

"Since there is not a preponderance of positive papers showing the benefits of a surgical technique over conservative therapy, the nonoperative treatment is still considered a valid procedure in the grade III acromioclavicular separation." 

^ This is a good generalization of what I have read on the subject, but listen to the surgical bias in how it is written. It's like the surgeon is in a headlock being forced to admit surgery isn't the best choice, but he's still sure that once more papers are published it must come out on top.

I tore both of my AC tendons in mid-December. I read up on it, including an article on surgical vs. non-surgical outcomes in NFL quarterbacks. That study (done by a present or former Denver Broncos physician with about 15 QB's from a few years ago) found inconclusive results differentiating between surgical and non-surgical interventions. The conclusion I drew was let it heal naturally, take it slow, do proper rehab and see what happens. If the shoulder heals well naturally - great. If rehab doesn't work - then try surgery. 

Luckily for me I have nearly full recovery at this stage - right about 4 months post injury. I play competitive volleyball and I have given that up until summer because it is shoulder intensive and is hand over head. But I guided a raft down the Piedra yesterday w/o even thinking about my shoulder - no pain, good strength, and I paddled from both sides. For reference push-ups took about 4-6 weeks to be doable, pull-ups were more like 8-10 weeks. 

One more thing - surgeons like to operate and make money by operating, especially in private practice settings. They also believe deeply in their own abilities to heal through surgery - and many times they are right, but not always. I'm not trying to knock surgeons, there are a lot of good ones out there - but a surgeon has little incentive to tell you not to get a surgery when it's an elective operation without a clear outcome regardless of intervention. Surgery comes with the risk of a lot of complications and future consequences (like higher arthritis rates), it should be your second option. You can always get surgery down the road, but you can't ever take it back.


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## jennifer (Oct 14, 2003)

Nickdanger, sorry I just misread your post the first time. I thought you said you were NOT having probs kayaking - actually you wanted to know others with this injury who were Not having probs kayaking. Big difference, especially after 5 days. My bad.


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## Nickdanger (Mar 30, 2004)

No worries Jennifer. Thanks tho.


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## Nickdanger (Mar 30, 2004)

raftus said:


> but listen to the surgical bias in how it is written. It's like the surgeon is in a headlock being forced to admit surgery isn't the best choice, but he's still sure that once more papers are published it must come out on top.


Just for the record, neither of the surgeons I've seen have pushed me one way or the other on the surgery option. I was expecting that they would, but in fact, the Steadman Hawkins guy I saw said, "If it were me, I'd probably let it heal and see how it does." 

My inclination to do surgery is partly guided by the degree of separation. My shoulder has dropped a lot, which makes me think I'm likely to lose more strength than most. 

I'd like to read the entire text of this and other journal articles, but don't have access and at $20 a pop, that could get expensive. I'm in Boulder. Any suggestions? Thanks, Nick


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## GAtoCSU (Apr 18, 2005)

Nick,

Send me an email with a list of the articles that you want to read. I'm in medical school and I have access to these journals. Just copy/paste the titles in and I'll see what i can do.

Scott
[email protected] students dot mcg dot edu


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## cecil (May 30, 2005)

I dislocated my shoulder 4 years ago. It was only our of socket for a few seconds and I didn't have major tearing. I did not get surgery but rehab'd it back. I have a no major problems since, although my range of motion has never been the same since. 

My brother dislocated his, but it was out for several hours. Afterwards, his shoulder would pop out from even the slightest of weird movement. He ended up having surgery and is back to almost 100%. 

I guess the point is it depends on the severity. Regardless though, w/out surgery your shoulder will never be as strong, and that can create mind games while your sitting in the boat. 

Good luck man! These injuries suck


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## GAtoCSU (Apr 18, 2005)

AC separations are common, and as we've discussed, most grade I-III separations do not result in surgery. However, grade IV-VI separations require surgery due to the involvment of neighboring tissues (ie the clavicle is causing a problem to the surrounding area). It's not the same injury as one that results from dislocating the glenohumeral joint (~torn labrum) or a tear to the supraspinatus tendon (common rotator cuff injury).

If I'm not mistaken, the main reason for surgey in a grade I-III separation is cosmetic, since the illusion of a "hanging shoulder" can bother some people. Or, the patient fails to recover from the injury after therapy and time.


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## sbratt (May 10, 2006)

Hey Nick
I had the same injury several years ago in the half pipe. Trashed my right shoulder, type 3 AC tear. When I saw the first doc about it he said it would probably be ok in the long run, just keep an eye on it. I took up kayaking and boated for 3 seasons on it. Kayaking definitely made it worse. I would get the arthritis type pain, but the worst is that the joint is much more susceptible to injury. When lifting boats it's easy to crank more with your arms and shoulder. I eventually made enough mistakes that the shoulder became a real problem. Went to a new Dr and he gave me more of a long term run down. I would keep making the joint worse in the long run as long as I was doing shoulder intensive stuff. I was also likely for more pain in my later years if I left it untreated. I waited till fall an fixed it then (had awesome insurance so it was a no brainer). It's been about 4 years post surgery and it's pretty good. I had a accident last spring the really aggrivated the shoulder and made me miss lots of boating last summer. As long as I'm on top of my pt it seems pretty good but you always have to watch out on any lifting that is directly on the shoulder from below (like if you help a friend off the ground). The bottom line is that the joint will never be as strong as it was.
PM me if you have more questions.
Shawn


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## Nickdanger (Mar 30, 2004)

Just to give closure to this thread, I've decided, in the short term, to not have surgery. I saw my third orthopedic doc yesterday, who basically said you've got 2 chances for a successful outcome, and if you jump straight to surgery, you are blowing #1. Surgery is not always successful. There are 15 different surgical techniques, which he says is a pretty good indication that there is no one very good way. (ACLs on the other hand are all pretty much fixed using the same technique.) I'll see how things go. I may go the same path as Shawn, but for now I'm going to give rehab a chance. Shoulder feels weird as heck. I'm so grateful for all the help, particularly Scott, the med student from Georgia, who was kind enough to forward me a couple of medical journal articles on the subject, and Raftus, who offered to meet me and share his experience in more depth. Thanks again to all for sharing your thoughts. Nick


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## GAtoCSU (Apr 18, 2005)

Good luck with your recovery!


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## DanOrion (Jun 8, 2004)

Nick,

I separated my shoulder, level III in 2001. It was in a sling for about a month, very painful. Since then I've been rock climbing and kayaking with no problems. Visually, my left shoulder is way lower than my right. Is what it is. Range of motion in my left shoulder is somewhat limited. Keep the muscles strong and (in my non professional opinion) you should be fine. Good luck.

-Dan


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