Ask Dr. Geier – Shoulder Separations
I hope everyone had a great weekend! It was beautiful here in Charleston, although it is starting to get hot. Quickly I want to congratulate two teams. The Academic Magnet High School girls’ soccer team won the state championship Friday. It is one of the high schools we cover, and the team has several former patients, so I could not happier for them. It is perennially one of the top academic schools in the United States, proving that it is possible to be smart and good at sports. Also, congratulations to the Lowcountry Highrollers All Stars. Despite a few injuries, our awesome roller derby team continued its undefeated season Saturday. It is great to work with these girls!
Next week’s Ask Dr. Geier column will be a little different, as I will describe a typical week for me at the request of a reader considering sports medicine and orthopaedic surgery as a career. Look out for that. Spoiler alert – I’m actually not that exciting, but it will still make for an interesting post.
As always, please keep in mind my disclaimer about not discussing specific medical advice online or by email.
David
Terry in Rochester, Indiana asks:
I have a type III shoulder separation since October 2010. I’m 47-year-old male who is very active in sports and active in mission trips that require rugged and heavy travel. I still have the same range of motion, but I lack the strength. At times when I use it during sports and piano, I experience pain.
1) Can you please tell me how many surgeries, for this injury, you have performed?
2) And what surgical technique do you use?
Thank you very much for your time and expertise. Terry
Surgery for shoulder separations (acromioclavicular joint separations, or AC separations) is actually not that common. I probably perform 5-10 of these surgeries each year, although they are among my favorite surgeries. The most common types of AC separations are the less severe ones, namely types I and II. They fortunately rarely require surgical treatment. Types V and VI, which are much more serious and usually require surgical treatment, are fairly uncommon. Type III AC separations, like the reader has, often do well with nonsurgical treatment. Even in athletic individuals, studies have shown fairly good outcomes with nonsurgical treatment for these injuries, so most sports medicine surgeons will at least offer and try nonoperative treatment for type III injuries first.
Notice the vertical separation between the end of the collarbone and tip of the shoulder blade on the right shoulder (left side of image). This is a type V AC separation, where there is more than 100% displacements at the joint.
Newer techniques include implants that try to pull the clavicle down to the coracoid. I use a technique that takes a tendon, either from the patient himself or herself or from a donor. The tendon is looped under the coracoid and then passed through the end of the clavicle through two drill holes. It is anchored in the clavicle with absorbable screws in each drill hole, and then the tendon is sewn upon itself. The tendon reconstructs the ligaments that are torn in the injury, holding the end of the clavicle down in the appropriate position. Studies have shown that this technique, at least in simulated biomechanical studies, is among the strongest for stabilizing this joint. Readers who are considering surgery for AC separations should consult with their surgeons about the necessity of surgical treatment and the options for surgical fixation.
Have you suffered a shoulder separation? Did you have surgery for it, or did you let it heal on its own? Let me know about your experience!
C. David Geier Jr., M.D.
6 Comments
I am a 37yr old woman who has fallen down the stairs, in result I now have an AC Separation type III. I am devastated to say the least!! I desperately desire surgery though my Orthopedic Surgeon keeps reminding me that most people “don’t” do it. Personally, I don’t care what MOST PEOPLE do, I would like to regain my sexy shoulders. My injury is fairly new, nearly 3-weeks old. I am due to return for a follow-up in a few weeks. Your enthusiasm in regards to AC Separation surgery excites me!! I would be extremely HAPPY if I could be under the care of a Dr. so confident and optimistic when it comes to this procedure.
Yes, typically type III AC separations are treated nonoperatively, as the results of nonoperative treatment are pretty good, even in athletic individuals. Surgical reconstruction can improve the cosmetic appearance, although there is an incision, and it still occasionally appears larger than the opposite side. And it requires a fairly aggressive rehab of the shoulder after 3-6 weeks of immobilization. But in some people, surgery is a good option. I hope that helps. Please go to the Contact section to send more information if I can help further.
I injured my shoulder in June 2010. AC separation III. Due to my active life style I chose to have the surgery. In late Febuary 2011 it failed. The pain was far worse from when I first had injured my shoulder. A 2nd surgery was performed in May 2011. Here I am now nearly 8 months later experiencing the worst pain of my life!! I still am unable to use my shoulder, cant sleep at night and needless to say the constant use of meds and pain killers has pretty much screwed up my stomach. Although I feel that surgery was my only option, I feel that I will end up regretting having the surgery for the rest of my life. I am going for yet another CT scan next week to find out why I am having so much pain. I never thought in a millions years I would end up this way. I used to work out every day and was a interior house painter for 15 years. Now, I sit home every day in the most unbelievable pain ever….I am losing my mind and honestly dont know what to do.
I’m sorry to hear that. I can’t really comment, since I’m not involved. I hope it goes well, though!
I just had 2 injections recently in my AC joint to try and relieve chronic pain from a old grade 2 AC seperation. My doctor want me to come back in 3 weeks for an MRI and possibly surgery if the pain in the AC joint does not let up. He talked about doing a distal clacical excision. My question is if this surgery relieves my pain will it also take care of the noticible prominence “bump” on the top of the shoulder also? I ask this only b/c I feel like I’d im going to have to go through surgery I would like to fix not only the pain but the deformity as well.
In general, distal clavicle excision (removing about 1 cm from the end of the clavicle) does relieve most of the pain coming from AC joint arthritis and injuries. The “bump” that most people have after an AC separation is the prominent end of the clavicle. Removing part of it should improve the prominence for patients, even though it might still no be as flat as it was before they were originally injured.