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.


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.

A type III AC separation has a moderate amount of vertical instability of that joint. There is approximately 100% displacement between the end of the clavicle and the acromion. If surgical fixation is attempted, the surgeon uses a technique that reduces this vertical instability. Simply cutting off the end of the clavicle won’t change this instability. In the past, surgeons tried to take a ligament from one part of the shoulder and transfer it to the end of the clavicle to try to hold the end of the clavicle in position.

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!

57 Responses to Ask Dr. Geier – Shoulder Separations

  1. 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.

  2. 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.

  3. 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.

  4. Did both of my shoulders a little over 14 years ago. One is a type 3 and the other is a type 4. In both cases I think I was fortunate to get great doctors advise to not get surgery. Instead I spent two months in the pool for rehab progressing to breast stroke arms only, no feet. To this date I have no issues at all. Every doctor I have visited since tells my how smart it was not to get surgery as it leads to more complications down the road.

    • There is no question that surgery to reconstruct the injured ligaments is a big one. Depending on the nature of the separation, some require surgery. Fortunately most of the mild ones, while painful, do well with nonoperative treatment and rehabilitation. Thanks for sharing your experience!

  5. hi doctor,
    i had a “button and pulley” operation on my left shoulder after a type 3 ac seperation 4 1/2 weeks ago.
    i have failed to ask my doctor the “right” questions at post-op visits, simply because i am relying on my own decisions, nutrition, and body to tell myself that im going to be alright. if i recieved the #5 fiberwire from arthrex corp., do you think that i will be able to wakeboard again?? its my true passion and i honestly exert more force wakeboarding than anything else in life. the force of pull on the handle used to be great, and i am so very curious if i will be able to participate in fun behind our boat ever again? this, of course, includes hardcore tubing and waterskiing!
    thank you doctor.

    • Patrick, I can’t say specifically in your case. The goal with surgical repairs or reconstructions for AC separations is to get people back to all of the activities that they like to do. It takes a lot of work with therapy after surgery and a lot of time, but it often happens.

  6. I had an anatomical ac joint reconstruction with allograft 10 months ago, although my shoulder is much better than pre op, I am now having some pain around the coracoid…if I press firmly upon it I get a sharp pain throughout the shoulder.. What could this be? I’m scheduled for a ultrasound in 2 weeks..would this be of any use ? My age is 17 and I am healthy otherwise

    • Sorry Jeff, I don’t know that I can really say without examining you. Your surgeon can probably determine the cause by physical exam and possibly x-rays or MRI.

  7. I really like that you ask for peoples experiences and comments.

    Before talk about my injury, I would first like to say that I am and have been, very dismayed in general by the orthopedic community’s attitude towards separated shoulders. From the beginning I was treated like a petulant child who only cared about “looks”.

    In December of 2011 I had a grade 3 separation of my left shoulder. There was a massive 2 inch drop plus the “bump”. But not just a bump, my clavicle was (and still is) completely out of alignment with the clavicle now pushing into my back with a very noticeable up angle, approximately 25 degrees. Here I should note that I was told that the separation was “only a bad grade 2”. Later I have to come to find out I was lied to. It was a grade 3 at least, and most likely a 5. Reasoning was that I would want surgery and the doctor figured that it was fine like it was, and like you have mentioned, figured most separations “do ok on their own” according to the literature.

    I was told it was “normal” and that it would “heal” and “be fine”. It was not, and did not. I had a complete inability to move my left arm forward under load. As a hockey player I knew there was something wrong beyond what the sports doc told me. I was unable to shoot or stick handle up to nearly a year after the accident, I am left handed shot. As well, during this time my arm continued to droop badly. During this time all activity, physical and social, stopped. The continual fatigue and pain was too much. I lost 30 pounds of muscle; it was as if my body was in constant toxic shock.

    Finally after 10 months, a surgeon took my case on. I had the tightrope procedure with a tendon graft, clavicle top button with a toggle lock and suture material pulled tight to reduce the gap. Immediately there was improvement. In a week the pain was much less, even with the surgery pain. The fatigue left. Cosmetically however it is still messed up. As a body composition competitor, this is unacceptable. The deformity is massive and ends my current life. Even after surgery. Currently I have only 25% of the strength I had prior to the accident, despite full mobility. All contact sports are out, as is beach volleyball, and any other activity where my arm could sustain a hit.

    It has been a year since surgery and while it is a far improvement from what is was, I am still very disappointed with the aesthetics, it ends my competing. I do not have anywhere near the strength I once did, it is doubtful it will ever return. It is doubtful I will return to anywhere near my previous level of activity. In short, this injury was devastating to my life, and I really have not liked the “suck it up buttercup”, and “be a man attitude” I received.

    I read Terez Shelby’s comments and I have to agree with her attitude. For men, a large part of a males sexuality is how broad his shoulder are. I would like a surgeon to try explain to me how this is different than a woman who needs to have her breasts removed. A woman feels as that a large part of her sexuality is gone, and she is right. This is why doctors worked so hard to do something about it, now breast augmentation is standard to restore “cosmetic” appearance. Beyond a complete change in lifestyle, losing my shoulders meant losing my sexual appeal, and as a single male looking for a partner this is horrible, mentally debilitating. And there is no “just getting over it”. When a single woman looks at you and says “gross”, you know it, are aware of it “cosmetically”, and going to the beach, forget it. Nothing being a freak that people and kids point at, stare, and make comments constantly. I suggest any doctor with this attitude should have his shoulder badly separated and then talk to a male in this position. I was given the “a lot of hockey players have this” speach, like I was a 10 year old kid. I DON’T CARE IF THE ‘BIG BOYS” have it.

    I have reviewed the current literature on this injury, which after reviewing, I find is highly suspect in regards to the posts used to measure what acceptable means. Immediate surgery (acute) will be standard procedure in the next few years. Complete AC & CC ligament reconstruction using a tendon graft with tightrope and clavicle hookplate should be standard treatment now. Leaving the “bump” (it is not a bump, I do not appreciate the minimization of the injury by calling the entire injury a small bump) is professional folly. Leaving the injury means that almost all people will suffer daily and later life will have severe problems.

    I have decided to undergo surgery again (despite recovery time again … for a third time), this time with the hook plate to get my scapula up again and to get my clavicle back to at least semi-normal alignment. I do not expect miracles but it can, and will be better. I am disappointed I have had to do this all on my own.

  8. What Timothy says is so absolutely true – a man´s shoulder line is absolutely critical to his attractiveness. And a step deformity is not a cosmetic flaw, it´s a deformity (while a small scar is a cosmetic flaw that is well accepted). Acute stabilization using the tight rope technique should thus be a standard treatment. Why not reduce the ACJ with this relatively safe and minimally invasive technique? I was initially not informed about this option and now have to live with asymetrical shoulders for the rest of my life :(((

  9. I am a junior in high school who received a level 3 separation. I plan on playing college football and do not know whether surgery would be the right thing to do or to physical therapy. I still feel pain in my shoulder at times it is very painful. I do not know what to do?

    • Difficult question. Typically Types I and II AC separations do well without surgery, and Types IV, V, and VI usually do require surgery. Some studies have shown good success rates with nonoperative treatment of Type III AC injuries even in athletes, but many athletes have surgery if they are limited by pain, stiffness, or weakness.

  10. I had shoulder surgery on Sept 10th 2013, and it was a tear in the rotary cuff. However, I went to therapy and guess what happened the PT had me lift 25 pounds over my head. Now my shoulder is popping, clicking with great 9-10 pain level. I don’t have full range and now I have a bump on top of my shoulder. My doctor was angry, now I have to start over in therapy been to 45 sessions still hurts so the doc gave me a cortisone shot and now it hasn’t help at all. I think I might have to have surgery again?

  11. Timothy Edin has said a lot of what I am feeeling. My Orthopaedic Surgeon was badgering me that he would be wrong to even suggest surgery. Now that I have the energy to look for an alternative, my time for normal healing processes will soon pass, which means much mor invasiv surgery. How can I locate a surgeon who does the surgery (with regularity and good results) to get an evaluation. The literature always refers to the surgery as “controversial” which means some clearly believe it is often the better course of action. I would like to at least discuss this with someone doing the Bosworth screw or the suture method. PS – I have above average upper body strength and never broken a bone in my life (and all my teeth) – I think I’m a good candidate for surgery.

  12. Just went to the DR today he said it was a 3 or 4 with a little tear in the cuff. My coller bone sticks way more up than that pic. therapy is what he said I don’t think so. I think that won’t get rid of the musle for over compisating to get by.

  13. I just found out I have a partially separated ac joint in my left shoulder. I have seen my nurse prac two for this. Once to get on some meds before a trip when we didn’t know what was wrong and now after I had an xray that showed the problem. My dr, the nurse prac isn’t sure what to do and wants me to get another set of xrays with me holding weights. Im leary to do this, as when I hold weights its very painful and I also have a pinched nerve that gets worse. DO you think its wise to get another xray when we know the problem? I feel she should just send me to a specialist now so I can see someone who knows what they are looking at and I can start to recover. I have had this problem for over 2 months now. Also would physical therapy be an option? My pain is a lot less now but if I lift a little or do more chores then I get a throbbing pain and a pinched nerve. Please help.

    • Weighted x-rays are often used to determine the extent of injury on the injured side compared to the opposite side.

  14. Hello, thanks fort your answering section ans sorry fort m’y english i’m from France,

    Due to a grad 3 AC joint separation I had shoulder surgery the 12 june ”ACROLIG technic ” this was done one week after the separation .
    Now i have a smal bump in my shoulder ‘4-5mm high’ is it comon with other ac joint reconstruction technics ? As X rays does not show the joint can i ask fort another scan ”MRI?”.

    Thanks in advance for your answer

    • Omar, it is impossible for me to really say without being involved in your surgery and seeing you as a patient. It is not uncommon for surgery for a Type III AC separation to still have a slight prominence at the joint even after surgery, but your orthopaedic surgeon can evaluate you and give you a more specific answer.

      • Dr. Geier thank you for responding to my question regarding lump on shoulder, id like to elaborate, after surgery my bump had disappeared, but after 9 weeks bump reappeared size of a golf ball im concerned that I may have retorn the ligaments somehow, if I did what now? Id hate to go thru surgery again, what are my options?

  15. sir I have left shoulder pain and diagnosis AC joint subluxation I did Physio therapy little releaf but after joining work again same problem what shall i do can you give me your suggestion MRI for cervical spine did it shows C4- 5 disc , Left shoulder did MRI shows normal

    • I would address both of those problems with your orthopaedic surgeon. I can’t give you specific medical advice on this site since I am not involved in your care.

  16. My son is a college baseball player and ran into the outfield wall during a game and sustained a Grade 3.5 shoulder separation in his throwing shoulder. He was operated on about a week and a half after the injury. After the surgery the doctor told us he repaired it to about a Grade 1 with a button pulley system. We went for a follow up appointment yesterday and the x-rays showed it had spread out to about a 2-2.5 separation again. He said something obviously went wrong after the surgery, possible slippage of the pulley or something coming loose after surgery. He gave us the option to wait and rehab or go back next week to tighten the clavicle down again and check the ligaments. My son’s concern isn’t a bump on his shoulder, but rather getting things fixed as best as possible in order to get back on the field sometime in the fall, and certainly by next spring. Any input would be greatly appreciated!!!

    • I wish I could help, but I can’t really say much without seeing him and the x-rays. I’ll defer to whatever recommendation your orthopaedic surgeon gives. Good luck!

  17. Hey David,

    I took a massive slam whilst on a gap year snowboarding in whistler. I landed on my back and was lucky not to break any bones, however… I broke every ligament in my shoulder, except for one that was just about torn off anyway. my shoulder had dropped close to 1.5 cms. I undertook surgery and they inserted a graft to hold my shoulder in place, then they took the ligament that is unused to hold the rest of my shoulder in place. I am about 3 months from getting my sling off, a bump has risen however I was told it was simply the ligament ‘slipping’ a bit that is common after surgury. when it slipped I was really upset because I had taken such care of it and my perfect shoulder was suddenly not perfect again. I went for a ride on my bmx this weekend. I had so much fun I decided to go again the day after however I’ve been in terrible pain for the past 3days. I feel as though it was the ligament stretching because I had to take heavy pain killers to seduce the pain. I was wondering how much strength I should expect to have lost and when (if I ever will) have made full recovery. I was told the surgery had completely process had completely healed however I should undertake physio because my muscles are weak. I can push the bump on my shoulder inwards to make it flat and when I shrug my shoulder the bum raises. currently I feel as though I have lost 60% of my strength. do ligaments strengthen? I feel as though I won’t be able to throw my bike around unless I am in peak physical shape like I was when I played rugby (i.e. 4 days a week of gym for a year) and if I don’t remain in shape I won’t be able to participate in sports that I love because of my weak shoulder. p.s the xrays are on my instsagram ‘Le_Rupes’ if you are interested in looking at them.


    • I can’t say or give you specific medical advice, but I would definitely ask your surgeon. Generally we try to restore full motion and strength, although it can take many months of physical therapy.

  18. Hey David,

    I suffered a grade 2-3 separated shoulder snowboarding about a month ago, decided to go the non surgical route and I am very happy with my ROM and strength at this point. I have been doing strength training with resistance bands since week 2 and am able to do 5 pushups and 5 pull ups now pain free while doing them. However I wake up most mornings with alot of tightness and pinching pain in my ac joint. Am I pushing it too hard if I’m feeling this much pain in the morning? Don’t want to cause any long term damage. My pt said to train and listen to my body and while I’m training I feel great, it’s just the mornings where it kills. Thanks!

    • Dan, generally discomfort in the early weeks after AC injuries is not uncommon. Nice job on getting back to where you are now!

  19. HI David, I had a grade 5 AC seperation, I had a hook plate in for 5 months, I changed surgeons he said it is old technologie and that the hook plate was in to long, he removed it as I was suffering grinding of the bone from the hook, and survere Bursitis which I had had cortisone for when the plate was in. The plate has now been removed 3 months, physio is slow going, I am suffering a burning heating sensation in my shoulder, as well as very achy sore fore arm and elbow, any ideas what could be causing this? Physio suggested still Bursitis?

    Kind Regards in advance


    • Mandy, I wish I could tell you, but I would ask your orthopaedic surgeon his opinion on the cause of your continued symptoms.

  20. I separated my shoulder (Type III) 4 years ago. My doctor recommended that I rehab as surgery is relatively uncommon and is not proven to be better. I am highly athletic and compete used to compete at national championships in a throwing sport. The injury essentially ended my career even though I have done a good job of rehabbing it. My range of motion is much less than my uninjured arm and certain ranges result in quite a bit of discomfort.

    My question: Even though it has been a couple years, I think it is quite apparent that this injury continues to cause me discomfort and limitations. I would like to try the surgery to see if it would make things better. Can you do the surgery after 4 years or is everything scarred down to the point that it may cause greater issues?

    • Surgery can be done for chronic Type III AC injuries. The exact procedure can differ from those done acutely, but there are surgical options for patients with continued problems.

  21. Hi David,

    I separated my dominant right shoulder at grade 2 3 months ago. Even right after the incident at the basketball game, I was able to play longer and even make some shots.
    Doc told me he wouldn’t operate such a shoulder and wouldn’t even let his shoulder operated for such an injury.
    Now after 3 months of rehabilitation, I have almoat full ROM and %90 strentgh back. Excellent results so far.
    But I have still a problem, my acromion and scapula has also been malpositiioned, it’s not the ac joint (it is now stabiler than the healthy one on the other side) but shoulder blade and the scapula giving me a lot of pain and cracking sound. My arm and shoulder pit also moved down remarkably after the injury, in the beginning it wasn’t as such.

    This worries me a lot. As far as I understood ac joint reconstructruction injuries don’t help for acromin and scapula positioning, are there other surgery methods to help to improve this problem?

    Many thanks in advance

  22. Hey Doc,

    My question is: if a successfull TightRope procedure after three months comes (partially?) loose, what should I do?

    I had TighRope surgery on a AC Luxation Tossy 4, 13 days after a car crash. I used to be a enthousiastic bodybuilder, but I didn’t touch a weight at all during my 3 months after surgery. I didn’t need therapy since during checkups I regained full mobility without pain.

    This was past three months.

    After the second month of surgery (after the last and positive check-up) I have been driving my motorcycle (on-road) four times, for recreational purpose, had causal sexual intercourse and didn’t go to work at all. This is to demonstratie to you, the amount of activity I did.

    Two nights ago, I got a severe pain at the spot of surgery (This is three months after surgery). I couldn’t lift my arm without pain. I took painkillers and rested my arm until today. I have no more pains, but I am afraid that the TightRope came (partially?) loose. I don’t know whether I see the knob in the shoulder when I look in the mirror.

    I made an appointment with the X-Ray people in hospital to see whether it really did come loose.

    Thanks for your advice!

    • I can’t really tell you what you will need to do, as it will depend on what, if anything, actually happened to the repair. Your orthopaedic surgeon can determine if the fixation failed and if you need a revision surgery.

  23. My 12 yr old son was involved in a dirt bike accident at a national motocross race at 9 am He got on his bike and tried to race and ended up pulling off. He said his left arm felt like it was broken. Took him to the medic and they threw an ice pack on felt it and said it doesn’t appear broken and said it was up to us to get X-rays but it looked good. I chose to get X-rays. At the hospital the dr said it was not broken and sent us on our way. We let him swim in the pool and got him ready for his next moto that was at 5 pm figuring it was only bruised. Iced Advil and KT tape. Sent him out to race and he finished very slowly and in pain but not extreme pain at all the entire time. Finally I called my sister in law and sent her a pic of him standing and noticed he was dropping his left nipple looked pinched. She is in Orhopedic Trauma as a PA in an ER. She said he has a possible Grade III separation. I got 1 X-ray from the hospital and the bones do look like what I see as a Grade III. She said not much to do but let it heal and get X-rays again in a week since the hospital seemed to not provide all of them. Ok so now that he missed the biggest race of his life and rides 5 days a week. What is recovery time for a 12 yr old. He is concerned in how long until he can race again. Any recommendations for pt and when does that usually start. Will he be able to ride again anytime soon? He is In a sling all day. Ice and ibuprofen. Thanks for any information.

    • Every patient is different. An orthopaedic surgeon can give hi specific recommendations based on his specific injury and how he progresses. Typically physical therapy starts in the first few weeks of recovery. Full recovery can take 6 weeks or longer depending on what an athlete is trying to do in his or her sport.

  24. Dear Dr. David,

    I would like to have your opinion concerning removal of the “Tight Rope”

    15 weeks ago I had a single-rope “TightRope” on a grade 4 shoulder AC separation.. Surgery performed five days after injury

    First 4 weeks.. The clavicle was tucked back and reduced tightly.. After starting physiotherapy on week 6.. Slowly by week 8 I started noticing that the clavicle is rising.. For Example.. When i’m in a seated position and my arms are hanging loosely.. Or when I swing my arms downwards.. I can feel the clavicle bone to be higher than the other normal side.. The screw is noticeably sticking out as well— All of that as opposed to the first 4 weeks after the surgery

    From week 8 until week 15 it has somewhat remained the same..

    I have come to learn that this is a normal process for this type of surgery

    The top screw is now positioned in a very awkward place since it’s sitting exactly on the tip pointing upwards.. Does not feel good to the touch nor does it feel natural.. There is some discomfort once I wear a messenger bag.. But most of all.. I do not wish to keep something inside my body that possibly has no longer a function

    I have searched online for this topic.. However.. Very little people/doctors have discussed this issue..

    One website for medical studies advises to remove it after 12 weeks to avoid clavicle fracture in case of impact on the area.. Also.. Another doctor systematically removes it after 12 weeks.. But did not explain why

    Most importantly.. After I discussed this issue with the doctor who performed the surgery on my shoulder.. He said he would remove the whole system after 12 MONTHS have passed on the surgery (With the same arthroscopic procedure).. Explaining that this single-rope Tightrope surgery is designed to let completely loose after 12 months of fixation inside the body.. Meaning that it would NOT be acting as an extra ligament or support after one year

    I asked after 12 months does it make a difference in functionality if I keep it or remove it.. He said “No difference”.. However.. I would have to go through the same after-surgery process of immobilizing with sling.. Followed by physio

    At this point I decided to get another opinion from a doctor specialising in sports injuries.. After examining my shoulder.. Doctor #2 said that the results seem very good.. However.. He was concerned that once I remove the tight rope fixation at the mark of 12 months.. The ligaments “might” stretch.. Which might result in the clavicle bone to perhaps move upwards.. Note that this doctor does not exactly specialize in shoulder injuries like doctor #1 does.. And he has never performed a removal of Tight-Rope from any of his patients

    Hence.. I would like to know what you suggest.. Which doctor do you agree with most ?

    In your opinion.. What are the risks if any, to the removal of tight rope after a 12 month period

    Does tight ropes remain tight after 12 months in your experience ?

    If in fact it does become totally loose after a year ->

    Does scar tissue grow around the rope.. Adding a greater bond between the two bones ? And when removing/pulling out the rope.. Does it also remove scar tissue formation that grew around ?

    If a ligament has healed itself around that rope.. When removing the rope.. Does that disturb or damage the ligament leaving it weaker ?



    • I don’t know that I can give you specific advice. I don’t use that device and instead use a tendon graft. Typically surgeons don’t remove those devices unless there is a specific need. In theory if only the device is holding the bones in position and the ligaments did not heal, then the clavicle could displace again. Your surgeons can better advise you on the pros and cons specifically for your shoulder.

  25. I am a 27 year old male who has type 3 ac separation and when consulted with my surgeon he made it seem that if i didn’t have suegey that i would struggle in my career as a maintenance technician with job duties. So i had the surgery. But here i am 4 weeks later having to reepeat the surgey because the tight rope device used came undone and my shoulder is completely seprated again and pain is much worse and comes in different varieties from dull throbbing to sharp almost like pinching pain and i was curious if u have heard of these devices coming completely apart like this or if i should be seeking a second opinion from another local orthepdic surgeon im schedule for surgey Thursday September 10 your advice would be greatly appreciated

  26. Hello, I was in a MVA in 1999 and somehow the Dr’s missed my separated shoulder so it was never fixed. I was in the hospital for 3 months and I was on a lot of pain medication so I never felt any discomfort really, plus I was 17 at the time. Now 16 years later, its starting to give me problems. Its almost as if somethings being squished or pinched and it was just under my “lump” on my shoulder but now its in the back of my shoulder and towards the back of my neck. Im seeing the chiro on Monday and going from there I guess, they ordered xrays that I will be taking with me to my next appt. Im wondering if surgery is even an option at this point because it has been so long. Also, any idea why it would now give me problems? It started about a month ago but the last week, it has been getting progressively worse. Hard to lay down/sit sometimes without having it in a certain position. Any insight would be helpful.

    • Often orthopedic surgeons treat AC joint separations non-surgically. Having said that, it could be a good idea to see an orthopedic surgeon to determine the source of your pain and figure out treatment options.

  27. Hi dr. Geier , I am on week four after a grade 3-5 separation from riding bmx. I am extremely active and ride bmx professionally. The surgeon in the ER never even took my shirt off and only went off the X-rays during my exam. He said that my shoulder had been separated before and that it was an old injury that could not be fixed, and that I could only rehab it. My question is about the massive amount of skin tenting I have …..the distal end of my clavicle has an avulsion fracture that has left it sharp like a knife edge under my skin and I worry that it could burst through my skin at the slightest impact!!

    How much skin tenting warrants surgery ?

    I’m at week four , is the lump likely to decrease at all as all as the injury heals?

    Last question , what is the best reconstruction technique for contact athletes?

    Thanks again for any help

    • I’d probably see an orthopaedic surgeon and get advice based on your specific injury regarding possible surgeries if he or she feels you need it. Most surgeons use a reconstruction involve a graft or implant that attaches to or around the coracoid.

      • Thanks so much for the response!!! I have been taping my Shoulder with athletic tape for the last 4 weeks in an attempt to make it heal less pronounced and with less tenting……does taping it down do anything ? I am four weeks into this injury is it likely to get any less pronounced as time goes on and the shoulder remodels etc? Or will is stay looking like a knife under my skin? Thanks again for you responses , it’s vey cool that you take the time

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david-headshot I am an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina.

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