AC Joint, clavicle dislocation post plate removal?

Last July I dislocated my clavicle in a mountain bike crash then had it plated straight away.

I had the plate removed a few months ago and have been back into full training for a couple of months.

The clavicle decided to let go again today ...only just noticed it post a 17km training paddle. No pain, no sudden noticeable changes, really only noticed it when getting changed and seeing the big lump under my scar

Has anyone else who has had thiers fixed had the clavile come away from the joint again

Really hoping not to have to get another op after just getting back to close to full fitness, swimming is the big question I guess

If you are lucky, it may have just become inflamed and swelling is lifting the collar bone to the limit of the looseness of the repaired ligament.

I say this, because having never had mine repaired, it is obvious to me that paddling puts it under the most mobilization of any activity I do.

It is also the one activity that has the most potential to make it hurt.

There are three ligaments holding it all together and I doubt if all three were repaired, or even if they were all torn to start with.
Usually they just repair the one large one and this leaves more mobility than the structure normally has, throw in a long paddle that really moves the injured parts around a lot, and you have the potential for irritation.

Hopefully, it all settles down after a while.

As an aside, when mine used to hurt, a switch to a left control paddle for a while used to let it settle down.

Good luck and let us know how you go, as I am still considering getting mine fixed.......

Rightarmbad wrote:

There are three ligaments holding it all together and I doubt if all three were repaired, or even if they were all torn to start with.
.....

Yep, did all three,(type III rupture) it was a very good dismount after going over a jump on a downhill slope and falling from about 2 metres onto the shoulder

That was the reason I went for the plating repair. The hook plate holds the clavicle in it's correct position with the idea being that the ligaments are forced together and will knit back together.

Plate was left in place for 7-8 months.

The surgeon did warn me that it sometimes doesnt work and if necessary later they can do other procedures involving goretex tape or allograft tendon (donated tendon).

I will go and see my surgeon and see what he thinks.

Had xrays taken today which confirmed it has dilocated again.

No pain, so I'm gonna go out for a ride today and see how it goes on the road bike.

Surgeon is away for two weeks so booked in to see him on his return...figured if there isnt any pain there's not much worse I can do in the mean time!

May even try a gentle paddle or two in the two weeks just to keep everything loose

You may find that paddling is incompatible with that type of repair.
From observing mine, I believe that there is quite a large front to back force on the ligament when paddling.

You might find that if you repair it again, you may have to spend a year or so getting it stronger with other exercises before exposing it to a lot of paddling force and or frequency.

Just a hunch I get from observing the motions I see in mine without the repair.
Mine is quite painfree also, but I do suffer from a numb finger and thumb on that side if paddling hard on flat water for several kilometers.

Good luck.

Rightarmbad wrote:

Good luck and let us know how you go, as I am still considering getting mine fixed.......

As a Uni student I have access to all the Journal search engines so have been busy researching the latest in Grade III AC joint dislocations and have discovered quite a lot more than I knew before.

Had I known then what I know now I would probably have opted for a more aggressive approach given that the hook plate option has a 55% failure rate once removed in athletes.

It is a good option for those wanting a good cosmetic result but the scarred/reknitted ligaments as in my case cant handle the forces applied by athletes.

I would encourage you to look into it as there is some research on men our age having procedures done years after the intial injury that have good outcomes.

The weaver-dunn procedure is popular and has good success but the one I think looks less complex with just as good a result is the
Nottingham Surgilig.

I wont be paddling as the shoulder has loosened somewhat in the past day or so. I've decided I will just go and do the paddless leg drive/rotation drills to keep working on stability while waiting to be able to paddle again. The water is only 200m from my door so it's not a hassle.

Geez surely your surgeon should have known about the 55% failure rate . . . I imagine he'll be getting an earful from you when he's back in town!!!

Good luck . . . .

considered giving up mountain-bike races?

SS@Bermuda7 wrote:

considered giving up mountain-bike races?

Yeah yeah Dont you think I got enough of that from the wife

I have stayed away from the shorter races where you are jostling for position, just doing enduro racing now and while it was an enduro race where I crashed I wont be out to try for podium finishes anymore...only using them to train for multisport/adventure races

Perth ski chick wrote:

Geez surely your surgeon should have known about the 55% failure rate . . . I imagine he'll be getting an earful from you when he's back in town!!!

Good luck . . . .

I am a bit annoyed he didnt tell me about the failure rate...but in his defence he did say it was a conservative approach and that it may fail down the track (no pun intended).

Reflecting back I was only a couple of days post op, full of pain killers and just happy that he could operate within a couple of days.

When I did it there was an orthopaedic surgeon actually racing in the same race in a team. When I was picked up and taken back to the race organisers tent he took a look. I remembered him saying go for a particular technique for the repair but I didnt get his name and couldnt remember when I went to see the surgeon in Perth, he said something about not going for the plate repair but again I was just trusting the surgeon I saw in Perth to do the right thing and I made a point of telling him how active I was and didnt care about rehab, scarring etc.

oh well, lets see what he says, 10 days to go till the appoitnment and I'm already getting frustrated at not paddling

Thats tough Brett. Gary mentioned you were paddling well....until now.

Good luck
Martin

Martin wrote:

Thats tough Brett. Gary mentioned you were paddling well....until now.

Good luck
Martin

Thanks Martin, yeah I was coming along in leaps and bounds, had started training with Steve, Chris, Mark, Linsday etc from Mandurah. A few of them are training for Mauritus.

They were really pushing me a few weeks ago, but on the weekend the shoulder let go I had been out with them and actually felt like I belonged with the group rather than just trying to hang on....so disappinted that this has happend now.

If I can get the procedure I think I want it sounds good to return to training quite quickly

Not gonna pull out my entries for the mainpeak multisport and Anaconda just yet

Hopefully they sort you out quickly! But if not, and you can still run and ride and want to do a mixed team for the Mainpeak race, I'm keen to do the paddle.

I'd still much rather see you do the whole thing yourself so fingers crossed the surgeon can fix you up!

Perth ski chick wrote:

want to do a mixed team for the Mainpeak race, I'm keen to do the paddle.

Actually Di, my wife wanted to do part of it (first 7.5km run) so I organised a mixed team for her and we still need a paddler for the last leg from middle swan through to the finish if you are interested. While a couple of the guys in the team are fit, it will be a social hitout for them, all 40+ as well.

I fully intend on doing the whole thing, plenty of time for rehab following an operation.

Just back from the surgeon, he came back early from holidays and only contacted me this morning to come in.

He expressed surprise at the AC joint dislocating again in this manner and could only offer that it was due to the amount and intensity of training I did. As the conversation went on he also thought he may have taken the hook plate out too soon (7 months).

Anyway after talking about several surgical procedures I had researched we came down to two options.

1) Do nothing, return to training and see what happens. He doesnt think this will do any more damage. It will either be comfortable or uncomfortable and if not bearable he can operate in 6-8weeks.

2) Have the Nottingham Surgilig procedure now and write myself off from racing for at least 12 months!

We spoke at length about reasons why I could not go back sooner after having surgery and he warned that although possible to return quickly the ramifications down the track as I age if I damaged or dislocated the joint again would be serious. We spoke of current football players here returning to play after using similar technology in other joints and the word around surgeons is that although possible they are starting to see these joints degenerate again quickly.

Seems a no brainer really, when I went in there I was determined to get an op straight away so I could rehab and get back to fitness to race later in the year. But since thats not adviseable I've got nothing to lose to give the shoulder a go without surgery and if in a few weeks it isnt any good then I can book myself in.

If by chance it does cope with training then great

You will suffer a loss of power in that arm, depending on the motion.
I certainly lost a lot of power on that side swimming.
Doesn't seem to effect paddling except for pain and irritation in the first twelve months and again a couple of years later when I upped the distances paddled.
But I'm pretty much pain free now apart from numbness in the thumb and pointer finger if I paddle at my limit on flat water for a more than 5km or so.
As a bonus, that shoulder has a much better rage of motion and helped my swimming position on that side.

Rightarmbad wrote:

I certainly lost a lot of power on that side swimming.
Doesn't seem to effect paddling except for pain and irritation in the first twelve months and again a couple of years later when I upped the distances paddled.
But I'm pretty much pain free now apart from numbness in the thumb and pointer finger if I paddle at my limit on flat water for a more than 5km or so.

Thanks for weighing in to this thread, knowing that you have been able to paddle and swim without surgery has been an encouragement.

As you may have gathered I dont do not being able to train very well

I can put up with the symptoms you describe if I can get back to training for this years events then take stock after my major races to figure out what could be gained by having an operation. It may even come to the point that I have an operation booked in the week following my last race if I am really having a hard time with it

I have let my swimming get progressively slower over the past few years from lack of time in the pool and am happy just to be a midpacker over the distance swam in adventure & multisport races(1.5-2km) making up for it in other legs.

I am tapering for a 14km run this weekend now so wont be putting the shoulder to the test before then. Will report back next week.

I may be taking PerthSkiChicks offer of forming a team up yet

I had talked myself into surgery after not being able to sleep for a few months, it just started aching like hell once I went to bed.

The day before I was to go see the surgeon for the rundown and to set a date, I went for a paddle and it stopped hurting during the paddle and never hurt again since.

I think it is just a matter of what scar tissue you have there, especially where the main AC ligament was.

Mine is quite mobile, with the collar bone being able to kick up a good 2cm and move forward 1 cm and backwards 2cm in relation to where it belongs.

For the first couple of years it used to ache in the afternoon after the surrounding muscles got sick of holding up my arm.

It certainly emits a lot of popping and creaking noises.
People often comment about some noise hey can hear and not know where it is coming from.

My pre injury swim time for a pool training 1500m was around 18min, afterwards I have never got under 20min.

Swimming certainly makes it ache if I try and do too many miles, doesn't seem to worry about sprinting, just how many times it kicks over.

I've paddled up to 45km in the canals and one long 37km downwind with no problems.

I can certainly relate to the sleeping issue. I had shocking nights sleep after I initially injured it and for months after, you dont realise until you cant lay on that side how much it affects you. I used to wake myself up countless times per night with pain on rolling over and was racking up an impressive painkiller consumption.

Thankfully my shoulder isnt affecting my sleep now.

I thought that perhaps taping it could help with longer paddling after researching different techniques. Any physio's on here confirm this?

Tape, sweat and water don't go well together.
The anchor strips soon come undone and the tape stops offering anything but a sticky annoyance after a few kilometers.

For me, shifting the peak power phase of the stroke slightly rearwards offers some relief from numbness, as does running the paddle short.
But in the end, if I want to go flat out for 10km or more, I just got to live with the distraction of numbness.

My heart rate starts to drop until I notice that I am no longer thinking about working hard, but the control of the paddle.

It's fine in the ocean though, I've never felt it in the rough.
Certainly have in the broad water though.