AC Joint, clavicle dislocation post plate removal?

I tried the Rocktape after my dislocation, and although not as supportive (not what its designed for) I found it to adhere better and therefore lasting.............

BUT.......I always still felt cautious on the couple of down-winders I did when it still wasn't 100%...........

If it ain’t right.....don’t paddle!!

I know this from when I had a re-con on the other shoulder when I was younger......

I was playing top end volleyball and came back way too early for a big tournament.....and paid the price afterwards.

Thanks for the insight guys

I am chosing to believe that I will be returning to paddling albeit cautiosly

I sold the plastic ski I bought for river racing yesterday as I had wanted a new adjustable paddle and a lighter kevlar K1 for river races.

Ordered a new adjustable paddle from Carbonology.

Also went and tested a K1 for sale locally, a Cleaver "Max" 13kg kevlar boat.

I was smiling for two reasons while paddling it, one that I didnt fall out and that I loved the challenge of trying to paddle it faster and faster...and two I realised that I had forgotten all about my shoulder while paddling it

Admittedly it was a very short paddle, but it gives me more confidence that I should be able to give it a go.

I still think swimming will be the deal maker/breaker for my racing

Well couldnt help myself this morning. Winter storm had whipped up some swell and most of the local ski paddlers were headed to a local stretch of water to surf the runs as they come into a stretch of about 2km of protected waters.

I got down there early and paddled a few km's on flat water to see how the shoulder reacted...so far so good.

Joined some paddlers as they arrived to head out to the swell.

We ended up doing paddles out to a marker into the swell then turning and paddling back catch runs, moving through the break zone which is about 800 long (deep water so waves dont get real steep) then turned around near beach, each out and back was about 3.8km.

Did several at a moderate pace, accelerating onto runs but really concentrating on good form so I wasnt using the arm too much, more isometric force on shoulder.

So I ended up doing 17.6km, no pain, right pectoral muscle started to ache towards the end of the paddle and top of the trapz are sore now that I have cooled down. I guess that is just the muscles getting used to the change in the shoulders anatomical position.

Not celebrating just yet, will have to see how it pulls up over the next 24 hours.

EDIT 23/5 - here we are 48 hours later and despite doing a 14km road running race yesterday (the jarring of running sometimes upsets the shoulder) the shoulder is no worse for wear, so looks good to return to paddling. Might try to find time for a swim this week and see how that goes.

My trap muscle on that side developed quite markedly.
But paddling evened them out again.....

Rightarmbad wrote:

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.

Just wondering if you had to adjust your swim stroke? ie, do you finger tip drag on your recovery or straight arm? do you still hold the affect arms elbow high throw the pull stroke (greater force on shoulder)?

I managed about 800m swim today using fins to make sure I was just spinning the arms over without too much force being applied to the shoulder before some nerve impingement came on, no pain just a cold sensation along the bottom of the arm. Got a similar feeling when I started paddling again after the AC went again.

Will give it a couple of days to settle and try again, hopefully over time it will settle and I'll be back to full swimming training.

I am paddling full tilt again with (seemingly) no ill effects.

I have a much better streamline on my injured side as I can maintain a higher straighter arm on that side.
Lets me sink my head lower in the water and allow my feet to glide higher.
My stroke is very much an Ian Thorpe type stroke, high vertical elbows on recovery, lots of body rotation and a long gliding forward catch up timing.

The very action of the front part of the stroke as you skull outwards actually puts the shoulder back into it's correct position. So no loss of form, just a loss of power.
It may very well be that I simply never strengthened it enough after it lost it's strength after the injury.
I pretty much stopped competing after that.

Very soon after the initial injury when I tried swimming, the recovery phase was the painful bit, the rubbing together of the ends of the bones was excruciating.
I swam breaststoke and heaps of sculling drills until I could lift my arm above my shoulder.

Now that I have been paddling for a while, it would be very interesting to get back in the pool and see if the power loss is still there.

But for me, good news is that I have been doing a lot of long rest 450m flat out efforts to develop some speed, and it seems that the extra strength has stabilised the shoulder, as well as possibly sorting out a bit of the scar tissue and mobilising the whole area, and now I am showing no sign of the numbness for many weeks now.

Good luck....

Hi there,

I read with interest your experience with ACJ dislocation and hook plate repair. I have done something very similar recently. It has been 6 months since initial injury and and 2.5 weeks since I had the plate removed. I am about to embark on a period of rehab to strengthen my shoulder, and hopefully the newly healed ACJ.

I am disappointed to read that your ACJ dislocated under benign circumstances. I am an avid mountain biker and snowboarder. Both sports can create spectacular stacks and I am extremely worried that it is only a matter of time before my ACJ dislocates again.

What was the outcome after your second dislocation? Did you opt for further surgery and if so, how long did it put you out for and what has been the long term outcome?

If you didn't, how are you getting on with a permanent grade 3? ACJ dislocation?

I've included a couple of X-rays to show that I'm legit.

Seperated my AC bout 2 years ago. Doc said probably heal by itself and surgery put me out of commission for 6-12 months. Shoulder is deformed but works fine-no surgery. Can,t elaborate right now heading out to Santa Cruz Island for 14 mile downwinder. Forecasted 15 - 25 kts. waves 3'-5' @ 6 seconds. Whoo Hoo!

donaldduck wrote: What was the outcome after your second dislocation? Did you opt for further surgery and if so, how long did it put you out for and what has been the long term outcome?

Gidday DD, I'd like to say I lived happily ever after but I guess it depends on how you look at my outcome.

I didn't opt for more surgery, as I had already had surgery a few days post the fall I had really used up the one chance I had to get the ligaments to heal in the right place. Also once the scar tissue is formed a 2nd op is risky ( or so I've been led to believe).

I have to consciously keep my right shoulder in good posture as it doesn't naturally sit in the right position due to it's increased range of movement (ROM). This can be tiring.

I can paddle very well and it doesn't effect my racing ability, however, I have to compensate for that lack of normal positioning by concentrating on pulling my shoulders back when racing, otherwise on the catch phase I can tend to hyperextend the right arm due to that increased ROM.

After a solid sprint or short interval session the shoulder will ache. Same with a challenging downwind that has had me doing more bracing. Sometimes I fear that due to the shoulders decreased stability I risk a dislocation when bracing so I tend to hold back downwind and concentrate on keeping my hands low so I dont get my elbows too high which is where the shoulder is less stable in the joint.

I gave up on swimming I continued to get numbness down the underside of my arm and the 4th and 5th finger.

Maybe a way to explain it to those who havent had this injury is that it feels like you are carrying your arm and shoulder around rather than it just hanging from your side.

I went back to my surgeon not long after it happened having researched a procedure called the Nottingham Surglig www.shoulderdoc.co.uk/article.asp?article=973

I think I got the wrong surgeon as he appeared very disinterested and dismissed it out of hand. I have since formed the impression he is not used to dealing with athletes using their upper body.

For paddlers I wouldn't recommend what I had ( hook plate), I don't think it is strong enough once the plate is removed to cope with the stress. If that is all that is available , leave the plate in for as long as the surgeon will allow to get the most amount of tissue growth (Scar tissue) formed so it stands a better chance. My Surgeons reaction was "I never had that happen before" but from the research I have read it is in fact very common for it to fail in athletes.

The other thing I would recommend is taping the shoulder, I have started doing it when I have races or I know I have some hard training planned, it really helps contain any movement in the shoulder. If you want to see what it looks like tape any game of AFL football and look at their shoulders, half the players seems to have their AC joint taped! but you can find proper instructions on you tube.

I also tape my shoulder for mountain biking as you are putting weight on the shoulder and then using the shoulder to lift the bike as well.

Hope this has been some help.

Thanks AR,

It's interesting to hear of others experience with this. Although I gather ACJ separations are fairly common, I can only find scant information about long term outcomes.

Thanks for the tip of taping. My physio taped me prior to the hook plate surgery, which at the time provided some much needed pain relief and stability. I will attempt to do that (or at least a mini version of it) when mountain biking or boarding. I also have just purchased a McDavid Lightweight neoprene Shoulder Support for use when doing sports. I haven't used it yet so don't know if it will help. It might be a good product for your paddling?

I had the hook plate in for 5 months in the end, the surgeon had said 4-6 months so that seems about right. It's hard to get a straight answer out of the the orthopaedic team but I gather I no longer have the 3 ligaments doing the work holding the ACJ together, rather I have a shed load of scar tissue in there.

I had also read about the Nottingham Surgilig recently, but it's not a procedure offered at my local hospital. Im undecided whether to pursue this in future if my current fix fails. I guess if you can live with a natural remedy long term it's better than having a prosthetic ligament in there permanently.

I am only doing light resistance physio at present, but I have had 2 mtb rides with minimal problems. The two main issues so far are a creaking/popping sensation/sound when the joint is under load, eg 12kg dumbbell press, and a short sharp burning sensation if I have to flinch all of a sudden, as if I'm about to have a washout on the bike and I react to catch it. Did you get anything like this?

Cheers!

Fath2o,
Compared with my X-ray, how bad was your injury?

If you are asking was my clavicle completely seperated from my shoulder, yes, it looked just like your xray.

Here is my initial post on the crash

www.surfski.info/forum/1-general/4901-di...-joint.html?start=20

and another blog in an adventure racing forum

www.rapidascent.com.au/Forum/ForumMessages.aspx?t=1170&e=

unfortunately whichever site I used to host the photos of my xrays is no longer hosting them.

Donaldduck,
As I recall it looked about the same as your xray,(and still does). I must admit though my shoulder(s)and arm have been pretty sore since the paddle. We had a lot of counter current and cross chop to deal with otherwise a great run. Toured painted cave which is allegedly the largest sea cave in the world. 400m deep x 30m x 48m high.
I injured myself surfing. ER doc xrayed shoulder and tells me I've got degenerative arthritis, degenerative disk disease, stenosis and a mass in my lung. Said the good news was the injury was a rhomboid strain. Yeah right! So now I'm seeing a pulmonologist talking about lung cancer and removing part of my lung. Never had any symptoms. Subsequent scans, MRI's xrays etc. weeks later are inconclusive for the lung mass but discover the broken rib and separated AC. So I didn't really get proper treatment instructions for the injury. Wondered why it sounded like there was a bag of rocks in my shoulder when I paddled. I think it was 6-8 weeks before I consulted an orthopedic about AC injury. He said surgery probably wouldn't improve outcome.
Still don't know what's going on in my lung, figure it's scar tissue or maybe a jellyfish.
So, I thought waking up 20 times a night and rolling over with throbbing, aching, tingling, numb arms hands and fingers was normal!?
Physical therapy didn't seem to help much. I don't think the therapist was really very good, plus that was before the ac separation diagnosis.
Ended up going to restorative exercise yoga classes and a trained massage therapist. The yoga was the best treatment and definitely helped get my range of motion back.
I'm 53 176cm 200kg and work construction when I'm not paddling or surfing.
Good luck with your rehab. It takes time.