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Old 04-24-2009   #11
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Boulder, Colorado
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Originally Posted by jennifer View Post
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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Old 04-24-2009   #12
Boulder, Colorado
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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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Old 04-24-2009   #13
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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.


Good luck with whatever path you decide to pursue.
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Old 04-24-2009   #14
Idaho Springs, Colorado
Paddling Since: 2005
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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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Old 04-24-2009   #15
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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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Old 04-25-2009   #16
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"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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Old 04-25-2009   #17
Join Date: Oct 2003
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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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Old 04-25-2009   #18
Boulder, Colorado
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No worries Jennifer. Thanks tho.
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Old 04-25-2009   #19
Boulder, Colorado
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Originally Posted by raftus View Post
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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Old 04-25-2009   #20
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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.

smccorvey@ students dot mcg dot edu

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