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Ruptured shoulder ACL help & advice
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snowie




Joined: 06 Nov 2007
Posts: 747
Location: derby

PostPosted: Sun Mar 23, 2014 2:43 pm    Post subject: Ruptured shoulder ACL help & advice Reply with quote

Looks like my season is over just as it was about take off.
I had an off today cycling the wiggle Cheshire Cat & have ruptured my shoulder acl (grade 3).
Will have to miss London marathon & Lanza plus everything else that's planned, I might just make I'm Sweden if I am very lucky.

Anyone on here have any experience of this type of injury.

Sat at home feeling very depressed after googling it!
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e-j




Joined: 16 Aug 2006
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PostPosted: Sun Mar 23, 2014 7:51 pm    Post subject: Reply with quote

do you mean ACj (acromioclavicular joint / collar bone) or knee ACL (Anterior Cruciate Ligament)?
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fruit thief




Joined: 18 May 2006
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PostPosted: Sun Mar 23, 2014 8:59 pm    Post subject: Reply with quote

Are other injuries too? I would not have thought an ACJ sprain would rule you out of those events. Sure, the swim may sting a little in Lanza. Sorry if misunderstood though
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SteveI




Joined: 25 Jan 2011
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PostPosted: Mon Mar 24, 2014 12:32 am    Post subject: Reply with quote

I had a grade 3 ACJ separation in July last year, which I'm assuming is the same thing as you have suffered.

The evidence is mixed on whether surgery is a good idea or not. I managed to ride a 50 mile TT 17 days after the accident, and I'd say that was pretty much the first day I could have done it. My training had suffered in the intervening period as I was able to do very little in the TT position on the turbo, many of the early sessions were just 1 minute intervals resting on my good forearm. I could at that point have carried on without surgery, and it would have continued to improve from that point on, but I really wasn't happy about the long term implications for swimming, and the evidence suggests early surgery can be beneficial for overhead movements such as front crawl. So a few days after that 50 mile TT I had surgery, with a clavicle hook plate inserted. That was the end of all physical activity for 3 months, but apparently many people tolerate the plate much better and can be active while it's in. The plate is removed when the ligaments have healed, and my recovery was reasonably quick after the plate was removed. I now have pretty symmetrical shoulders but a noticeable scar on the injured one.

My first swimming session after the plate came out I could barely do anything with the injured arm, took me 1:44 to swim 100m. A month and 10 swimming sessions later that was down to 1:15.

You might be surprised how quickly you recover from it, albeit with the collar bone remaining permanently out of place to some extent if you don't have surgery, but the doctors told me 90% of people don't have surgery on a grade 3.
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snowie




Joined: 06 Nov 2007
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Location: derby

PostPosted: Mon Mar 24, 2014 8:38 am    Post subject: Reply with quote

many thanks steveI , it is the shoulder separation thing i have & your comments have given me some hope Very Happy

anyone else have any experiences of this type of injury they would like to share?
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Groovy




Joined: 02 Nov 2009
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Location: London

PostPosted: Mon Mar 24, 2014 9:40 am    Post subject: Reply with quote

I had similar in 2010. Hit by a car and seperated the shoulder - grade 3. I had it strapped in the immediate aftermath. Hurt like a bastard for a week but, on the specialist I saw's advice, did not have surgery (he had two separated shoulders and hadn't opted for an op on either).

What he told me is that he would recommend surgery only if mobility/ functionality was seriously hampered. Also, if you do not have surgery within the first week or so it does not matter when you have the op (ie: leaving it is not going to harm or improve the chances of surgery helping). The big thing for me was that the surgery is tricky (not guaranteed to work) and the recovery takes a long time (my separation is total - all three ligaments are gone). Like 6 months long time....

In terms of recovery it took a few weeks to get mobility back. Swimming was surprisingly problem free (I did the Dorney 10k a few months later) as was running. The only time I have felt discomfort is if I jolt it on the bike (say hitting a speed bump too fast).

My shoulder is pretty much fine now (albeit slightly lower than the other and with a lump that I use to gross out the kids with). I think the deal is that the muscles compensate for the ligaments eventually.
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RedZep




Joined: 17 Aug 2012
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PostPosted: Mon Mar 24, 2014 9:55 am    Post subject: Reply with quote

Grade 2/3 shoulder separation for me last Oct in an off and I opted for no surgery as it was recovering quite well (ie strength coming back quickly with loads of external rotator cuff work) and the fact Id had plenty of surgery with the other injuries sustained. Triathlete physio said not to bother with surgery to avoid complications. Range of motion was fine after a few months but just need to work on strength still.

If you're worried about asymmetry, could do what the downhill riders do and do the other side in too...
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SteveI




Joined: 25 Jan 2011
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PostPosted: Mon Mar 24, 2014 10:33 am    Post subject: Reply with quote

Groovy wrote:
What he told me is that he would recommend surgery only if mobility/ functionality was seriously hampered. Also, if you do not have surgery within the first week or so it does not matter when you have the op (ie: leaving it is not going to harm or improve the chances of surgery helping). The big thing for me was that the surgery is tricky (not guaranteed to work) and the recovery takes a long time (my separation is total - all three ligaments are gone). Like 6 months long time....

The difficulty is you don't know how it's going to turn out when you have to decide whether or not to have the early surgery. The information I was given differs a bit from yours in that I was told early surgery is normally done inside 2-3 weeks, with a limit of 4 weeks. Mine was done after a little more than 3 weeks and seems to have worked out okay. I was told the procedure has a >90% success rate. This is the procedure:
http://www.shoulderdoc.co.uk/documents/synthes_clavicle_hook.pdf
There are other ways of achieving the same thing such as using a tightrope to hold the collar bone in place, which can be done arthroscopically, so less cutting/scarring, but they are more prone to breaking before the ligaments have healed. But yes, once you're outside the window of opportunity for the original ligaments being able to heal, you're into a reconstruction of some sort that can be done at any time, so at that stage you may as well see how it turns out and only have surgery if you're unhappy with the function. As for 6 months recovery time, I suppose it depends on what exactly you mean by recovery. Some people have so few problems with the hook plate in that they don't want it removed, so they must be basically recovered in no time at all. I managed a 10 mile TT 4 months after having the plate put in. There is zero doubt you'll be more functional sooner without surgery. The problem is nobody knows how a specific injury would have worked out if they had made the opposite choice, so I don't know how mine would have ended up without surgery, and people who don't have surgery don't know how it would have ended up with surgery. I'm certainly a lot happier with mine than I was before surgery, it felt like the displaced bone was really digging into my shoulder when I moved it overhead whereas now it's back to normal, but presumably it could have improved without surgery, too.
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Groovy




Joined: 02 Nov 2009
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PostPosted: Mon Mar 24, 2014 10:43 am    Post subject: Reply with quote

Steve,

Absolutely agree it's a case by case job. My surgery would have been the tightrope option which could have involved taking a a little tip of collar bone off and the stapling an tieing together with heavy duty dental floss (well, not really - but you get the idea). I also didn't have the bone digging you speak of and mobility was pretty quick to return (primary check was raising the arm without discomfort). So for me, it was a decision to leave well enough alone.

Having seen yr 3 lap challenge times it doesn't surprise me you were back TT'ing in no time. Bike Monster = high pain threshold!
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snowie




Joined: 06 Nov 2007
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PostPosted: Mon Mar 24, 2014 2:59 pm    Post subject: Reply with quote

thanks for the replies, i am feeling a little more confident that my life is not completely over, just the next 8 ish weeks.

i am at the clinic tomorrow to discuss the options but do not think i will go under the knife.

i am deferring the london marathon till next year & will be doing lanza.
my focus will now be on sweden IM in august, although my focus will move to the bike & run & a 1 hr swim has been put on hold maybe 1:30 will be more realistic ?
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DanL




Joined: 24 Aug 2006
Posts: 1254

PostPosted: Mon Mar 24, 2014 5:29 pm    Post subject: Reply with quote

snowie wrote:
thanks for the replies, i am feeling a little more confident that my life is not completely over, just the next 8 ish weeks.

i am at the clinic tomorrow to discuss the options but do not think i will go under the knife.

i am deferring the london marathon till next year & will be doing lanza.
my focus will now be on sweden IM in august, although my focus will move to the bike & run & a 1 hr swim has been put on hold maybe 1:30 will be more realistic ?


Good luck with your recovery.

The road to an Ironman finishing line is 90% complete at the start of the race. This is all part of your personal experience and the source of your pride and pleasure when you finish.

Not meant to sound as mushy as it reads - I just think it's easier to cope with these things when you treat them that way. As is often discussed here - Ironman is 'easy' but that does fail to take into account the trials and tribulations you may face on the way.
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ris




Joined: 08 Nov 2009
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PostPosted: Wed Mar 26, 2014 9:42 pm    Post subject: Reply with quote

i came off my bike about 14mo ago and ended up with a gd2 ac rupture/sprain/whatever it is called. i was referred to nhs physio within 10 days of the injury (i think), and was told to get it moving as much as poss - bike, run and swim in whatever way i felt able.

surgery not deemed necessary (may be different in your case), i was told that my long term mobility would largely be known in 3-4mo.

within 2weeks of the injury i was on my turbo. 4weeks i was cycling on the road, and back in the pool, mostly doing kick sessions. i started running again at about the same time, but bloody carefully so i didn't fall over (and jarring seemed to gravitate to my shoulder!).

when the nhs physio discharged me (three visits), i switched to a sports physio but quickly concluded they weren't making much difference. i was fully swimming again after about 8weeks, with a careful return to make sure i didn't mess my technique up as my mobility returned.

i made the start and finish line of IM sweden in august, and swam pretty well! i've found my shoulder has got stronger over the last 4-5months, i have full range of motion and full strength back - it just looks a bit wonky and my shoulder blade still wings a bit.

take it steady and i would think you'll be ok - my experience was that once i got the range of motion back it was quite quick to get the strength back. my physio was very keen on getting it moving to reduced the chance of a frozen shoulder.

don't know what sort of swimmer you are, but 1hr at IMSE would be a great result if you can get it - the course last year was a couple of hundred long and only 100 swimmers went under the hour as far as i recall!
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snowie




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PostPosted: Thu Mar 27, 2014 8:48 am    Post subject: Reply with quote

went to the hospital on tuesday (accident happened sunday) & was told i needed urgent operation & was booked in for the next day.
The injury was graded as a 3 in A&E but the consultant grade it 4 boarderline 5.
on wednesday the surgeon was not happy with the road rash on my shoulder, he cancelled the operation & put some stuff on the road rash.
i am back again on tomorrow (friday) for an update & possible operation.
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SteveI




Joined: 25 Jan 2011
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PostPosted: Thu Mar 27, 2014 12:55 pm    Post subject: Reply with quote

Top tip - buy some shoes that are either slip on, or fasten with a velcro strap, because you won't be able to tie shoe laces for a while after the operation.
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Cobbie




Joined: 02 Aug 2005
Posts: 7444
Location: Chester

PostPosted: Thu Mar 27, 2014 1:34 pm    Post subject: Reply with quote

I got hit by another cyclist who wasn't watching where they were going and suffered a shoulder separation. Mine isn't a total separation (grade 2) but as it was back in 2006 I thought I'd contribute with my own recovery issues.

First off, I was 3 weeks out from IM and tried to get back into the pool to see if I could compete at all. After 2 weeks I managed a very painful 200m! The answer is a definite NO. However by the end of the year I was swimming normally.
The other issue I had was being unable to lock out my core on the bike - so power transmission was compromised a great deal until things properly healed.
On the flip side, I had probably the best ever autumn/winter running season of my life as I took my IM training and focused that fitness on trail and fell running. Smile

Over the next 3 years I had periods of pain in the shoulder; I had some physio which helped (I have some stretch / strengthening sheets which I could scan for you which might help - PM me if interested) but eventually I did seek more specialist help.
I eventually got to see a specialist shoulder physio but they were utterly arrogant and useless - basically told me that it was down to my posture but didn't offer any constructive advice on how to sort that out.
After that I basically got on with it and gradually the pain went and so far hasn't come back.

As others have said, the operation isn't something to take on lightly. I think only if you can't swim or whatever else you want to do after a good year of trying?

Good luck with the recovery Smile
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