YANMD, but...
May 1, 2014 7:37 AM   Subscribe

I have separated my shoulder. Should I get surgery?

I separated my shoulder on Sunday and need to decide whether or not to have surgery to repair it. I met with an orthopedic surgeon yesterday who said that the outcomes for surgery are not drastically better than those without surgery, and that many people regain full or very good use of their arm and shoulder with PT alone. He said that he personally would not have surgery, but that it was my call.

I am torn (hah!) between the two options. On the one hand, surgery is dangerous and the recovery would be painful and longer than just starting PT now. On the other hand, I am attracted to the idea of "fixing" the problem with my shoulder. I have torn ligaments that will not be growing back; if I don't have surgery my clavicle with be permanently detached, with a visible bump on my right shoulder. The aesthetics don't bother me, but I am a very active person and would really like to be able to have the full use of my right arm for as much of my life as possible. If surgery meant a longer recovery now, even for the next year or two, but better use of my arm in 15 or 30 years, I'd want the surgery.

So, my questions. I know that AskMe is not my doctor, but I would like to know if any of you have experience with this kind of thing. If you (or someone you know) have had this injury, did you have surgery or not? How is your use of your arm today? If you have faced this kind of dilemma before (with a knee or some other injury) how did you think about the tradeoffs between surgery and PT? What good questions can I ask the surgeon when I see him next (a week from tomorrow) to help me make this decision?

Again, I know that YANMD and will not treat any answers as binding medical advice.
posted by Aizkolari to Health & Fitness (15 answers total)
If ever there were a case for a second medical opinion, this is it.

However, if you start with PT, perhaps you can get to a place where you can live with it. It doesn't preclude surgery down the line, if you decide to do that.

But get a second opinion, not to confirm what you want, but to fully understand your options.
posted by Ruthless Bunny at 7:44 AM on May 1, 2014 [1 favorite]

Why is this a decision that needs to be made now? Is there a reason you can't engage in the number of months of PT your physio recommends and see what the outcome is? "The outcomes for surgery are not drastically better than those without surgery, and many people regain full or very good use of their arm and shoulder with PT alone" would seem to be a recommendation for that prudent course of action.
posted by DarlingBri at 7:48 AM on May 1, 2014 [1 favorite]

Bri, the surgeon said that it would be better to do the surgery now rather then to wait. If I could do PT for a while and then opt to have surgery later, I would definitely do that but I'm not sure that's an option.
posted by Aizkolari at 7:49 AM on May 1, 2014

I would avoid surgery if possible but do seek a 2nd opinion.

Hospitals are filled with germs and you can get MRSA or whatever else.

Jeez I sound like my mother but there you have it. Yesterday's post about antibiotic resistance on the rise just confirms not to get sliced open if you can help it.

I know we think of people like cars "just pop the hood and fix it!" but this isn't always the case. I know a guy who ruptured his Achilles tendon and several surgeons said Do Not Operate just rest it for a year. Good physio can easily equal surgery.
posted by St. Peepsburg at 7:49 AM on May 1, 2014

Then get a second opinion.
posted by DarlingBri at 7:54 AM on May 1, 2014

I would definitely do that but I'm not sure that's an option.

Waiting's pretty much always an option, and surgery is inherently risky. Do get another opinion or three, but remember that if the PT doesn't work, the more likely outcome is that it's just not going to make your shoulder much better. If the surgery doesn't work, the outcome can be much, much worse than a simple "no improvement."

Also, ask the surgeons you consult with to explain the reasoning for their opinions in as much detail as you can take.
posted by asperity at 7:56 AM on May 1, 2014

I have had an AC separation of each shoulder at different points in my life. I did not choose surgery. Today, more than a decade later, I have never wished I went ahead with surgery. I have full range of motion and live a very active lifestyle.

Of course, we have no idea how bad your separation is, so maybe it's different in your case, but if your surgeon doesn't recommend it, I'd have a hard time recommending it. If a second opinion makes you feel more confident in your choice, please do so.
posted by advicepig at 8:54 AM on May 1, 2014

I had shoulder surgery for a different problem 3 weeks ago. I had tried to fix it with PT and postpone surgery for multiple years. When I had the surgery they found far more damage than expected. This leads me to suggest the following to you - ask the surgeon what are the possible pitfalls of doing PT first and then needing surgery? You definitely want to get a sense of the long-term results of PT without surgery vs surgery with PT, particularly for your lifestyle - and I'd be specific with surgeons about what kind of activities you do and hope to resume doing.

I would certainly get a second opinion and I'd make sure that person was someone who does a LOT of shoulders. (my surgeon does pretty much nothing but). If you have surgery that involves re-attaching ligaments and doing muscle repair you will be looking at a lot of PT after being immobilized while things heal most likely. On preview advicepig has good advice.
posted by leslies at 8:58 AM on May 1, 2014 [1 favorite]

Hey, sorry about your shoulder. I separated mine three and a half years ago after I got hit by a car on my bike. It was a bad one. My doctor recommended no surgery as well.

So now I have a visible bump on my shoulder, but that doesn't really bother me so much. Also, I had back/neck pain for most of these three and a half years, and my loads of PT didn't really help. (I think this is unusual?) That did bother me, but the pain is mostly gone now.

On the other hand, I have fun range of motion and good strength, and I've had it for a while. (I'm an active person too.) And now the pain is mostly gone. So to sum up: it took a bit, but I am 100% better (except for the bump).

And my outcome was the worst of my three or four friends who have separated their shoulders, none of whom had surgery. Anyway, I don't know what you should do, but this is what happened to me.
posted by middlethird at 9:04 AM on May 1, 2014

I know lots of folks with this injury (many Ultimate players), and I don't know of a single one who opted for surgery. I don't know all the details, but they all returned to play at or near their previous peak. Can't comment on outcomes decades down the line.
posted by that's candlepin at 11:30 AM on May 1, 2014 [1 favorite]

candlepin, I was playing frisbee when I hurt my arm. It's good to hear that people can have this happen and come back to the game.
posted by Aizkolari at 12:19 PM on May 1, 2014 [1 favorite]

Both of my previously mentioned AC separations were a direct result of Ultimate.
posted by advicepig at 1:51 PM on May 1, 2014

I crashed on skis and suffered a class 3 separation about 3 years ago. I decided against surgery and have had no issues with range of motion or pain. However, the crash also damaged my rotator cuff, which has caused me some pain here and there. I do some exercises that help alleviate it. If you don't have any collateral damage and its just a shoulder separation, my suggestion is to skip surgery. Of course, IANAD!
posted by Don_K at 1:54 PM on May 1, 2014

I had a very acute AC joint separation due to a mountaineering accident eight months ago, two doctors recommended surgery. There was no question about it, all of the shoulder bones were wriggling around freely, I could hardly stand up or move around, or put on a shirt (I had to wait for surgery for four rather uncomfortable days, when they opened me up they said all of the bands were completely ripped apart).

Now, you're probably not in this position but:
1. Surgery took < 1.5 hours, I was released home one hour after it was finished.

2. The initial recovery was rather quick - the first two days were uncomfortable, no showers for five days, after a week I started going back to school for half-days. I started using the injured hand about 4-5 days after surgery.

3. They put two metal rods in the shoulder, that actually did hurt pretty bad for two months
because they kept shifting around the shoulder and touching nerves. I was not allowed to lift my hand above shoulder level, and lost a lot of strength in these muscles. Removing the rods was a really horrible experience (local anesthesia). I lost the tactile sensitivity around the area of the second surgery.
However, I had a very acute injury and I think you'll be spared that.

4. After the surgery I spent four months going to physiotherapy - initially for 30 minutes "passive" physiotherapy twice a week, then in a gym, for a two-hour session once a week. The gym sessions kicked my ass. I'd do it in the morning, go home, eat and sleep for a couple of hours to recover for three months.

I have two buttons holding my shoulder together (I can feel them under the skin). The entire joint is positioned a bit differently than the healthy shoulder. The shoulder is still not at 100% performance. Its getting better slowly. After four-five months it did not feel as connected to my body as the other shoulder. Now it's a bit better, but it feels different.

Performance wise - I'm really lazy when I don't have a good physiotherapist and a training plan. I'm back to rock climbing at almost my previous level pre-accident, but my pull ups are not as strong as before. I haven't done any physiotherapy in two months. I didn't do any sports for a month (crunch time at school) and the injured shoulder doesn't approve, it feels stiff and hurts a bit.

Practical stuff: I initially stayed with my parents, but moved back to my studio a week post op. They bought me a shit load of supplies, I got couple of big button down shirts, some waterproof band aids for showering and slowly built back up to normal life.

TLDR: The surgery was a piece of cake, the recovery was quick, unless you get metal rods, which were hell. Physiotherapy was very demanding in energy and time. With some logistical help you can back to independent life pretty quick post op.
posted by sockpuppetdirect at 4:11 PM on May 1, 2014

Thanks for all the advice, everyone.

I ended up not getting surgery and am very happy with my decision so far. Day to day I have no pain or noticeable lack of functionality in my shoulder. I have not gotten back in to contact or semi-contact sports like frisbee but I've been playing soccer, running, and riding my bike fine with no issues at all.
posted by Aizkolari at 9:24 AM on September 5, 2014

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