shoulder separation: surgery vs. doing nothing, or is there third way?
August 28, 2015 6:32 PM   Subscribe

Asking for a friend: he fell off a motorscooter while riding it and fell on his left side. The main injury was "AC separation" [a type of shoulder separation -- damage to the acromioclavicular joint -- which is _not_ the same thing as shoulder _dislocation_], type 3;means that surgery is optional but worth considering. Is there some other choices beside surgery, or doing nothing?

I am in Austin, Texas.

I fell off a motorscooter while riding it and fell on my left side.
The main injury was "AC separation" [a type of shoulder separation --
damage to the acromioclavicular joint -- which is _not_ the same thing
as shoulder _dislocation_], type 3; the "type 3" part means that
surgery is optional but worth considering. Without surgery, the
injury heals with the clavicle in the wrong position on the shoulder
end, which results in a potentially-large permanent bump, but it is
reportedly tolerable for many people.

I don`t want this permanent bump, especially since it is bothering me
very much already, and I also don`t want the bone to stay in the
position it is now in: I`ve seen my recent left-shoulder X-rays, and
they look wrong and scary.

I visited an orthopedic surgeon last week, and he explained the
severity of the injury to me and gave me some facts about surgery. I
wasn`t very comfortable with him, partly because he made me feel
rushed [I ask a _lot_ of questions]. I didn`t really want to have him
do my surgery.

I went for a second opinion to another orthopedic surgeon today, and I
felt much more comfortable: he answered all the questions I asked him
without making me feel bad for asking so many of them. His bio also
inspires a lot more confidence: he has a long track record as a US
Army surgeon, for example. As of now, I`m leaning towards having him
do the surgery for me. He says the probability of complications is
10% and the probability of success is 80%.

Another thing that`s nicer about this second surgeon is that he says
he can try to do this work "arthroscopically", i.e. with 2 or 3
smaller-than-otherwise incisions into my body. The first surgeon told
me that the surgery would definitely result in a long [2 ... 3 inches]
scar, but the second surgeon said that he would only use that
technique if the less-invasive technique would prove problematic at
surgery time [paraphrasing, i.e. not his exact words].

Even though I went to the second surgeon with lots of prepared
questions and he didn`t rush me, I forgot to ask one question: is
there a third choice? That is, besides:

* get the surgery, the bump will be gone because the bone will be
back where it should be [or at least much closer]
but there will be scars, plus there are always potentially
complications from surgery

* _don`t_ get the surgery, just let it heal "naturally" and tolerate
the bump and the bone position

... is there a _third_ choice that`s worth considering? For example,
is there anything a chiropractor can do about this which is effective?

By the way: either of the existing two choices involve lots of
physical therapy afterwards.
posted by Oli D. to Health & Fitness (4 answers total)
Best answer: I'm sorry I can't answer your primary question at all, but if you need a PT recommendation, I do have an awesome one. Send me a memail if you'd like it.
posted by jaksemas at 9:54 PM on August 28, 2015

However, I do have an AC separation on both sides and a rotator cuff tear that has been repaired.
I've found the rule of thumb for orthopedic surgery (especially shoulders) is to ask yourself how much this is interfering with your daily life. Not just aesthetically. Can you lift a book? Get things off a high shelf? Put shirts on or off? If you're pretty much functioning normally, it's probably best to leave it be.
Even if you're in some pain now but function isn't severely impaired, see how you're doing in a few months. My most recent AC separation was from an MVA in March, and I'm pretty much back to normal.
I say this specifically with regards to shoulders for two reasons: the recovery is epic, and there's really only one shot. A messed up surgery is really tricky to fix in that area, and you'd be surprised how much it can impact your life generally to have that area truly messed up. There is also not really an option for a replacement joint for later.
posted by susiswimmer at 12:52 AM on August 29, 2015

When I worked in insurance, I was told that AC separations are typically treated by putting it in a sling to imobilize it and let it heal. This was information I needed for reviewing claims. I have no firsthand experience with the issue, other than reading medical records and cutting checks for five years.
posted by Michele in California at 11:50 AM on August 29, 2015

Response by poster: Thank you-- and this is from my friend:

"I chose to have the surgery done by Dr. Sean Gallagher of ATX
Orthopedics and to have it done at Bailey Square Surgery Center. The
surgery was done a few days ago and IIRC I was told it was a complete
success with no complications.

Thanks to everybody who took the time to read my request, both those
who replied and those who didn't."
posted by Oli D. at 4:13 PM on September 29, 2015

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