AC Joint Separation

Hey there
I separated my AC Joint today (type 3) when I fell during training from my Mountainbike.
The Doctor said that they’ll need to put a plate on my Clavicula to help the joint and tendons heal.
6 weeks no outdoor riding after the operation. What should I do on the trainer indoors and when do you think it would be alright to start.
Basically I am peaking right now and at least want to try to get back into the second half of the road season and maybe some XCO races .
Thanks for the help

Not sure where you live, but that’s odd that the doctor is recommending to “put a plate on your Clavicle to help the joint and tendons heal”. That’s very odd (likely wrong advice) and you may want to get a second opinion. A plate will not help your joint and tendons heal. I had a Grade 3 AC separation on my right shoulder in 2017 and on my left in 2018.

A Grade 3 AC separation is a pretty common injury for MTB and the recovery is not that bad. Basically, you should have the injured arm in a sling for 2-3 weeks to allow the tendon/s to form scar tissue and reattach to your Clavicle (collar bone). You will now have a permanent bump on your shoulder but it’s only cosmetic and shouldn’t limit you in any way. I have recovered 100% from both of my AC separations with full range of motion and strength.

After 2-3 weeks in the sling your doctor should have you start physical therapy to regain your range of motion and build the strength in your shoulder. At this time, I’d recommend Traditional Base 1. That’s what I did during my recovery period. I also raised my handlebars so I wasn’t putting as much pressure on my hands and AC joint. Let your shoulder pain be your guide and use common sense not to work through pain. I would use caution doing intensity on the trainer until you can rest your injured arm on the handlebars pain free. In about 6-8 weeks post injury you should be able to do some outdoor rides, but reintroduce this very slowly. Your shoulder will feel 100% way before it is actually healed 100%. No reason to rush back only to re-injure yourself or turn your shoulder into a nagging issue for years to come.

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Not wanting to scare you but…

It took me a good year until I was to the point I forgot I was injured. At least until I look in the mirror and see my collarbone sticking out.

I’m 1 year 9 months from the injury now and can finally deadlift and bench heavy again.

Doctor told me the same crap about 6 weeks or so… yah no, not for me. Surgery was an option for me but the doctor said it was a coin flip if it would actually help outside of the cosmetic fixes.

I’m almost 41 now, was 38.9 when it happened.

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I think that 6 weeks is to when you can get back on the bike and “normal” activity. I agree, no one is fully healed in 6 weeks after a grade 3 AC separation. In fact my doc said no pull-ups or lifting anything heavy for a least 2 months. Even then, they recommend reintroducing it very slowly. I’d say it took me at least 3-4 months until I could no longer tell that I had been injured. However, I took PT very seriously, doing it twice a day, every day, for 3 months. My injuries were at age 40 and 41.

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Thank you guys for the quick answers. I guess it is a rather personal thing regarding the recovery process. Gotta have to see what they will tell me at my appointment tomorrow and how surgery went I guess. PT is something i will take very serious and I am in the fortunate place that the German health insurance covers that and that 2 of my friends are PTs. I just do not like to discuss things like training etc. with them because they get to “doctor” with me then :grimacing:

I had a grade 3 AC joint separation at 58 YO and did not have surgery. Doctor and internet search said after one year the outcome should be the same whether you did or didn’t have surgery. I started PT with stretch bands ASAP and kept at it. After about 6 months I would say my shoulder was stronger than prior (since I wasn’t doing much strength work on the shoulders before the injury).

image

The image was the calendar from the time I got injured to the time I returned to outdoor riding. Just over 4 weeks.

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Depends on the nature of the separation. I had a complete separation of both the acromioclavicular ligament and the other that holds your scapula up. They drilled holes into my clavicle to retie the ligaments onto the bone, and used a plate and screw to keep it secure and keep the clavicle where the holes were drilled from eroding.

6 weeks no riding isn’t bad. I had to keep it totally immobile for 15 weeks I think. light stationary biking after 6 weeks, nothing risking a fall for 6 months.

Anytime surgery is involved it will be a much longer recovery. We were discussing the OP’s grade/type 3 AC separation, not sure if you had a grade 4 or 5 which mandates surgery.

Historically they used to operate on most grade 3 separations, but have since found that the success rates to a full recovery were the same with or without surgery. Furthermore, surgery required a longer recovery and other risks. The benefit of surgery though is that they can tie the clavicle back down so you don’t have a shoulder bump, but that is merely a cosmetic thing.

Some Orthopedic surgeons still push surgery for grade 3 separations, but the general consensus is that it’s not necessary. This may differ from county to country and doc to doc.

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I had AC surgery 4 weeks ago. Grade 4 ++, which means it pushed into my trapezius muscle and had more than 200% displacement. Almost came through the skin as you can see in first pic. Repaired with the Surgilig or “Lockdown” technique. That technique is far better than any other I found and WAaaay better than a “hook plate” which is what it sounds like your surgeon is talking about.

Related to training. I rode the trainer one handed for 2 1/2 weeks until surgery. Mainly zone 2 with some short efforts up to 1 hour. After surgery I could only ride base for a few weeks up to 1 hour and then at 4 weeks I got the sling off. Starting to do SST, at a much lower FTP, to work my way back. I can ride MTB on paved roads at 10 weeks and released to race at 16 weeks. See last photo for my modified trainer set up.

Also post a pick of your X-ray so we can see how bad it is. Also what country are you in?
First 2 pics are initial injury. Next is at 4 weeks post op. 4th is 1 week post op.




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The bike setup looks great. Yeah they want to put a hook plate on their and whenI asked about other options the hospital doctor told me he doesn’t perform these. I also got no info on any other way of treating it except from what I gathered here and what I read in some medical journals.
I feel that a hook plate is not a good option for an athlete especially since it will very much limit movement for 3months.
At the moment I think I will cancel the scheduled operation and go the non invasive route. Have until tomorrow evening to decide

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From my research the hook plate is about the worst option. You have to get another surgery to get it out as well. It can’t be left in place. Do you have a pic of your X-ray?

I’m 36 years old and suffered a level 3 AC separation on the 2nd lap of the opening race of the year. It was a Saturday.

I took Sunday and Monday to rest and I was back on the trainer on Tuesday. Arm was in a sling for 2 weeks and I also did 2 weeks of physical therapy. After those initial 2 weeks, I didn’t need the sling any more and continued on the trainer for another 6 weeks before making my redebut back to racing. That was back in early February and I’ve since been racing non stop.

Trust your body and give it time to heal but don’t lose that fitness!

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I suffered a level 3 separation last year after a crash in a crit. The doctor wanted to do surgery but I held off to research it…my PT told me not to do it as over 50% of the surgeries fail due to ligaments popping off which would suck after a 3 -4 month period of having it immobilized. I was on the trainer a few days after the crash and riding 2 weeks later. I have a significant bump on my shoulder but really haven’t lost any strength.

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I had a grade 4 separation in September last year (impact with a car at 60kph) and had to wait a month for surgery as I had abrasions that needed to heal first.
I had a small implant and everything was tied together.

I was back on the trainer after 3-4 days (it would’ve been quicker but I had the accident and surgery 1400km from home whilst away for work and my wife had to fly down to drive my car home)

I pretty much just did endurance workouts for a couple of weeks before going into SSB 1. I rotated the handlebars up on my trainer bike to reduce my reach and after a week or so I was able to rest the injured arm on the bars. During this period I was doing mobility exercises 2-3 times a day as directed by my PT. I was out of the sling after 6 weeks and did my first outdoor ride a couple of days later.

PT progressed pretty rapidly over the next few months and from January I started light weights gradually building up until late March when I was cleared to do fitness tests prior to medical review (I’m military). I was medically upgraded mid April with restrictions on upper body exercise (I still need to build more strength and to avoid any excessive impact).

So my recovery took about 6 months and I still wouldn’t say I’m 100%, my PT was impressed with the speed of my recovery (considering I’m 43), I lost maybe 5% of my FTP in the period off the bike but built that back pretty quick. I’m on another training course now but plan on getting back on my XC bike when I return home in the next couple of weeks.

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So it has been nearly 3 weeks since the incident and I in the end went with no surgery. After a week with just very light stuff, I am now in the second week of SSB. My shoulder still feels unstable but nearly no pain when being on the trainer. Worst is laying in bed on that shoulder. Still a long way to get back up to a full training load. Indoor FTP is just a rough estimation. I know my outdoor one and deducted a little.A ramp test would be to much stress 36

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No surgery was a good decision. Remember, your shoulder will start to feel better way ahead of it actually being fully healed, so don’t over do it and let pain (and doc’s advice) be your guide. Really focus on PT over the next couple months making sure to do it every day based on the progression they lay out for you. The trainer is likely good to go doing SS and below intensities. Again, if pain is above 3/10 then it’s too much. Your shoulder may feel sore afterwards and ice can help with that.

You are just looking to maintain your aerobic system and not build fitness at this time. You are “building” your shoulder back together and that should be the priority. At about 6-8 weeks post injury you’ll likely be able to increase intensity based on how PT has been going. Shortly after that the doc will also give you the ok to do outside rides.

I had a grade 3 AC separation in September 2018 following my Specialty phase peaking for my last race. After my injury I did hiking for a couple weeks then started Traditional Base 1 as my recovery. Below is what my TSS looked like post injury:

Yeah I am trying to take it easy. I came off an 6 week average of about 750TSS and easing in at 400-500 hundred now. I am trying to maintain fitness and get back into more steady state efforts, since sprints are anyways out of the scope .Eating more to aid with recovery off the muscles as well- gets me right in a perfect summer body shape :wink: .
If everything works well enough I might still be able to race road nationals :slight_smile:

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Would like to dispel some myths. As an Orthopaedic surgeon, I see these injuries not uncommonly. When reading the below keep in mind there are very few Absolutes in surgery.

Also a great (and free) reference for all Orthopaedic injuries and conditions that would be very useful to our community here is a website and mobile app called Orthobullets. It’s at Orthobullets.com.

Here we go . . .

  1. Type 3 injuries are the most controversial. There are 6 types (7 really as there are type IIIA and IIIB). All are dependent on degree and direction of displacement.

  2. The displacement is indicative of injury to the main stabilizing ligaments called the CoracoClavicular ligaments. Ligamentous healing is predicated in reduction of the displacement to allow the ligaments to heal, thus . . .

  3. Plates are a completely reasonable and evidence based modality of treatment - when surgery is required this is THE treatment in most cases. HOWEVER

  4. Not all plates are the same. You can do a hook plate but yes it requires a second surgery to remove which is something I try to avoid at all times. You can also do a clavicle plate with the combination of a biologic (usually an allograft -cadaver- tendon) or non-biologic ( strong sutures in a tension construct to bring the clavicle back down and let the ligaments heal) augmentation.

  5. When to recommend surgery is the trick. Typically people with Type 3 injuries - in my hands- that are high demand or high level athletes are CANDIDATES for surgery. I think everyone reading this is probably a CANDIDATE for surgery. Couch potatoes are not.

Type I and II are non surgical in hopefully everyone’s hands. Types IV (posterior displacement thru your trapezius muscle) and types V and VI (>100% displacement and inferior displacement -very rare-respectively) are surgical in most people.

  1. Recovery. Limitations do exist and this is typically for multiple months based on individual patient progress. 6 weeks of passive range of motion to allow ligament healing is pretty standard and then you up the activity from there. That does not mean that on the first day of the seventh week you are magically healed. It’s a spectrum. You’ll hear a varying degree of restrictions and recommendations on this as there’s not much consensus from one provider to the next.

I hope that helps dispel some confusion. Please look it all up on Orthobullets as that is actually a peer reviewed site for further info.

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Thx for your comment. I have 5 grade with huge displecement and my surgeon recommended hook plate. Yes, it has to be removed after all but according the surgeon this method suted the best to my case.

There is too much disinformation in the internet and I feel so confused. But I trust my sergeon - it’a a big name in Poland, very expirienced doctor. I am having the sergery the day after tomorrow. Wish me luck :slight_smile:

Hey Bolton,

Yes the internet is full of nonsense. Trust your surgeon. While a hook plate is something I avoid if I can, it can be a very useful tool in certain situations and is definitely not a wrong answer. Especially if your surgeon is comfortable with it. Sounds like you are in good hands.

Good luck with your procedure and be sure to DO YOUR REHAB.