Question - AC grade III

by Tamer
(Boston, MA, USA)

I just survived a motorcycle accident and I have a left shoulder AC grade III. It is tough to stomach the fact that you will always have a bone jutting out of your left shoulder and you will probably not restore full-capacity of the shoulder.

Out of curiosity, my doctor also said that surgery is not the way due to the associated complications but does this mean that the network of bones and ligaments in that shoulder area are non-essential to functionality, structure and protection? My doctor made it seem like it was a common accident and that most people return to full activity after 14 weeks.

I am just curious, is this some evolutionary adaptations are bodies made from previous forms and they become less and less important and functional (like the appendix)?

Jun 22, 2008
by: Bart - SII

Grade III AC separation is usually not treated surgically unless there is just a very strong desire to correct the cosmetic aspect of the shoulder. Surgery to repair the AC joint often leads to limitations in motion and more problems than just leaving it alone.

Recovery does take 3-4 months because the injured tissue has to heal and the shoulder has to calm down. But once time passes, you should have full range of motion and fairly good strength.

As far as the function of the shoulder, the AC joint has little to do with stability of the shoulder. It isn't necessary for it to be intact for the shoulder to function and remain stable. I don't know if I would go as far as comparing it to the appendix as far as usefulness, but perhaps.

So, if you can stomach the deformity of the shoulder, you should do fine with your recovery.

Thanks for the question!

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ac seperation with adhesive capsulitis

by susan

I realize this isn't a "sport" injury but hope you can help. Intermittent left shoulder/neck pain x approx 5 yrs. I began to elevate/shrug both shoulders and extend my neck while keyboarding. Pain increased in 2007 & I developed adhesive capsulitis; Lt shoulder froze Dec 2007 with loss of normal arm swing, very restricted rom all directions and hiking of shoulder.

Subsequently keyboard lowered 7" and now use a chair with arm supports. I've gradually rtw but I can't stop involuntarily elevating (shoulder shrugging) my shoulders with keyboard or other activities requiring use of arms.

Blood/thyroid/sugar levels normal 2007 & 2008. X rays Jan 2008 negative; u/s showed minute calcium deposits throughout a number of muscles and calcium deposit/small amt of fluid in biceps tendon.

Apr 2008 normal arm swing returned and hiking of shoulder was less. I managed to get some of my rom after attending physio Jan - July but still limited (ie currently +5degrees at elbow, forward ext about 5 degrees below shoulder height; sideways extend is about 10 degrees below shoulder). I was told to stop physio in event this was aggravating the ACapsulitis.

Aug 2008 excruciating pain (worst since start) in the back (trapezius?), and I assumed it was an adhesion releasing. Since then my arm is swinging in towards my body instead of back and forth at my side. The arm strikes my leg as I stride. If I carry something the swing goes back to normal but it hurts to carry anything. With effort I can pull my shoulder back but it just rolls forward again when I relax. I also have pain in scapula and it is winging. I have had no improvement in rom since Aug 2008.

In Sep 2008 I had further x rays c/out that show a gap in the AC joint. I don't know the degree. I'm now getting symptoms on the right shoulder which I feel is the start of ACapsulitis . I've lost some rom in forward and sideways raising of rt arm but no pain at end of range so I think I'm just in first stage. I'm back on anti inflammatories (which isn't helping with pain on either side) and have been told to do ROM on the right. I have appt with Spec but not until Jan 2009.

I am anxious the right shoulder will freeze before I have rom back in the left. My questions are:
Will the ac problem, shoulder hiking, shoulder rolling forward and scapula winging resolve as my shoulder unfreezes?

What has caused the AC separation and scapula winging?

Why is my arm swinging in towards my body instead of at my side?

What can I do to stop shrugging my shoulders/any exercises?

Can the problem(s)be addressed while I still have ACapsulitis?

I'm hoping someone will offer me surgery. Any comments?

Any advise for either shoulder while I'm waiting till Jan 2009 is really welcomed.


Oct 14, 2008
by: Bart - SII

It sounds like you may have some type of nerve involvement - perhaps the long thoracic nerve, which is responsible for the serratus anterior muscle that moves the scapula and keeps it from winging out from the spine. Do you remember having any significant sickness prior to starting to develop the shoulder problems - a virus or anything that was more than the sniffles?

Injury to this nerve is not common, but from what you describe, it is something that you may want to look into with your doctors. It can sometimes come from a viral infection that damages the nerve, or from a traction injury where your arm was pulled severely.

The adhesive capsulitis is likely to be a problem as long as you do not have normal shoulder function - which is hard to have when your scapula continues to not move correctly.

The hiking, rolling forward, and arm swinging could all be related to the scapula not stabilizing. If you don't have good muscle function in the back of the shoulder, then all of the other muscles will pull extra on the scapula - that means the trapezius will pull it upwards, and the pectoralis will pull it forward. Until the posterior muscles wake up and counteract the pulling, it will likely continue.

If you could find a therapist that specializes in shoulder rehabilitation, one that believes in scapular stabilization and functional muscle patterns, that could help.

I would also recommend talking to your doctor about the possibility of the nerve issue.


Oct 16, 2008
by: Susan

thanks for feedback... A few weeks after the shoulder froze, a working colleague who is a physician, assumed I had a "stiff shoulder" and asked me to relax the arm and then yanked on it outward and upward (like when you pull back to throw a ball). Shoulder reached the end point and I almost fainted with the pain. I had to stop working after that. I think an assumption was made that because I had continued working and plodded on without complaining it wasn't FS but a stiff shoulder, oh well the colleague did mean well. Apart from that I don't recall anything other than flu like symptoms about 12 months prior to shoulder freezing. I'll bring your thoughts to my GP when I see him and make sure I find a physio who can offer me what you are recommending. Thanks again. I'll let u know outcome.

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AC Separation after fall?

by Dave
(Winter Park, Fl)

Hello, I just found the site, great site.

Approximately 6 months ago me and a friend were pulling a tree along the ground with a vehicle to move it to another area of the property for it to be sawed into pieces. When the tree got stuck between 2 other trees, the individual in the vehicle pressed the gas and the tree began to bend and then it suddenly bent enough to clear 1 of the trees and it violently released with enough force to immediately hit me in the rear of my calves and swept me a few feet into the air and I landed on the ground with my upper back/shoulder area and knees were directly next to my head. It was traumatic and the hardest I have ever been hit.

Feeling pain all over but not particularly more so in the shoulder area, after a week or two I continued to workout with weights but it appeared that one shoulder was weaker than usual. One workout I went slightly lower than usual in the front shoulder press and there was tightness in the shoulder. Then some pain became evident in the left shoulder and I decided to rest it for 3 months. I then did yoga for 2 months and it was doable but some pain lingered in the upper shoulder area. I then recently began to workout with weights but the pain still lingers and it seems that one shoulder is weaker than the other and has some range limitations overhead.

Last week I noticed in the mirror that with both of my shoulders relaxed there is a very small bump (almost unnoticeable) where the trapezius muscle connects near the end of the clavicle. As I lifted this shoulder as if to shrug, this small bump seemed to move and feels as if the shoulder joint is allowing the bump to raise up somewhat. The other shoulder has no small bump in the mirror nor a small bump whatsoever when I shrug.

Please advise asap. I do not desire surgery.

Thanks in advance.

Sep 19, 2008
by: Bart - SII

This sounds like you may have had an AC joint injury - the bump you describe could be the small separation of the AC joint in the shoulder - a direct fall on the back / shoulder is a common way to cause this injury. The good news is that it is very rarely treated with surgery, and usually gets better with rehab - the bad news is that the bump usually remains forever.

I would recommend seeing a doctor for an evaluation and X-rays to get to the bottom of this and make sure everything is healing normally, as well as getting options for treatment.


Sep 19, 2008
by: Anonymous

Thank you Bart. I will schedule an appointment right away.

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Question - Broken Clavicle (4 weeks)

by John

I broke my clavicle 4 weeks ago today. I have full range of motion in my arm now. I still feel pain about an hour into running (which I then stop) and swimming. I can still hear some clicking and popping when i shrug my shoulders (sometimes). It seems as though I'm getting stronger everyday. Can I feel this way and still not be healing properly? I still cant put body weight on it (push-ups and pull ups).

Aug 30, 2008
by: Bart - SII

You are doing well for someone 4 weeks out from a fracture. The pain with running is normal - you could be inhibiting the healing, but no pain is a good sign. I would recheck with your doctor and have a follow up X-ray to make sure things are healing correctly.


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