3 Degrees of Separation

[No Brainer]

Hello,
about 3-4 years ago I suffered a fall and injured my right shoulder. My Dr. told me that it was a 3rd degree seperation. My Clavical bulges up. He explained to me that surgery on this injury often causes more problems than it solves.. and unless I was a professional baseball pitcher I should pass on surgury. He sent me to Physical Rehab. I did that for a period then basically stopped and went on with my life.
To this day it is very hard for me to sleep on my right side (I'm a side sleeper) very long before the pain makes me reposition. There is a day to day underlying pain (low-grade) that I live with always. And if I really use my arm hard (tennis - sailing etc.) It hurts pretty well for a few days. Pain is my issue.
I have a new GP who said that a cortizone shot might help with the pain... but I'd like to know your thoughts also before I get anything done.
Do I just need to stop crying and suck it up or is there anything that can be done to ease my pain?
~Scott

[mtomaino]

Scott:
If this is truly a Grade 3 AC separation, cortisone probably won't help, but it's certainly possible that you have an associated unrelated problem---such as bursitis---that might respond. As with many diagnoses that have historically been challenging to address surgically (like AC separations), with time surgical advances develop.

For your third degree separation, there are newer techniques that may help, so a decision regarding treatment really relies on an analysis of your current function and level of pain, and what the likely result of surgery will be. Then you can make an informed decision.

Nowadays the most effective solution continues to be a so-called "anatomic" reconstruction of the injured conoid and trapezoid ligaments between the clavicle and the coracoid process. Tendon graft is used.

Happy to see you for an evaluation.

[mtomaino]

I apologize for the delay in my response. I have attached the xray you showed me, which is a grade 3 injury. My recommendation, in general, is to give this type of injury at least 3 months-- as it may get better. Long-term, reconstructions have been unsuccessful in "holding the clavicle" in a completely corrected position. So---the indication for surgery is NOT correction of the "bump/deformity" but Pain Relief. I have tried the various arthroscopic techniques and have gone back to an open coracoclavicular type reconstruction as described bt Mazzoca using tendon allograft and biotenodesis screws. But, I think there is very little downside to seeing how it goes and holding off on surgery for a few months. If PT and rest do not result in a satisfactory return of function, your surgical outcome, if surgery is elected, will not be compromised due to the delay.