How to Shorten Your Shoulder Scope Recovery Time!

Shoulder - AC sprain 281Today is a true day of “role reversal” for me.  Instead of being the physical therapist, I’ll be the patient rolling into the operating room for surgery to fix a chronic shoulder injury by Jacksonville Jaguars Head Team Physician Dr Kevin Kaplan at Jacksonville Orthopaedic Institute.

I have to admit, consulting others about a shoulder scope is much more fun than being the one starving yourself after midnight and wearing the paper-thin johnnie!  I’ve had my share of surgeries.  I find them all to be great opportunities for me to learn better ways to help athletes recover quicker when they have to “go under the knife”.

The AC Joint Injury

I’ve had a chronic grade 3 acromioclavicular (AC) joint sprain for many years that needs to be fixed.  How did I get it?  Here comes the entertaining part of the blog post.  I crashed hard on my mountain bike doing a downhill slalom race at Mt Snow in Vermont……in March….in blizzard conditions!  No, it truly wasn’t my smartest day, but it sure was a fun event until I slammed on the ice with my shoulder.  As a fan of extreme sports I might not be any smarter today than I was back then but I’ve learned how to crash more gracefully.

Here’s my game plan for a successful shoulder surgery:

Loosen Up the Good Stuff

I started doing extra shoulder, upper back, neck, rotator cuff and chest stretching during the past week.  Those ligaments, joints, muscles, fascia and tendons are the very things that will dictate my shoulder function after the surgery.  Therefore, I want those structures to be limber, strong and relaxed going into the operation.

Get Rid of the Bad Stuff

Inflammation and edema are bad so my shoulder filed a Restraining Order against them just last week.  Meanwhile, I’ve focussed on icing, controlled exercises and massage as key steps to start the recovery process from my  surgery before I even get to the hospital.

Hydrate the Right Way

Healing tissue needs to be happy tissue.  Approximately 60% of the human body is water.  Staying well hydrated starting three days before the surgery will make the doctor’s job easier and my recovery faster.  I take my hydration serious in any type of weather so when it comes to recovering from surgery, water is my best friend.

Tune Up My Rotator Cuff

Resisted rotator cuff exercises such as external rotation, forward flexion and side raises will continue to be done 3 times per day right up to 2 hours before the surgery.  I want “my cuff” to be as active and as strong as possible before Dr Kevin Kaplan sticks that scalpel into my arm.

Listen to Your Commanders

The surgeon and his staff are your commanding officers so listen to them closely.  They know best so read their memos and listen to their tips.  They will ultimately play a huge role in your outcome so be a great patient before, during and after your surgery.  Post-surgery rehabilitation is priceless.

Plan the Recovery

I have my ice, bottled water, pillows, books and, most importantly, my beautiful wife ready before I leave the house today.  Limping in the door with my arm in a sling is not the time to be setting up my recovery zone.

Think & Be Positive

Healing and recovery starts between the ears.  Positive thoughts and self-talk about my shoulder is dominating my mind today and will continue for the next four weeks.  Those healthy images involve much more than just my body and mind.  They include a strong sense of gratitude for Dr. Kaplan and his highly skilled staff involved with my care.

In Closing……

I view my involvement with today’s surgery as an active process, not a passive event left to the skills of others.  I’ve prepared my body, mind and home to both maximize the benefits of the surgery and accelerating my body’s recovery from the trauma of the operation.

I have way too many exciting things I want to do this off-season with this better-than-new shoulder and just laying around isn’t one of them!

 

How To Treat Shoulder Pain Caused By AC Joint Separation

Location of Separated Shoulder Pain

Acromioclavicular joints or AC joints are easily injured and susceptible to secondary issues such as arthritis, laxity and shoulder pain.  Often referred to as a “separated shoulder”, an AC separation takes place when the ligaments that stabilize the collar bone (clavicle) and the shoulder blade (scapula) become damaged.

The acromioclavicular joint is the connection between the lateral end of the clavicle (collar bone) and the lateral end of the scapula (shoulder blade).  This bony section of the scapula is referred to as the acromion. The AC joint creates a stabilizing union between the front and back of the shoulder girdle.  It’s important to note that when healthy this joint has ample mobility, which allows for significant motion of the shoulder.  The AC joint forms an important archway that protects the rotator cuff and shoulder joint below.

Stabilized by a joint capsule, the acromioclavicular joint encompasses the ends of the clavicle and acromion along with several ligaments. Because ligaments attach bones to bones, when the AC joint ligaments, located under the clavicle, are damaged with a separated shoulder they create a downward pull to the clavicle and AC joint.

What Causes a Sprained AC Joint?

Falls are often the cause of separated shoulder injuries.  The AC joint is not overly stable and its location makes it quite vulnerable to injury.

The two most common reasons for injury are:

  1. Landing on the lateral part of the shoulder forcing the shoulder downward.
  2. Landing on an outstretched arm or elbow, which forces the shoulder joint upward in into the undersurface of the acromioclavicular joint.

With either of these, the AC joint capsule is disrupted and the stabilizing ligaments are compromised.  The grade or degree of separation depends upon the level of damage to both the ligaments and capsule.

Grades of Separation

Shoulder Separation, Grade I

A mild disruption of the AC joint capsule resulting in minimal instability of the joint.

Shoulder Separation, Grade II

A moderate disruption of both the AC joint capsule and stabilizing ligaments resulting in moderate instability of the AC joint.  Partial tears of both the AC joint capsule and the stabilizing ligaments are present.  You’ll notice moderate laxity of the AC joint with a visible elevation of the outer clavicle when holding a weighted object with the injured arm at your side. The amount of elevation with a Grade II AC sprain is typically ½ to 1 inch when compared bilaterally.

Shoulder Separation, Grade III

A significant disruption of both the AC joint capsule and stabilizing ligaments resulting in significant instability of the AC joint.  Complete tears of the AC joint capsule and possibly complete tears of at least some of the stabilizing ligaments are present.  There is visible laxity of your acromioclavicular joint with a visible elevation of the outer clavicle with the injured arm resting at the side of your body.  When your arm is reached across your body towards the back of the other shoulder, the abnormal lateral clavicle elevation increases.

AC Sprain Grade IV to VI’s are much more severe and are based on the hyper-mobility of the acromioclavicular joint.

Signs & Symptoms You Have an AC Joint Sprain

  • Pain and localized swelling on the top of the shoulder at the acromioclavicular joint.
  • Swelling and or bruising may be present on the top of the shoulder.
  • An obvious bony lump on the top of the shoulder, which is the end of the displaced collarbone.  The higher the grade of shoulder separation, the larger the elevation of the outer tip of the clavicle.
  • Limited range of motion (ROM) and pain with any lifting of the arm.
  • With a grade II and grade III AC joint sprains, a “clicking” or shifting can be felt in the AC joint with shoulder motion.
  • With active motion (when you move your arm) or passive motion (when someone else moves your arm) of the injured arm horizontally across the body towards the back of the other shoulder, significant AC pain will occur.

Treating a Separated Shoulder

  • Ice the top and front of your shoulder with the elbow flexed to approximately 90 degrees and supported.
  • Using an arm sling is helpful if having pain or clicking with walking.  This helps to support the weight of your arm while restricting motion.
  • Once a fracture is ruled out, early motion is started to reduce stiffness and pain.  No horizontal adduction motion (horizontal movement of the arm across the midline of the body) is allowed until you have full pain-free motion.
  • Easy pendulum swings to help regain motion of the shoulder.
  • A shoulder strengthening program can be started early with a Grade I & II sprain as tolerable.  Starting with rotational motions and progressing with overhead lifts as tolerable.  Continue to avoid horizontal adduction as long as possible.

Questions a Pro Athlete Would Ask To Heal Quickly and Safely

As always, my goal is to help you get back in the game as quickly as possible while ensuring you can return safely.  Ask the following questions—the same ones a smart professional athlete with a Separated Shoulder would ask his sports medicine specialist, so you too can recover quickly and safely:

  1. What grade is my shoulder separation?
  2. Do you think I can manage this AC joint sprain with rehab without needing surgery?
  3. Do I need any special padding, taping or altering of my sports equipment to minimize the chances to reinjuring this acromioclavicular joint?
  4. What specific lifts, activities and motions do I need to avoid to allow my AC joint separation to heal quickly?

Sports Medicine Tips For an AC Joint Separation

  • Little Need for a Knife – AC joint surgeries are not overly common unless the instability is severe or the limitations are complex.
  • Sleep Well? – Don’t plan on sleeping on the injured shoulder for a while.  I severely separated my right AC joint in a winter mountain bike race on a ski slalom course (I know, it’s not the smartest thing that I’ve ever done but it sure was a lot of fun…until I crashed!) in Vermont in 1994 and I still can’t sleep on that side!
  • Posture is a Factor – Any position, any movement or any activity that rounds your shoulders will worsen your pain. It’s that simple.
  • Ice, Motion, Ice – Ice it, move it in pain-free directions and then ice it again.  Simple formula with fast results.
  • Upper Back Squeezes – While sitting or standing tall, relax your arms while you squeeze your shoulder blades (scapula) together while exhaling hard.  Hold for 2 seconds and repeat 10 times.  Do this drill as much as possible to stretch out your chest muscles, strengthen your shoulder stabilizing muscle and, very importantly, decompress your AC joint.