Shoulder Separation: To Operate or Not After Injury?

Acromioclavicular joint dislocation

Hello, Doctor:
I was in a car accident a week ago, resulting in an injury to my right arm.
Besides a closed fracture of the rib, I feel that I am gradually recovering.
An X-ray examination showed that the normal left clavicle is approximately 0.7 cm away from the coracoid process, while the right clavicle is about 1.5 cm away.
There is a slight upward displacement at the end of the clavicle, and it appears somewhat prominent, although the sensation is not very pronounced.
I experienced tenderness for the first five days.
The first hospital diagnosed it as a Type II injury, suggesting that it might be a ligament strain.
They mentioned that surgery could be performed or not, but recommended surgery to use a locking plate and fixation wire to bring the clavicle closer for proper alignment while allowing the ligament to heal on its own, which would reduce future complications.
They immediately scheduled a surgery date for me.

I then went to a second hospital for a diagnosis, where another physician assessed it as possibly a Type III injury but leaned towards not requiring surgical intervention, suggesting that treatment could be deferred until any potential complications arise in the future.

A week later, the tenderness in my shoulder has almost disappeared, and I have been able to move and raise my arm freely since the injury, without any significant discomfort.
I would like to ask:
1.
Is there really a necessity for surgery in this situation? I feel scared and uncertain, and I believe that if there is no functional impairment or confirmed necessity, surgery should be avoided.

2.
If I do not undergo surgery, is there a significant chance of developing long-term complications? For example: soreness, weakness, or inability to lift heavy objects.

3.
Can I use a figure-eight brace or arm sling for support and recovery? How long should I rest before returning to work? I work in the food service industry, which involves lifting various weights.

Thank you for your clarification.

Mr. Chen, 40~49 year old female. Ask Date: 2016/08/28

Dr. Shi Guozheng reply Orthopedics

Continuing rehabilitation is important; both surgical and non-surgical options have their advantages and disadvantages.
You should be able to return to work in about four to six weeks, as long as there is no pain in the shoulder joint.

Reply Date: 2016/08/28

More Info

Understanding whether to operate on a shoulder separation after an injury can be a complex decision, particularly when considering the potential for long-term complications and the current state of recovery. Based on your description of the injury and the differing opinions from two medical professionals, let's break down the considerations involved.

1. Is Surgery Necessary?
In your case, the first physician diagnosed a Type II shoulder separation, which typically involves a partial tear of the ligaments that stabilize the acromioclavicular (AC) joint. Surgery is often recommended for Type II injuries if there is significant displacement or if the patient is experiencing persistent pain and functional limitations. The second physician suggested that your injury might be a Type III separation, which involves complete tearing of the ligaments and significant displacement of the clavicle. In such cases, surgery is often considered, especially if the patient is active or has a physically demanding job.

However, since you report that your pain has significantly decreased and you can move your arm freely without discomfort, it may indicate that your body is healing well. If there are no functional limitations and you are not experiencing pain during daily activities, you might be able to avoid surgery. It’s essential to weigh the risks and benefits of surgery versus conservative management, particularly if you feel confident in your recovery.

2. Risks of Non-Surgical Treatment
Choosing not to undergo surgery can lead to potential long-term complications, such as chronic pain, weakness, or instability in the shoulder. Some patients may experience ongoing discomfort or difficulty lifting heavy objects, which could affect your work in the restaurant industry. However, many individuals with Type II or even Type III separations can manage their symptoms effectively with physical therapy and rehabilitation, especially if they are not experiencing significant functional impairment.

It’s crucial to monitor your symptoms closely. If you notice any increase in pain, swelling, or instability, it would be wise to revisit the decision regarding surgery.

3. Use of Supportive Devices
Using a supportive device like a sling or a figure-eight brace can be beneficial in the early stages of recovery. These devices help immobilize the shoulder, allowing the ligaments to heal and reducing the risk of further injury. The duration of sling use can vary, but generally, it is recommended to use it for a few weeks, especially during activities that may strain the shoulder.
As for returning to work, it largely depends on your comfort level and the physical demands of your job. If your role involves lifting and carrying, you may need to allow for a longer recovery period before resuming full duties. Gradually reintroducing activities and monitoring how your shoulder responds can help you determine when you are ready to return to work fully.

Conclusion
In summary, the decision to operate on a shoulder separation should be based on the severity of the injury, your current symptoms, and your functional needs. If you are experiencing minimal pain and can perform daily activities without discomfort, conservative management may be appropriate. However, if you have concerns about long-term function or if symptoms worsen, seeking further evaluation or considering surgical options may be warranted. Always consult with your healthcare provider to make the best decision for your specific situation.

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