T Nation

AC Joint: Surgery or No Surgery?


#1

Been dealing with pain in my AC Joint for about 8 months. Was doing some DB Flys and felt the pain in my rt shoulder. Have had 1 steriod shot in the joint that resolved the issue for a couple months. Now its back and very painful for any sort of pressing movements. I have full range of motion and strength in the shoulder - according to my physical therapist - only hurts in the AC joint/collar bone if I try to press. The othropedic surgeon is suggesting surgery to cut off the distal end of my clavicle to give more space in the joint.

I read Eric Cressey's "shoulder savers" and am I wondering if others have followed his advice and been able to avoid surgery for an AC Joint issue?


#2

I can only talk of my experience when I felt mine go during a set of floor presses. It was a nagging pain right on the AC joint itself and put an end to all pressing activity.

I tried ART and I believe it helped, although it seemed to return after therapy sessions. In the end resting it as much as possible and training around it worked - but it took the best part of 10 months to get to that position.

I would encourage trying some sort of myofascial release, such as ART, particularly on the posterior shoulder capsule, as this does help to return the shoulder to its natural position and allow healing, before opting for any surgery.

I believe my shoulder problem may have been triggered by tightness in that area, and it did respond well to the ART, although realistically it took an additional rest period of around 4 months following ART until it was healed enough to start seriously loading the shoulder again.


#3

Thanks for your reply James. When you say "training around it" what could you do? I find that I can do anything but pressing motions - so chest day is out, even pushups are killer in the AC joint. Curls and Tri kickbacks with lower weight are doable and ofcourse any lower body and cardio are fair game.


#4

Stop pressing for the time being you are just aggravating it further. I did Cressey's "Shoulder Saver" series and it does help. You will find that you can rehab it back to a point where it is pain free, at least I was able to. Ibuprofen and ice are your friends. You need to get the swelling out of the joint or your impingement will continue. I also took fish oil which seemed to help. Focus on strengthening your scapular muscles and upper back. This helps with posture issues that you may have which would add to your impingement issues in the shoulder.

I had to cut out pressing movements completely in order to stay pain free. If I incorporated pressing movements back into my training and attempted to progressively increase the weight I eventually would re-aggravate the injury and have to start all over.

I did get Cortisone shots and they did help with the pain. I found they would eventually wear off and that the more Cortisone shots that I got the quicker it would wear off as well. Looking back I think in some ways they may have set me back because they would mask the pain and I would train with the shoulder when it was still injured.

I repeated this pattern for almost four years. In the end I ended up getting the surgery. About two years ago I had a distal clavicle resection, a sub acromion decompression, and my labrum needed to be cleaned up due to fraying from the impingement. I rehabbed religiously after the surgery and within a year I was pressing pain free and making gains.


#5

Thanks for the post. I'm giving rehab with my PT a chance and will see where I am in 6 weeks.


#6

A little late to the party, but I commend you on your decision. Surgery should be the VERY LAST OPTION.

Also, my guess is that you: 1) press too much; 2) press with lousy form, too much weight, or both. It's in your best interest to make a life-long commitment to resolving these issues. And I say life-long because even as people get stronger they are never immune to the occasional act or two of horrific stupidity.

And finally, take many of the articles on this site with a grain of salt. Many of the authors imply or flat out state that if you don't perform certain lifts, you're less of a man. Well, ask yourself this: where will these authors be if/when you blow something out...?


#7

I've had surgery on both shoulders by a well known shoulder specialist here in OZ.
I can tell you now, I wish I never had it, For a start the pain is still there (although not as bad)
I am forever getting pins and needles down my arms and now and again my shoulder joints spasm.
I found before the surgery that if I lifted (pressed) heavy the pain actually subsided for a few hours?
So for me I should have put up with the pain and toughen'd up.


#8

Sorry for late response.

Basically pressing movements were out, so were things like squats due to the obvious impact on the shoulder area. Pulling was fine, even some pull-ups if I avoided lock-out.