T Nation

Distal Clavicle Osteolysis - Resection


#1

Hello Tnation, I'm a long time prowler, new poster :slight_smile: I searched this topic and found a few threads on it, but I wanted to share my experience with you all, and anyone who might think they have it.

First off, I'm 23 years old, almost 24. Been lifting since I was 16, but seriously lifting for about 3 years, maybe 4. About two years ago, I starting noticing a sharp pain in my left shoulder when I bench pressed.

Since I had never had any previous injuries, I thought it was overtraining and cooled it on bench for a couple of weeks. I resumed full throttle, noticed the pain immediately, and from there it only got worse. I then started noticing it in dips, which I ended up fully removing from my routine, all variations of bench/flys (even DB supinated), front lateral raises, then finally in shoulder press (all forms).

The first year I noticed the symptoms, I worked through it like any bull headed 20something year old (with the help of cortisone shots). My doc said if I cut out the lifts that made it hurt, I'd heal up and be fine, but seriously? Cut out all chest and shoulder work forever? When your major is Kinesiology, and athletic training is your goal, you don't want to give up your own physical goals, especially when your self identity is in weightlifting and you enjoy anything that relates to it! I enjoy just READING about routines, I'd rather do that then watch tv :slight_smile:

Recently, about 4 months ago is when my shoulder started to hurt from shoulder pressing. At one time, I prided myself in my heavy bench (heavy to me, 315). Since I had removed heavy bench for months from my routine, I've had to switch to heavy military press. When I was at my heaviest, I was 260lbs and was able to get 1 strict mil press @225lbs. I could also rep the 120s. I was really proud, and that's exactly when it caught up to me! The pain presented itself in a whole new light, and was quick to reach the 8-9 on a 1-10 scale. I went to see my ortho and he said its time to opt for surgery.

Ok, for those who want to know if you have Osteolysis, the pain is present when doing any chest work, main flat/incline, flies, dips. The pain is located on the front of the shoulder (AC joint to be exact). Here is a link with all the details:

http://www.wosm.com/index.php/orthopaedic-services-/shoulder/141-distal-clavicular-osteolysis

NOTE: That site, as well as others, are misleading. Some state you can return to overhead activities within 4-6 weeks. This is false! Also, full ROM will return in 1 week - FALSE. I've spoken to 2 ortho surgeons, both told me I can expect to return to LIGHT overhead activities withing 3 months! Very different. Also, I've had 2 P/Ts and they both told me the same, 3 months.

I had my surgery on June 6th, pain wasn't that bad. They gave me hydros, I basically slept the whole first week. They shaved off 5mm of my clavicle, cleaned up my bursitis that I had from it (loud popping, pain etc.), shaved the end of my acromion, and removed 2 bone spurs. Can you believe that? 2 bone spurs and bursitis all from this stupid osteolysis!

Week 2 I was introduced to PT, basic ROM exercises. Last week, more advanced ROM exercises, less and less pain. I would say I'm at 30% ROM, and my PT says I'm right on track. My current PT told me he has literally hundreds of patients with my surgery a year, seeing as how this problem is growing at a crazy pace, so that whole 100% rom in the first week is bulllll!

The past 2 weeks I've been doing legs basically every other day, really showing them some love, and doing around 2-3 hours of cardio a day to cut, while keeping my protein intake as high as I can. Today will be my first day back doing light arms :smiley: I haven't been okay'd by my PT, but I'll be taking it extremely easy. If the pain shoots up with the 15 lbers, I'm calling it, but I really don't think that'll happen.

At first, I was super freaked out about getting the surgery, but now that I had it, I really look forward to the future. Painless shoulder and chest work? Sign me up!

NOTE: My surgeon said only about 10% of his patients see this in the other shoulder, requiring another surgery. Since I'm a weightlifter, who focuses on strength rather than hypertrophy, I'd say my % chance is a little higher... Seeing as how I already have bursitis in my other shoulder now. I've thought about switching to hypertrophy only in bench/shoulder work, we'll see :stuck_out_tongue:

Also, this surgery didn't leave any visible oddities such as a drooping shoulder or anything, other than 4 soon to be small scars from the orthoscopes.

Ask questions, comments, etc., like I said, the main point of this thread is to share my experience and eventually my full recovery :slight_smile:


#2

Update: Yesterday, June 17th I hit bis and tris for the first time since before the 6th. I was able to do all of my previous curl variations fine with my old weight, but the triceps press downs were limited. The pain was pretty bad once I got to about 65lb for the rope press downs, and 30 for the single arm underhand press downs, and I noticed swelling where the AC joint once was.

The pain however was no worse than the pain I'm in at the PT twice a week, and the pain was gone by the time I drove home. This just shows how fast of a recovery this surgery is! If you're diagnosed with this problem, non surgery isn't much of an option since the pain will creep back no matter what if you lift weights.

For us gym rats, who can't imagine a life without moving big things of iron 7 days a week, surgery is the only option... Sure, 3 months off of chest/shoulders, but that's absolutely worth it over not being able to do those lifts at all, and trust me, with the pain from osteolysis, you can't "work through it" once it advances to a point. In fact, the surgery was WAY less pain than when that pain was at its most.


#3

Update: 17 days out of surgery, full ROM back, able to do light bench press and lateral raises! My PT told me I'm recovering faster than anyone he's ever had recover from this surgery. He had told me no weights for 4-6 weeks other than legs... I think I'm healing so quickly from actually hitting the weights.

I'm not being a moron about it though, I'm just taking what they tell me to do at PT and doing it heavier and for more reps at the gym. They had me doing rows, triceps extensions + pressdowns, biceps curls, lateral raises, bench press, and some rotator-cuff exercises, so I've been doing these all, just... Heavier and more sets - less and less pain daily, thus I must not be impeding my recovery.

This is just amazing since I was told 3 months at LEAST before I could hit chest or shoulders again, and I'm 2.5 weeks out from surgery! My PT told me Fri that I should be 2 months out according to my lightning fast recovery. He also said me doing 1-2 hours of cardio a day is helping the healing as well.

Ok, more to come!!


#4

I mean you have already went through with the surgery so its too late to recommend this now but did you ever look into using peptides to heal your joint. I am mainly talking about GHRP-6, GHRP-2, and CJC 1295. They would help speed up your recovery and I am currently going through physical therapy for Distal Clavicle Osteolysis and it seems to be improving.

Also easy on the weights if he is telling you to wait you should probably wait. It may feel great now but you could end up fucking yourself in the long run. Just be careful and make the surgery worth it instead making yourself need another one. Wish you the best and hope you can go at it hard soon.


#5

Yeah, I went through everything first, peptides didn't help by the time I tried them. My acromiun and clavicle were just too close and both were hooked, P/T wasn't helping either. The only thing that helped was cortisone shots, which my last round of them was what did it in for my shoulder... Since I could lift heavy again I pushed it too hard and had a stage 2 a/c joint separation LOL. My clavicle shifted up and is now visible when I pull my arm back behind me or flex my traps, and is my main cause of pain now. My bone may still be healing though, which could be the reason.

I really don't mean offense, but I must disagree with you saying to avoid weightlifting. I've recently spoken with my surgeon in a post op visit, and he was astounded with my progress. He attributed my quick healing to weightlifting! He was the Colt's surgeon for 4 years and has helped pro athletes get back to their top game, and he told me its always because he's prescribed weightlifting as soon as they're able to after surgery. Also, after this whole thing - physical therapists aren't exactly always right. They are a great blessing for the elderly and those who haven't lifted all their life, but for those of us who have, I honestly think they're almost detrimental to the quickest and most efficient recovery possible. Our bodies are trained to rebuild and adapt to stress, and when your p/t tells you to bench the 7 lb DBs in month 2 of recovery, that's not enough stress. Him telling me to avoid all shoulder work is also no good, I was doing lateral, front, bent over, side raises all along without him knowing, and from his own mouth, I've recovered quicker than any of his patients with this surgery.

As of today, I'm roughly 2 months post surgery, and I was able to shoulder press the 100s for 4 reps after doing extremely high reps with the 60s and 80s (40,20). Today was the first day I've tried shoulder press, and I was just shocked... Very happy to say the least :slightly_smiling: After doing those seated, I did standing military press with just 135 for 2 sets of 20, with minimal pain. Looks like I can have a full shoulder day again!! It only hurt for about 30 min after I left, no pain right now. Also, T11 - don't be afraid of this surgery/recovery... It's a very viable option if the peptides and p/t don't work out. I'm extremely pleased with my surgery and recovery time :slightly_smiling: Also, my bill in total was $8k, which my insurance only paid for half, but rotator cuff surgeries can get to over $50k, so I'm pretty happy with the end cost.

Anyway, just an update. In short: Going into month 3 post op and able to return to all my previous exercises. I still can't bench heavy, but I'm positive I could shoulder press my old weight (240) if I hadn't pre-fatigued with high rep work...

Just for any out there who are freaking out about this problem, just know: 2-3 months isn't a long time to be able to lift without a horrible pain ever again! :slightly_smiling:


#6

Awesome insight and yeah I'm going to talk to orthopedic tomorrow and hoping I can get the surgery as soon as possible. Being in the Army the surgery would be paid for but Army medical care takes forever. They are trying to recommend 4 months of physical therapy(I've done 1 so far) then op for surgery when I'm already 5 months post injury so I feel like time is being wasted by not going with it. I'm at the point of its not healing anymore and I'm sure you know that feeling of not being able to do some of your favorite exercises due to your shoulder screaming in pain. Being a competitive powerlifter and not being able to bench is driving me crazy. I can only hope I can get some better news tomorrow.


#7

Did you have a tight Trap as well as pain in your AC joint?


#8

Sorry for the late reply, yes my trap was constantly sore. And yes, my AC joint was the main source of pain, and after the surgery it'll be much less. For me, it moved to the tip of my clavicle.

This is also an update, my right shoulder has now fully developed symptoms of osteolysis. I go in to my surgeon Wed the 28th, I'll be setting up the surgery ASAP.

The way I see it is why continue doing all this hard work when you'll eventually need a surgery anyway and lose 20-30% of that hard earned mass?! Nip it in the butt asap to get back into the gym asap to rebuild that mass asap!

My left arm still hasn't fully regained its old mass, its about 10-15% smaller than my right.

My advice bro: get this surgery asap. My strength is already back to my old weight, its just a matter of mass loss, which typically isn't a huge deal to powerlifters, but to me... It sucks, though like I said, its almost back to the same. Only I can tell too, so its not that bad.


#9

Yeah I can certainly understand though. They don't want to give me the surgery though because I'm getting out of the Army in October so they are pretty much fucking me. I guess 4 years in and a tour to Afghanistan isn't good enough for me to deserve surgery which is another reason I'm getting out and would suggest for many people to join. My left arm is definitely smaller than my right now. My best hope now is to get out as fast as possible get on my mom's healthcare(obamacare does help with somethings) and get this surgery so I can get back at it. I mean I'm 5'3 166lbs right now so mass means something to me. I wanna look good but I would rather be strong and look like I work out then be huge and put up decent weight. I hopefully will be able to do both one day.

That sucks about your right arm hopefully you can get fixed quickly and be able to get at it hard again.


#10

Wow, I'm absolutely appalled at our military's rigidity... I'm extremely sorry to hear that they won't help one of the nation's heroes, that's just disgusting...

Well at least you have a game plan, thank goodness for your mom's healthcare! I'm on my school's insurance, only pays for half... In the end I'll owe something like $10k for both, and that's IF my insurance okays this second surgery since its technically an elective surgery.

Everything about this sucks man, and I'm sorry you gotta go through this too - but just keep your eye on the end game, 3 months after your surgery it'll be like new! :slight_smile:


#11

Within a few days subsequent to discharge from the Army I would go and file a claim with the VA. This action is very important for your long-term success from any and all injuries incurred while in the military service. Having done a tour in the sand box will definitely work in your favor. The VA has a contract with Humana to oversee a program (called the "HERO's" Program; and I am 66 y/o combat veteran and still receive external private specialists when I am not satisfied with the looks/attitude/reputation of the in-house professional medical staff) where private specialty physicians (ie sports medicine) are utilized for services to the veteran when the VAMC nearest you does not have a physician qualified both personally/professionally to perform the service. It is for your long-term "quality of life" this recommendation is made so do not shy away from those available benefits.


#12

Yeah I have an appointment with Orthopedics on Tuesday and I'm going to get them to fill out part of my VA claim form now. The sad thing is I have a memorandum now that says I need the surgery but they will not perform it on me since I have less than 6 months left. Its getting sticky claiming things like PTSD now because certain states are trying to say you can't own a weapon if you have PTSD which really sucks for a combat arms guy like myself. I wish it would be a better situation and its messed up that they won't help a person out and it took them 6 months to finally give me a proper diagnose when I was telling them it was this the whole time. I'm beyond pissed off with the Army right now.


#13

Yeah I'm hoping man because not working out is driving me crazy. Its my medicine for the day and without it I just don't feel right. I think her's should cover it all or most of it but I will have to wait and see.


#14

Understood about the hurdles some states are presenting when a veteran of the military/LEO/Fireman has PTSD. Don't let the rumor mill b/s get to you as it is false. I got major PTSD and a 45% GAF and still have a CWP thus carry 24/7 while taking heavy psyche meds. LEO's and Firemen, at least those who are on the street and are presented with consistent life-threatening decisions/situations walk the walk of a military combat veteran and have PTSD on the same level. A judge has to declare you mentally incompetent to not be allowed to carry plus no driving license, no hunting license, no nothing, etc. Contact me via PM to continue discussion as things can get deep. And as I do, talk with and become friends with the LEOs and Firemen at your gym, and you will find out their thought/reaction pattern is comparable to yours.


#15

So somehow I had a Major put his foot down for me and have my surgery scheduled for the 4th. I really don't know how this worked out but I'm excited for all this. I have my pre-opp for surgery tomorrow and can't wait to get this ball rolling. If you could give me a guide of what you did in the gym to get you healed so quickly I would really appreciate it.


#16

That's awesome man, I'm super glad you're taken care of! Sorry for the late reply as usual, so you've had the surgery I take it, 4 days ago. How was it?

I did legs for a while, always wearing my shoulder sling, so it put me at the smith press, leg press and leg extensions, as well as calf raises wherever.

Only took like 1.5 maybe 2 weeks, can't remember to start arms again. Just stuck with curls, super close in, and leaning a little forward to be as gentle as possible, and triceps I did rope press downs and single arm underhanded/overhanded pressdowns. I did all workouts with light weight, starting off with like the 15s to just see how it went. Worked up to about the 40s for curls and up the 60 for pressdowns, 15 for single arm. I'll say this, pressdowns started to hurt... Also, do external/internal rotator cuff exercises and cable rows - lots. Also, stretching it is so freakin important. Even today when I wake up its very stiff and doesn't want to move, I have a shelf in my bathroom above the toilet and every morning when I take a leak I stretch it up and just rest it there...

I'm not sure if you're doing pt, but its not worth it unless its totally free. All they have you do is stretch it, then eventually curls, tri pressdowns, cable rows, supinated bench press (way later), lateral front raises and over head press (last to be done). Though they make you do it with like 6lb dbs... when at the gym you'll be able to get to your old weight for most of those movements in a few weeks (except shoulder press and bench press). I'll be honest, I'm still not at my old weight for bench, its still pretty painful past 100s, same with soulder press, though shoulder press heals quicker it seems.

Basically do what you're able to. Back big time, all pull movements don't hurt at all once you have enough ROM.

I took off 3 weeks from work so I had all day to work out, which is exactly what I did. I'd hit legs and cardio in the day, then arms or back in the evening, every day. I was training everything 3-4x a week. This, in my opinion, is what helped me heal so fast - super high volume. High weight will be manageable, but it'll hurt still... Also, don't try overhead press for at least 5 weeks, I didn't start that until 6 weeks after I think. Bench should be last also, like month 2 - still hurts doing pushups once I'm past about 15, though it becomes less painful by the week, same with bench and OH press.

Also, I'm only able to do bench with supinated DBs pressing against each other... Sounds weird, but it takes 90% of the pain away. I can do wide bench, just with very little weight. Also, since I started this super close grip style, I also take them down to my belly button vs my nipples, my chest has exploded, and this is from light - moderate weight, just sets of 40. I'll do 4 sets of 40 with 30s,35s,40s,40s then bump up to what I feel like I can manage for 2 or 3 heavy sets or like 8. High volume, like I said before is what I think helped heal so fast - weight doesn't matter! Plus, such high reps after lifting super heavy all my life (1-4 reps/set), I've seen some great mass gain, which is crazy because I've been dieting and eating waaaay less than before, 2.3-2.5k cals a day vs 3-4k. Could be because my body just wasn't used to it, but its still working. I recently swapped back to heavier sets of 6-8, and am happy to report my strength is pretty much still there, just painful when pushing after a few reps. Pain goes away after 20 min though, and like I said, it gets less and less weekly, and I can push more weight with less pain at a pretty constant pace.

TL;DR
High volume, 4-6 sets of 30-40 reps for pretty much everything you can. Don't be afraid to load 365lbs for deadlifts in week 2 - you'll be able to pull your old dl just fine. Like I said, back work and triceps work early on will greatly speed the healing process. Don't freak when your pt tells you to do bench press with no weight and you can't - that pain will leave, and you'll be back to pressing fairly quickly. Same for overhead pressing - high reps will make you feel like a wimp, but you gotta do what you gotta do. When you're back to pushing 240lbs overhead in 2 months, with slight tenderness (but no excrutiating pain like before) you'll be happy you got the surgery and looked like a wimp shoulder pressing the 30s for 40 reps!!!


#17

Thanks man, Yeah I went to my first physical therapy appointment today(its free) and she told me everything is looking great so far. I don't have my ROM back yet which she gave me different exercises to do.

She usually has people come back within the first week to see how they are doing but she said I'm doing far better than the usual patient so I am going back to her the 19th where I should be close to full ROM. I can tell my left delt is so much smaller than my right now. It hurts my pride a little bit but I'm going to have to work alot with dumbells to even this out eventually.

I have that and some bruising which I'm told is normal. Yeah, I think I will start hitting legs in a few days after the drugs wear off. My sleep schedule is still pretty messed up.

I can't believe I managed to get it so soon after I went to my follow up at orthopedics. The surgeon and the Major who saw me fixed my paperwork so it was classified as medically needed but not emergency, instead of elective. He asked me how does the 4th sound? I was in shock because the week before I got a memorandum saying

No we will not give the surgery you need because of ETS date is in November. I said sounds great to him, I got all the paperwork and everything went smooth after that. I was originally supposed to get 14 days of convalescent leave but after the surgery the Surgeon recommended 30 so thats what I got.

So now I'm just chilling doing what I can do to get this injury better and relaxing. I don't have to go back to work until October 7th so its going to be a nice break.


#18

Very nice to hear, ya 30 days will be perfect. You won't (or at least, I wasn't) be able to do push-ups by then though! I know boot camp is push-up heavy, but no clue about afterwards lol.

Great man, keep us up to date! You'll see massive improvements every week for the first month, but after that it'll start to slow down. Today I hit chest and wow, my shoulder hurt so bad, struggled with the 80s, when just last week I put up the 110s without nearly as much pain. The pain was very bad, shocked me. I haven't had pain like that in weeks - I think its because I didn't warm up enough, but if its not... Gotta slow down. Its so hard to slow down though. Oh, my mid tier of the delt is still very swollen, and that's where the pain was - I guess thats where the AC joint is located, kinda under it...

Strangely enough, I've noticed it hurts constantly on days when it rains...

My right shoulder surgery is the 26th of this month, very excited to get past this. It sucks bad right now because I had a type 2 AC joint separation in my left shoulder before surgery, so now my clavicle comes out a little and the tendons are stretched over it... My right one won't have as much pain luckily.


#19

I will be on a profile so I won't have to worry about push ups or wearing gear. I will probably be on it until I get out in November. I didn't push my left arm too hard so I just had the distal clavicle osteolysis. I hope it heals quickly which I'm going to do everything in my power to get it back lifting again. I figure once I can hold a push up position without it hurting I will start doing some yoga. I will make sure to keep you up to date. Good luck on the second surgery hopefully everything goes well.


#20

So I am at about 6 weeks and it is slowly improving. I can do light work on biceps and back but a problem I'm still seeing is my trap is tight. My physical therapist says its from an imbalance in my shoulder and my shoulder mechanics are still off. I am doing exercises to try to help that now but it sucks not being able to get back into it yet. Time will tell if everything works out but for now they said everything is normal and I'm on track.