Post-Op experience - Weaver Dunn - (AC III)

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Topic Title: Post-Op experience - Weaver Dunn - (AC III)
Created On: 08/31/2007 11:25 PM

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 05/21/2012 01:38 PM

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JackRussell

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Alan - Jack here.
Sorry for the delay. I don't check in on this site as often as I should.
Yes, I had a level 3 separation. It took a few months for the shoulder to feel better after I first injured it. I did a lot of weight training and just forced it to be "good". What really bothered me, and bothered me after the operation, was that not having the torn ligaments to support the scapula through the balance of the muscles in my back off, which caused some discomfort.
I had the operation because I was unable to throw overhand or swim the crawl (well).
In mid-Sept '11 I had a "modified" version of the Weaver Dunn. Now pay close attention. This was a new and improved version of the Weaver Dunn. Rather than snipping and rerouting ligaments in my shoulder, a donor tendon (probably hamstring) was looped from the scapula thru the clavicle and then back to the scapula - So it is doubled up. Some heavy (probably like nylon) sutures are in place to help support the tendon while it vascularizes/heals. This will take as much as a year. 10 cm's were removed from the end of the clavicle so that it does not bump into what it used to be connected to.
The downside I have found with this operation is that the original ligaments that ran back from the clavicle to the scapula were not replaced. Only the connection at the end of the scapula was replaced. The downside of this being that the scapula now chicken wings out in the back which allows the end of the shoulder to roll forward. This puts odd strains of the upper back muscles. Those strains have lessened over the past few months and it’s mostly an aesthetic problem now.
I now can throw overhand and swim. Though at 8 months out from surgery I still baby it when I throw because I think that throwing is a violent movement. I lift weights at will now, slowly having increased the weight to about 75% what it was pre-injury. By mid-June I plan to be pushing it 100% on the weights. I am laying off exercises where there is any jolting, like where I catch myself on my hands, but that will be changing soon.
For those in the US I had the operation done in Boston by Dr Laura Katz accompanied by Dr Guess (first name escapes me). I Chose them because they have a proven track record.
That's about it.
It looks better, feels better, performs better. Still got a ways to go but glad I got the operations.
Just make sure you get a Dr with a stellar track record. Don't settle.





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 04/28/2012 07:58 AM

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ardirom

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Hey all,

I suffered a grade 3 AC dislocation early this year while snowboarding in switzerland and the time has now come for me to have the Weaver Dunn procedure.

I'm looking for any advice from you guys on my rehab. What will help out? Would should I buy before hand to help me out later on?

And what is this special pillow that keeps getting mentioned?

I'm from Scotland, so don't know what the NHS will provide me with after the op.....

I have to be honest, I am fed up with my shoulder and glad that the op is getting close now (12th May) but i am also very aprehensive about the limitations and timescales for recovery. I'm desperate to get back to sport and the gym ASAP.

Any help would be appreciated.

Cheers,

Alan

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 03/12/2012 10:46 PM

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chancewilding

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Hey Jack,
I'm interested to know what your experience with your shoulder was like between February and September. I'll assume it was a level 3 separation, given the topic title, but i don't think you explicitly say it was. What exactly prompted you to get the surgery? Pain? Aesthetics?

It seems as though I'm in a similar position. I got a level 3 AC separation nearly a year after a level 1 separation (downhill mountain biking) on the same shoulder. My doctor recommended I wait a bit and see how things turn out. So I did. It ached at night constantly, even after a few months, so we tried a cortisone shot. No difference. Now I'm trying to decide if I should opt for the WD procedure.

My shoulder hangs a considerable distance below the other and I must be in a constant shoulder "flex" to keep it in its original position. When I sleep on either sid of my body, because of a mixture of muscle relation and the large amount of play that is in my shoulder, my shoulder will slide way down and forward causeing my clavicle to protrude a great distance, leaving my in much discomfort; I can only sleep on my back now. Constantly I have to tense my shoulder muscles to keep my arm from hanging down when standing or sitting upright.

Since the second separation, I've been to rehab, learned strengthening excercises, and come back to almost full strenth. There are certain exercises that I cannot do, like dips and some presses, but others i feel relatively strong. The problem with my shouler isn't the strength, but the stability. It shifts up and down, forward and backward quite a lot and it is uncomfortable. I was wondering if you experienced something similar to what I've described, and then decided to go ahead witht the surgery, or if it was something else. The way my shoulder looks is the furthest thing from my mind. What I'd like to change is the "hanging" feeling I'm constantly faced with and the dull, nearly non-existent throbbing pain that comes with it. Any insight as to why you ended up getting the surgery would be much appreciated.
thanks,
Chance

P.S. Also, how is the shoulder doing now? Your last post was a few months ago, I'm eager to hear progress.


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 01/01/2012 09:57 PM

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JackRussell

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1/1/2012 - 100 days post surgery - Modified Weaver Dunn. - At 90 days I was finally given the green light to do some jogging. I have been keeping it to less than 2 miles. Absolutely no resistance training is allowed, though I am using the arm of that shoulder quite extensively to carry everything from gracereries to luggage. Mobility is limited, though I have begun home PT. I can reach across my chest with my right hand and grasp my left shoulder. I can reach my right hand up my back in a direction of a "hammer lock" position only about 6 inches above the belt line - as oppose to reaching up and touching my back between the shoulder blades. I can reach across my waste with my right hand and get change from my left pant pocket. I can reach my right hand across the top of my head and cover my left ear, even though my head is slightly tilted right. If I lie on my back and interlock my hands behind my head I strain to touch my right elbow to the floor. I will continue to stretch in these directions and at some point I hope I can begin weight trainnig. My right shoulder blade is flexed outward for which I perform several sets of isometrics pulling it in while pulling back my shoulder and holding the position for a minute.
My surgery involved looping a doner hamstring tendon up through a hole in the corticoid process to and thru the collar bone and then back down thru the collar bone and back thry the process in a U shape loop. Now its a matter of several months while blood vessles grow into the area which will strengthen it.
There has been near no pain for the past 100 days, except when I stretch it - but some discomfort when trying to sleep on my right shoulder. I think it will take another 3 months before I'm can start pushing it a little. I expect to start light weights any day now. Really looking forward to it.
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 09/27/2011 02:49 PM

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JackRussell

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A different message: I separated my shoulder in Feb, 11. I live not too far from Boston. Boston arguably has some of the top Doc's in the country. I sought out the top 2 orthopedic surgeons (specializing in shoulders - and sports medicine specialists). They are out of two different organizations. Both doctors said it is best to wait before doing surgery. This advice is different than most of what is posted here of what doctors have suggested. I was told that many people suffer shoulder separations in resort type areas such as Boulder. The doctors there will advise surgery now because many of their patients are out of towners and will otherwise be getting the surgery done elsewhere. It is best to wait because the shoulder is traumtized/swollen which increase both the risk of infection and risk of a poor outcome. I was told to give it six months to heal and if I did not like it to come back and they will do the operation. I am now six days post surgery and so far so good, but knowing I still have a long road ahead. I will post an update(s) sometime in the future - but I might wait a few months so the post has something of substance. - So far I have stuck to the plan I was given. I keep the arm in the sling, and take it out only to put my sirt on, take a shower and do my PT which consists of bending at the waiste, hanging my arm and doing small pendulum circles. Out of surgery to today I have ised it several times a day while taking ibuprofen to reduce inflamation (there has been almost no pain). As of today I stopped the ibuprofen.
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 09/27/2011 02:35 PM

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JackRussell

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Hey "The Hoffer", you started thispost back in '07 and said you would post updates to your progress but you stopped before even completing the first month. It's been 4 years since you had the operation. How about an update? Thanks.
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 05/24/2011 08:44 PM

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philbikes

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I separated my shoulder too on February 26 falling off my mountain bike. Its extremely painful. My doctor recommended surgery right away. I also got a second opinion and that doctor agreed. I had level 3 AC damage. I had the bump and the x-rays didn't tell me much. The doctor; however, had seen it before and knew it was sufficient to require surgery. I spoke with various friends that said they had also separated shoulders, but never had surgery and it got better, but I'm told that with shoulders its all about degrees of damage. And it also depends on how active you plan to be. It sounds like you are active and don't want to be restricted in your exercise routines. I was reluctant to have the surgery, but after several consultations with my doctor, I decided to have it. Its been two months since I went through the surgery and so far I am glad I did it. Although there was recovery pain there wasn't the nagging pain I was feeling during the 15 days after injury and prior to the surgery. I'm told its best to do the surgery early to lessen the amount of scar tissue that the doctor has to deal with. Not sure how two months will affect that. You might ask your doctor. Good luck. Let me know how it turns out. Also, the bump is totally gone. But I have a scar of about 4 inches across the collar bone. Its clean looking, no staples or stitches, I was told the glued it.
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 05/11/2011 11:18 AM

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luv2run

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This message is for Adam who was successful back in 2007 from a surgeon in Pompano, FL. How are you doing now? My deformity is REALLY BAD on my left shoulder. It isn't even a bump, it is like a huge stick sticking up on my shoulder. It happened 2 months ago on Mar 13, 2011. All the orho doc said was "sorry it happened, the bump will be there" - uugghh. Well, I have never had much pain. In the beginning, I had limited ROM. Took 3 wks to reach overhead. I acutally ran a Half Marahon a week after (in a sling of course) I only wore the sling for a few weeks on an off. Doc said just to take it easy and it will heal in time. Well, I am a massage therapist and it has surely messed up my job situation. I get really tired from anything I do physically. --- My question is to myself....can I deal with the "awful look" of it and know that in time I will get stronger physically. I am afraid to go and do the surgery, however in reading about the Weaver Dunn procedure is what I need. Any thoughts or suggestions???
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 03/06/2010 06:41 PM

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Jon54

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I had the "wing" to the extent that I couldn't lay on my back...pain was tolerable but I could not do my usual activities. My OP opted to do a tie back using my own fascia..drilled a few holes in my scapuala, tied it to my spine...and things have been great since then...plenty of movement..no pain...I hope you feel much better

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 02/15/2010 06:13 PM

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ParisianGoldfish

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In June of 2006, I fell while running and separated my shoulder. After an emergency room visit, I found that I had a Grade III separation in my right shoulder. I was told to immobilize it and given a prescription for Pain Meds. After a month in a sling, I found that my strength returned quite easily, but I had a sizable bump, the circumference of a large egg.

Initially, I was mortified simply due to the aesthetic ramifications. It caused my shoulder to sag, and I found, after a few years, that I overcompensated for the sagging. I lifted my shoulder simply by tensing my upper back muscles below and beside my scapula in sort of a quarter-of-the-way shrug. I have always been tall and athletic, and maintaining my previous confidence and stride had become impossible. The overcompensation initially caused mild discomfort while sitting, and over time, I believe I have realigned my upper body in a rather oblong way.

In December of 09 I had a modified weaver dunn clavicle excision to repair the injury. THe surgery was simple and quick, though rather expensive, which is why I waited 4 years to have it done. All of the medical literature I read about the repair of this injury suggested that in terms of adhering the clavicle to the acromion again, the time period would not affect the success of the surgery. I did not use it for 5 weeks as i left it in a sling and for the first 3 weeks slept half upright. Aside from a stiffness I could feel even when immobilized, I was very optimistic about what I had done. THe incision was clean and the subdermal stitching left a decent sized if not subtle scar. The problems began when I began mobilizing my upper body. I wish I had known half as much about the muscle systems and relationships around the shoulder before I had done this. the simple act of craning my neck to the left, is when I first felt discomfort aside from swelling. A sharp pain if I remember... I saw no visible change in the healing injury so I did not think much of it. It's been 8 weeks since my surgery and I can't tell if I have just yet to revitalise the muscles surrounding the ac joint or if I have separated it yet again. Without exaggerating my shoulders as though I were flexing my upper body for show, the clavicle is still greatly higher than where it should be attached. The surgery did shorten the overally length of my clavicle and removed a good portion of the aforementioned "egg", but the bump is still pretty much there when I relax (I can't tell if I am relaxing or slumping my shoulders as I have been overcompensating and had back tension for so long I don't know where the original place they sit is). I sort of wonder if the ligament has torn again but the fiber wire is still in place so that's why it stays reduced and i cannot move it around like i could before the surgery. I can definitely feel a distance between my acromion and the part of the clavicle that was excised. they stay close but my acromion still sags when I am standing. At my 3 week followup, my surgeon told me that early shoulder instability is to be expected, as even when healing nicely, the ligament needs time to stiffen up. I find out on monday if I have indeed been cursed with a failed weaverdunn. I will demand an Xray even if he claims it's fine, because I sort of feel like he didn't want to admit that it failed so early on. It's still possible that I'm stuck with the bump, but until I rehab ALL of my upperbody muscles on both sides, and get my back into alignment again, I can't really know what it's going to be like.

What I believe they have failed to account for, and after reading for hours and hours today all over the internet about tales of failed surgeries, I believe there are factors unconsidered when this surgery is scheduled and post op advice and care regimens are delved out. The muscles in our body do not simply hang from a stiff frame. A period of time where you are shifting the load off of some muscles and parts of your spine and putting it onto others seriously twists the symmetry of your frame around. At least in my case. It's something that due to the clothing I wear and no doubt some dismorphia issues that I have had a hard time recognizing my secondary deformity on a day to day basis. That sounds gruesome I know but it is technically not anatomically correct anymore. Whenever I would actually stop and look though, i could definitely tell that my upperbody was tilted, the bump was prevalent, and the same goes for now. the bump is definitely smaller and will no doubt cause less local paint but the back tension remains.

So in conclusion, I think more attention should be paid to the posture, shape, and muscle health in the area around the shoulder, and pre op corrective exercises and posture management should begin. I am very frustrated, as the injury was very psychologically painful, and it's repair was a source of great hope and excitement for me. I don't regret it. I just think that the medical community is not doing all they can to make these surgeries successful. I will tell my doctor that monday. IF he listens then maybe he'll write that shit down and it'll get back to the AMA. anyway. thanks for listening. I will update in a few weeks.

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 11/14/2007 01:03 PM

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kfwoll5

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Stewart... another question. Did they talk about doing tendons or ligaments from your leg. I have heard of them using hamstring ligaments if the CC ligament is not that great when they do the weaver dunn. Is this what they are talking about.Are they talking about doing your ligaments because your original CC ligament that they used after the 1st procedure could not be reattached again?
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 11/14/2007 12:52 PM

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kfwoll5

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what do you mean that the bump is back. I had a weaver dunn back on May 2, 2006 and things were going pretty well up until October 1, 2007. I was using a weight machine to do revers flys (30 lbs and really stretched back) to try and strenthen my back ( my back never got a lot better after surgery) and after that work out it has been all down hill; we are talking almost 18 months after surgery. If I sit and type for any length of time my shoulder at the "joint" gets really stiff and sore. It seems impinged all the time. I went to my surgeon after doing this and he took X-rays and said that everything still looked good and aligned. So he sent me back to PT to strengthen my serratus muscle. I was with my PT yesterday and told him of all the joint stiffness and he decided that we should put PT off until I see the surgeon again. Well my backbone feels like it is sticking out of my back as I type this and my shoulder is killing me. I am so upset by this since I was back to running, light weight lifting and much of what I was doing before my class V separation. I am home from work today because my shoulder is so sore since I work at a computer all day. By looking at my "joint" it really does not look that much different than before the revers flys. I guess that I do not understand why I am now having all this difficulty with my shoulder. I go back to my surgeon this Monday, to see if he can figure out what is going on. Anyone else have this problem so far out from surgery.
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 09/10/2007 01:25 PM

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thehoffer

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Stewart... sorry to hear that bro. I'm curious what type of fixation they used during your 1st procedure and if they know what exactly failed? Hopefully they will get you squared away during the second procedure. Please let us know how you're doing...Arky, sounds like you are on the right track for recovery. The choice is completely yours. The only people I don't agree with here on this forum are those that deal in absolutes, such as "Don't get surgery!!!” especially when they do not have the experience to base such a call. Look, just as you will too, I recovered 99% strength back after my initial injury. However, I personally did not like the feeling of my unstable shoulder, and on my build, even though it is quite athletic, the bump was very pronounced and bother me greatly too. So you have to make the choice that you think is right. I just hope our experiences can guide you accordingly. The biggest disparity between everyone's feedback that you need to take into consideration, is where the procedure was done, and which technique was used. I'm going on week 4 now and feeling much better. I'm out of my sling, off my special pillow, and my incision is healing up nicely. However, I have two more weeks to go before I can even attempt to lift my arm over my head, because we want to make sure everything is healed up. So I will keep you posted... Thanks for checking in guys...
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 09/10/2007 12:01 AM

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arky

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Please keep us posted with how it is going. I am only 5 weeks out of a grade III separation. I have already started lifting weights, and I am quite certain my strength will be back soon...I am not sure I can deal with the bump...
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 09/09/2007 06:53 PM

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stewartp

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Glad that things have worked out well for you. I had the same op in june this year and like you it looked and felt much betterstraight after surgery and during the 4 weeks when my arm was immobilised. Sadly now the repair seems to have failed as the bump is back along with the pain. Surgoens are now talking of grafting tendons from my leg but i am not keen... hope yours continues in the right direction
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 08/31/2007 11:25 PM

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thehoffer

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Curious if anyone was interested to hear my experiences thus far, or wants to share their experiences and suggestions. Suffered Grade III separation back in Feb '07. Blew out all three lig's after a bad fall during MMA training. Recovered by May, and was actually back to pull-ups and 99% pre-injury strength by June. Missing 1% = the one thing the mechanism of injury prevented - dips. However, the deformity really got to me. I thought I could deal with it, but the sight and the sensation of my extremely displaced clavicle really wore thin. Between the self-consciousness of wearing tank-tops, and the revulsion of people when they patted me on the shoulder was not fun. For those of you that can deal with it, and are dealing with it, I commend you. It really wore on me... as well as the sensation of my shoulder. Although I didn't experience pain, it just didn't feel right. I literally had the constant sensation of my shoulder hanging off my body. Also being somewhat OCD didn't help either; I found myself constantly drawn to touching and massaging my lumpy shoulder. So I opted for surgical correction, and after seeing a few doctors, I settled on a clinic here in the Pompano, Florida area. For the price of HMO, I had both surgeons work on me, which I thought was a quite a bargain. After interviewing them, I came to the conclusion that they were very talented and right guys for the job. My biggest apprehensions were the several biggest warnings I received; it's a very invasive procedure, risk of infection, a chance of the "bump" still being there post op, and risk of musculocutaneous nerve damage when they wrapped the fiberwire around the coracoid process. So I went for it, and I must say that as of this juncture, 17 days post-op, I am quite pleased. I don't know exactly what the future has in store, but I definitely chose the right surgeons and they seem to have done a great job. They excised and put my clavicle back in place, bypassed and sutured the CC lig to the clavicle, and secured the clavicle with a #2 fiberwire and sutures. I am amazed at my progression so far; no infection and they used subdermal sutures to close the incision. At two weeks the incision is only a hair's width and healing nicely. Much less prevalent than I thought it would be, and I'll take it any day over the bump. While the whole ordeal has been a traumatic and painful experience, it all made sense when he took my bandages off and my shoulder looked normal again… could have cried at that moment! The X-rays were also amazing; clavicle looks to be right where it should be. So although I'm anxious to get back to working out, I'm being patient and sitting here with my special orthopedic pillow under my arm (love this thing, it's become like a teddy bear+security blanket of sorts). In conclusion, I am thus far very pleased with the outcome of my surgery and happy I opted for the WD procedure. Please let me know if I can share any other details or experiences that might help those of you out there who are pondering this same course of action. Or if you are ahead of me in this game and have some words of wisdom to share. Thanks, Adam.
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