Acromioclavicular Ligament Tear
What seems to be an never ended stream of injury and illness continues, this time with an acromioclavicular ligament tear. yep, I’m falling apart!
Until recently, my shoulder had been fairly bullet-proof. Despite lots of swimming and the wrenching and pulling of windsurfing I’d never had any issues with them. This changed over Christmas whilst on a usual Sunday morning swim my left shoulder started hurting and then proceeded to get worse until it got to the point where I had to stop my swim session and get out of the pool. Once out of the pool it was clear that there was a bit of a lump on my shoulder and over the next few days the pain was still there. It was never a really bad pain, just a certain amount of soreness, some discomfort in certain positions and the ever present lump disfiguring the usual smooth lines of my shoulder.
I’ve rested it fairly well since then with no swimming, and much to my disappointment no surfing or SUPing either. The pain has subsided a little and I’ve been able to bike and run. I still have pretty much a full range of movement in my shoulder as well, but any stress on the joint aggravates it and the pain flares up. I certainly haven’t tried swimming again yet.
Not having had any shoulder injuries before my knowledge of the shoulder anatomy and of likely injuries was fairly limited. I soon changed that though with research online and in various sports physiology text books that I have acquired. My self-diagnosis was a tear or at least a strain on the acromioclavicular ligament in the shoulder.
The acromioclavicular (AC) ligament is part of the acromioclavicular joint, which lies between the part of the scapula that makes up the highest point of the shoulder (the acromion) and the collarbone, or clavicle. It is possible to partially tear or completely tear this ligament. There is another ligament in your shoulder called the coracoclavicular (CC) ligament which is also often injured at the same time. The extent of shoulder separation caused by this tear is classified by the magnitude of your injuries:
- Grade 1: A mild shoulder separation involves a sprain of your AC ligament that does not move your clavicle and looks normal on X-rays.
- Grade 2: A more serious injury tears the AC ligament and sprains or slightly tears the CC ligament, putting your clavicle out of alignment to some extent.
- Grade 3: The most severe shoulder separation completely tears both your AC and CC ligaments and puts your shoulder joint noticeably out of position.
- Grades 4, 5 and 6 AC separations are very rare and usually require surgery.
Once back at work I had the chance to look at some of the skeletal models that we have in the Sports & Exercise Science Department where I work and at some of the posters detailing such injuries and this helped confirm my online research and my suspicions that I had an acromioclavicular ligament tear.
A 2nd more Expert Opinion
I’ve now seen a friend who is a sports physio about it and he suspects at least a grade 2 AC ligament injury. Grade 2 because according to him the lump on my shoulder is fairly substantial which indicates that my clavicle is quite convincingly out of alignment.
I then spoke to one of the lecturers/researchers in sports physiology and she seems to think that I’ve actually dislocated the joint because the lump is very pronounced and the bone is clearly out of place.
Both have recommended a visit to a professional who may be able to realign the joint and stabilise it or maybe refer me on towards health professionals for a X-Ray / Scan to see what the extent of the damage is.
Cause of Acromioclavicular Ligament Tear
I’m still not really sure what caused it as there was no trauma to the area and I didn’t do anything odd to it, it just gradually came on whilst swimming. All it could be is an overuse injury from years and years of swimming that has finally torn my ageing ligament.
The most common cause for a separation of the AC joint is from a fall directly onto the shoulder, but I don’t remember doing that. And no, I don’t often drink much even over Christmas so before you suggest it there was no chance of an injury such as that occurring without my knowledge!
Treatment for Acromioclavicular Ligament Tear
As usual, the recommendations for treatment is pretty much ‘good old rest’. Apparently a sling can help. It will support the arm and prevent use of or any additional trauma / tearing of the ligament. Cold packs and nonsteroidal anti-inflammatory drugs (NSAID) such as Ibuprofen can be used to manage pain and reduce swelling.
It was also said it could be worth taping it to add support, especially if I’m continuing to cycle and run.
Apparently most people return to near full function with this injury without any intervention from a surgical perspective. Although there can be significant, persistent deformity to the shoulder. Some people have continued pain in the area of the AC joint, but as always it is usually best to wait and see if reasonable function returns before investigating further methods of treatment.
So, that looks as though I’m unable to swim for a while. I won’t be able to go to the gym or do circuits either as pretty much any upper body exercise is going to be out of bounds. That probably applies to surfing, windsurfing and SUPing too (although I may not have heard that bit!).
At least I can still bike and run at the moment so I guess I’m going to have to revisit my training plan, remove all the swim sessions from it and any weight sessions or circuits sessions and focus solely on the bike and the run. At least by doing that, rather than just being a broken man I’ll at least be a broken man with a plan. Hopefully by the end of it I’ll be a man with a plan who is smashing it on the bike and run too.
It would seem that there isn’t much else that I can do about it , rest, re-plan and see what happens. I’ll make an appointment to see a physio for a 3rd opinion and possibly some realignment too.
This being a triathlete malarky doesn’t get any easier and simply seems to wear your body out quicker than it would if I were a ‘normal’ person. Maybe competitive eating is the way forward, I’m sure I could excel at that!
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Thanks need to be made to Ceredigion County Council for supporting my training. - Diolch hefyd i Gyngor Sir Ceredigion.