Crippled shoulder


I've managed to rip my Acromioclavicular joint (right shoulder), Sternoclavicular joint (left shoulder) and possibly fracture the radial head in my right elbow (need to get that x-rayed... thought it was just bashed and swollen, but 5 days later I still can't straighten my arm)
I basically fell off a mountain bike from about 5-6 feet up in the air, taking the brunt of the force through my right shoulder, and now moving my arms is a bit of an arrse.

As I'm just a reservist (RMR, and just a recruit to boot) I don't believe I have access to services medical care. Spoken to my GP and my mum who also happens to be a GP and they both reccommend seeing a shoulder specialist from the forces as they should have a better idea of recovery times, how much and what excercise I should be doing, whether surgery would be a good option etc due to the fact that activities within the forces put a lot higher strains on your body than most civvy jobs and that a civvy shoulder surgeon may not neccesarily understand what I put my body through. I have a civvy physio appointment booked for monday, but I'm not entirely sure what they'll do/say.

I've also been told by a very helpful friend( :x ) that ligaments don't heal, and that basically I'll rely on muscles to support the joints. How much of a problem can this be?

I also live reasonably close to Haslar hospital in Gosport... Is there any chance of seeing somebody there that could sort me out

Basically at the moment I'm fishing for information as I don't really know what my situation is.
All advice welcome.
I can't help you with the admin side of your query, best talk to a regular medic/doc on here or talk to the RMR.

I can give you some general advice from my experience of orthopaedics (fairly limited) but I am no expert so do talk all of this over with your doctor first.

Generally, your friend is right in that ligaments do take longer to heal than bones. They can heal but are often weaker once the process is complete and sometimes they do not heal at all. The acromioclavicular joint isn't very mobile and is supported by two ligaments (the acromiocalvicular ligament and the coracoclavicular ligament) and the surrounding muscles. Acromioclavicular injuries are graded depending on how badly the surrounding ligaments and muscles are injured. The lesser the injury the lower the grade and the better the outcome. Your management will depend on the damage that has been done to these ligaments/muscles.

If the injury isn't too great, then you will be able to recover well with conservative treatment and physiotherapy. If it is very severe then operative reconstruction will be the best option. There is a grey area however concerning injuries that are moderately severe, where both ligaments are damaged but the muscles are intact (so called Rockwood class III injuries). Here, studies have shown that conservative treatment may be more beneficial than operative reconstruction. These studies, however, will mainly deal with civvies. Some experts say that people with specialist occupations (including soldiers) may benefit more from an operative approach.

As for your sternoclavicular injury, my experience is that these are hardly ever treated operatively. There is limited movement in that joint and the surrounding muscles are able to sufficiently support the clavicle. Operating in that area carries a very high risk. There are your subclavian artery and vein sandwiched between the clavical and first rib, the lung immediately below, various nerves and smaller blood vessels also run in that area so it would be very risky even to wire the bone with a K wire. For these reasons sternoclavicular injuries are usually left. You would have to discuss your concerns about shoulder girdle strength with your orthopaedic surgeon, but I suspect they would not be able to tell you if it would be significantly affected if treated conservatively, or if it would be improved with an operation.

I would advise that you try and contact a regular army doctor about this as they may have more approriate experience than an NHS surgeon, but still discuss the matter completely with your NHS doctor, bear in mind that they will see a good number of sportsmen with these injuries (particularly rugby players) and so they will be knowledgable. Hope this helps.