Anybody successfully come back from this? Ortho is consevative, pt and then reassess for possible surgery. Sigh… it occured during an equipment failure and I ended up on the ground with my saddle. Fell on a cross rail…
This must be one of those medical conditions where one has no clue and no advice unless one knows what stage 5 ac separation is 
A grade 5 AC Joint Separation occurs when the clavicle is severely displaced superiorly. It represents the most severe type of AC joint injury. The separation between the clavicle and the coracoid part of the scapula has to more than 100% (more than double) the normal side in order to fit the x-ray definition of a type 5 joint separation. When the injury is this severe there is a very obvious deformity with the distal end of the clavicle now very prominently protruding under the skin. In these injuries it is actually the scapula that has pulled away from the clavicle.
https://www.acjointseparation.com/grade-5-ac-separation.html
Pro athletes return from this injury all the time.Though it may depend on what kind of riding you do and how strong you are . Its usually not aa big problem even with surgery as long as you are young enough to have good bone .
Don’t let the P.T. drive you too hard, let nature have time to heal. Sometimes, actually often P.T. can push too hard , no one ever said “it took to long to recover” but unfortunately the opposite is to often true and the damage may be permanent.
so do what you can , stop when it hurts, be good to yourself and let time heal it, you should be fine.
Wanted to add that reading and a diagnosis from X-rays is really not as reliable as we think.So don’t let this diagnosis influence you too much ,the surgeon only really knows whats going on when he gets in there.
The public and even the Ortho can give too much credit to film when the truth is often more complicated. Any good surgeon will tell you this so if you doctor thinks he knows everything then maybe, actually always get another opinion…
I wish I had known this when I was diagnosed with an ankle sprain (falling of my horse) from X-ray , when it never felt better finally he ordered a bone scan that showed a non- displaced fracture. By that time the Talus bone was dead and sadly my ankle remains painful and dysfunctional. The doctor was a friend of mine, very good surgeon and so upset at these results which where rare.
Thx. Yes, CT was done at the time due to other issues. The clavicle bone is actually unsupported from the scapula and pokes up like a knob. very bizarre.
PT starts end of next week, so we shall see. The lack of structure feels funky when I move my arm…
Walkers 60, your poor ankle/foot. Such a life altering circumstance.
My husband had this. He didn’t even do PT let alone surgery. His surgeon said they only do surgery nowadays to get an athlete back into the game asap so he didn’t have it. It looks of gross now but hasn’t caused him any problems.
It really does look disturbing… and the ROM is bizarre. My ortho guy wants PT, and I am going to give it a go. I almost want surgery for cosmetic purposes alone… it is like an alien on your shoulder.
I’m co-signing walkers60’s spot-on first reply. I fell & got my stage-5 ac separation (layman’s terms: “separated shoulderl at 16 y/o. It was for sure sore the next few weeks, but I opted against surgery b/c according to my ortho, unless I was going to engage in repeated overhead motion (eg tennis or basketball), it wouldn’t limit me in the future. + I was a 16 y/o girl, didn’t want the scar and didn’t want to miss any shows for the recovery time.
it ached off and on for the next couple years, esp till I figured out how to sleep right on it, but never limited my riding—went on to do GPs on a variety of horses, many of which took wuite a feel! IME, esp once the initial inflammation/physical trauma settled down, it didn’t limit my riding at all.
i WISH I had done PT soon after. A few years later, I started working w/light weights and building up some more muscle in the joint capsule solved almost all the residual pain, which was more in daily life than when riding anyway. There are a couple overhead angles that aggravate my shoulder now, so I just try to work around those planes of movement, but I’m sure you’ll adapt and find the things that are most comfortable for you.
Fast forward a couple years, if the visual still bothers you or you have remaining discomfort, you can always think about surgery then. It’s not a “speak now or forever hold your peace” kind of decision!! But in the meantime, hope you heal quickly, def do your physical therapy while also not overdoing (pain is not gain for this type of recovery), listening to your body, pacing yourself and giving that joint rest when needed. Startint conservative makes all the sense in the world.
In the meantime, ice (and the occasional NSAID if they work for you, if needed), but having been there, I am fully confident you can & will come back stronger than before. If you’re a woman, you may need to rethink your sports bra wardrobe (the single most painful part of the whole process for me!) but all solvable or improve-able problems. Let us know how your healing goes!!
