A blog for (semi) athletic middle-aged men (and women) holding on to (the last vestiges of) their youth
by training for and competing in running, cycling, swimming and triathlon events!

Thursday, January 12, 2017

A Break in Training Retrospective

I was scrolling through my Twitter feed early this morning when a particular headline caught my eye. "Yes, they do," I thought, "and I did." So I clicked on the article and as I read the memories came flooding back.
“It has to do with the way cyclists tend to fall," says Dr. Brian Cunningham, MD, a Minnesota-based orthopedic trauma specialist. "When you fall directly onto your shoulder, your clavicle [or collarbone]—which has an s-shape—compresses and is prone to breaking.”
Yep, that's exactly what happened, shortly after a car passed me on the left (as I flew downhill at 35 mph), turned right in front of me (causing me to slam on my brakes and start fishtailing), and I slammed into the passenger side door (taking the rearview mirror off with my left knee), flew over the hood and landed on the pavement in the middle of the intersection.

You’ll know you’ve broken your collarbone almost immediately, says Dr. Subir Jossan, MD, an orthopedic surgeon with the DC-area Centers for Advanced Orthopaedics. It’s not a subtle injury—moving your arm will be agonizing, and you may hear an audible crack as you hit the ground.
Well, I don't remember hearing a crack. I don't even remember hitting the ground, but when I tried to sit up the pain in my right shoulder was agonizing. I knew I had broken my collarbone even though the paramedic wouldn't confirm it. He told me later that they don't want to freak people out. I hated to break it to him, but I was already freaked out as I rode in the back of an ambulance for the first time in my life! 
The big issue with this break is that when it heals right, it won't impair your long-term function—but that doesn't always happen, and the repercussions extend beyond your collarbone. The collarbone acts as a strut connecting your arm to your chest; any kink in that system could mean you’ll have prolonged problems.
Tell me about it. I had no idea how important the collarbone is to the rest of the body. My doctor explained that there were two treatments options, as outlined in the article:
A sling: A tiny, hairline fracture is a pretty simple fix. Usually the doctor will put your corresponding arm in a sling and tell you to come back in six weeks. 
As my x-ray shows, I had more than a tiny, hairline fracture!
The surgical option: If there’s any sort of displacement—meaning part of the bone has shifted—things get more complicated.
Well, even though I had significant "displacement" my doc recommended putting me in a sling and giving it an opportunity to heal on it's own. He explained that even though he is a surgeon he prefers to avoid the inherent risks of surgery, if at all possible. I agreed. 
“If you don’t have surgery, there’s a zero percent chance you’ll get an infection and a zero percent chance of needing to have hardware taken out," Cunningham says. If you skip surgery but the break isn't healing properly, you may endure six to eight weeks of mild discomfort only to find out that you have to have surgery anyway. 
Unfortunately it didn't work and I began having issues with the nerves in my right arm affecting my ability to grip with my thumb. Not cool. So after six months I went under the knife to put the pieces back together.
Collarbone surgery entails placing a small plate over the fracture. In about 10 percent of cases, the plate may have to be taken out later; this is especially common in women who report irritation with purse or bra straps rubbing over the area above the plate.

I can feel all seven of the screw holes through the skin over my plate.
I did not have the hardware taken out. For the most part I don't have any issues with it (it doesn't even set off metal detectors) but I do experience some irritation when my computer bag or backpack strap rubs on the area above the plate. 

I also think the nerves never healed completely because I get some tingling on my forearm from the crux of my elbow to my thumb. But I can live with that, given things could have been much worse, and ten years later I am riding more than ever. Looking back, it really was just a break in training.

Ride on!


Next up: the long, sordid story of the legal battle over "Whose Fault is it, Anyway?"

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