BTW, you’ll be happy to know you’re always the voice in my head now in races to move up when I can before the climbs. Took your advice on Saturday and it was working until I flatted. All that to say, your generosity with the biking knowledge is one of the blessings of Kissena. And I hope the PT gods repay you kindly now. 

TL/DR:  Seems like I don't need surgery.

Getting there wasn't easy--it was in Scarsdale.  But it was either that or wait til Wednesday in NYC.  So the 8am in Scarsdale it was.  Walk to Metro North, walk from Metro North.  And the only way it happened was an internist raised the issue with the previous ortho I had seen in March/April.  That person thought I might need surgery.  

Essentially, while my type-three AC joint tear is big, nearly 2.5cm, it's not huge, and 100% recovery is likely.  Yes, I'll have a bump at the end of my right shoulder, but I already have one on the left.  More importantly, I currently have pretty good strength and decent range of motion without any tingling or numbness.  

This surgeon says the studies on type-three injuries like mine see, in the aggregate, no difference in results whether or not surgery is selected.  And surgery comes not only with more pain, longer recovery, but the potential for complications. 

So, his recommendation is I start physical therapy in two weeks.  He recommended a place that's a 10-min walk away, but he says there are at least two other neighborhood places that are pretty good as well.

So, that would mean probably 4-8 weeks of therapy and I'm scheduled to see this guy again two months from yesterday.  

And, as a bonus, he removed the six stitches in my shoulder.

I was curious about whether or not he thought it would be safe to ride.  He said that the pressure of the muscles on the shoulder would probably be pretty painful overall and would be inadvisable outside, because of reduced range of motion.  But if there was a way to ride indoors without putting pressure on the shoulder would probably be ok. 

In the meantime, I should wear the sling as much as possible and do occasional stretching exercises and ice a bit.  I should have asked about 'why icing' as the recent lit I've seen has questioned its value, but I'll give it a shot and see if it helps me feel better.  At least with this heat wave, it might feel good in general. 

the only question is whether or not to get a second opinion.  I'm of the mind to do so.  I already set one up for tomorrow morning, and headed to Scarsdale on the assumption that he was going to recommend surgery.  So, huge relief.  

Two weeks from today is August 18.  Guess the Ramapo Rally is out (8/21).  Not sure what road races are left in September, not that I could necessarily race by then.    But I'm starting to think about fall races and CX season.  

TL/DR: not so certain. This guy feels, on the balance, surgery might be better.

Interestingly, he started by getting an X-ray of both shoulders at the same time.  It's the first time this has been done.  

Turns out, the difference in the bones, between my right shoulder and left, seemingly because of the tear, is over 100%.  Though two other docs called my separation a "type three" this guy feels it makes it a type five.  

Also, this guy did not test relative strength between right and left arms--the previous orthopedist asked me to push against him to gauge strength.  This guy also didn't test range of motion.  

The concern is that I will have less strength and range of motion in my right relative to my left, if I don't do a surgical intervention.  (off-topic, seems I have a bit of arthritis developing in both shoulders. but they treated that revelation as normal)

At the same time, this doc seemed to think I had currently possessed pretty decent range of motion for someone seven days removed from this trauma, which indicates the body seems to be healing decently thusfar.  He also expressed surprise that my right AC joint was so flexible when he pushed against it.  don't know what that means.  Might have to send him some secondary questions.

Surgery seems to entail basically stitching in extra human sinew to bring the gap between bones down. And can be done now or if I feel that my strength and range of motion hasn't recovered enough after I go through physical therapy if I turn down surgery now.  Or, maybe I don't need it at all.  

Of course, surgery is 2-3 months of recovery and there's no guarantee I'd be at 100% of where I was before the crash.  

It doesn’t look like there’s been any adjustment to the positioning, but I’m guessing the cleats have just worn and are letting my knee drift a bit. 

Before I replace this pair, has anyone had a similar issue/is there a general deadline for when speedplay cleats should be replaced?