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What to Expect After AC Reconstruction

When we think of the shoulder joint, we often think of a single joint that allows us to raise or lower our arm, move it closer or further away from our body’s midline, or rotate it either internally or externally. The truth of the matter is that your shoulder relies on more than one joint. The “shoulder joint” consists of 4 joints: the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint, and the scapulothoracic joint. In order for the shoulder to have its full range of motion, these individual components must work together seamlessly.

As you would imagine, if any of these joints become severely damaged, the rest of the shoulder is affected. Unfortunately, shoulder injuries are common among athletes and other physically active individuals. Football players who take frequent blows to their shoulder, in particular, face a high risk of acromioclavicular joint separation. The acromonioclavicular joint, or AC joint, is located at the top of the shoulder and facilitates raising the arm over the head. When it is damaged, it can seem impossible to lift your arm, let alone reach overhead.

Not every AC injury requires surgery. However, if you are an athlete who needs to regain elbow function or if your symptoms impair your ability to live normally, an orthopaedic surgeon will recommend AC reconstruction. Reconstructive surgery is an option for both athletes as well as non-athletes to regain loss shoulder mobility. It is a standard procedure that has been shown to be highly effective. As with any form of surgery, though, your outcomes are determined in part by your adherence to post-operative guidelines. If you are considering reconstructive surgery, here is what you can expect during the months following your procedure and guidelines to follow in order to improve your outcomes.

Phase I – Immediate Post-Surgical Phase (Weeks 1 -4)

Rest should be your top priority following surgery. This will allow your shoulder to recover while also protecting it from further trauma. You can apply ice every hour for 15 minutes to minimize swelling and promote healing.

By the end of the fourth week, you should be able to passively bend your arm and move it away from the midline of your body by 70 degrees. A passive range of motion refers to someone else—such as a physical therapist—moving the joint for you. By contrast, active range of motion refers to your ability to move your joint on your own.

Goals:

  • Minimize shoulder pain and inflammatory response
  • Protect the integrity of the surgical repair
  • Achieve gradual restoration of passive range of motion

What to Expect:

  • Minimal pain which will gradually decrease
  • No active range of motion in the affected shoulder
  • Gradual restoration of passive range of motion
  • Use of a sling for the first 4 weeks
  • The need for assistance in order to complete daily activities
  • Physical therapy starting at week 2
  • Education regarding posture, joint protection, positioning, etc.

Milestones to Progress to Phase II:

  • Appropriate healing of the surgical repair
  • Adherence to the post-operative protocols
  • Achieved at least:
    • 90 degrees of passive forward elevation
    • 30 degrees of passive external rotation at 20 degrees abduction
    • 30 degrees of passive internal rotation
  • Completion of Phase I activities without pain or difficulty

Phase II – Intermediate Phase (Weeks 4 – 8)

Goals:

  • Continue to minimize shoulder pain and inflammatory response
  • Continue to protect the integrity of the surgical repair
  • Continue to restore passive range of motion
  • Achieve gradual restoration of active range of motion
  • Discontinue use of the sling by the end of week 6-8

What to Expect:

  • Minimal to no pain and inflammation
  • Discontinued use of a sling
  • Continued physical therapy
  • Gradual restoration of passive range of motion
  • Gradual restoration of active range of motion starting at week 8
  • Continued education regarding posture, joint protection, positioning, etc.

Milestones to Progress to Phase III:

  • Achieved at least:
    • Passive forward elevation at 165 degrees
    • Passive external rotation at least 75 degrees at 90 degrees abduction
    • Passive internal rotation at least 50 degrees att90 degrees abduction
    • Active forward elevation at lest 145 degrees with good mechanics
    • Dynamic control of the scapula (shoulder blade)
    • Appropriate posture of the scapula (shoulder blade) at rest
  • Completion of Phase II activities without pain or difficulty

Phase III – Early Strengthening Phase (Weeks 10 – 16)

Goals:

  • Initiate balanced strengthening program
  • Normalize strength, endurance, and neuromuscular control
  • Resume chest level full functional activities
  • Strengthen scapular retractors and upward rotators

What to Expect:

  • Pain-free activities
  • Continued physical therapy:
    • Exercises requiring progressively greater intensity, shoulder elevation and joint stress
    • Exercises consisting of both open chain and closed chain activities
    • No heavy lifting or plyometrics
  • Continued education regarding posture, joint protection, positioning, etc.

Milestones to Progress to Phase IV:

  • Achieved passive forward elevation within normal limits
  • Achieved external rotation at all angles of abduction within normal limits
  • Active forward elevation within normal limits with good mechanics
  • Appropriate rotator cuff and scapular muscular performance for chest level activities
  • Completion of Phase III activities without pain or difficulty

Phase IV – Return to Activity Phase (Approx. Week 24)

Goals:

  • Continue stretching and passive range of motion as needed
  • Continue all exercises from the aforementioned phases
  • Maintain full non-painful active range of motion
  • Return to full strenuous work activities
  • Return to full recreational activities

What to Expect:

Heavy weight lifting and overhead athletic moves should resume 6 months following your operation or after being cleared by an orthopaedic specialist.

Speak with an Orthopaedic Specialist

Your adherence to post-operative guidelines following AC reconstruction directly impacts your outcomes. And while the importance of rehabilitation cannot be stressed enough, it is important to also understand that it is only one half of the equation. Both your recovery program as well as your choice of orthopaedic surgeon will ultimately determine the success of your joint reconstruction.

Dr. Robert Rolf is a board certified orthopaedic surgeon at Beacon Orthopaedics and Sports Medicine who provides extensive expertise in rotator cuff tears as well as other conditions related to the shoulder or elbow. For your convenience, Dr. Rolf meets with patients at Beacon’s Batesville, Lawrenceburg, or Northern Kentucky locations as well as Beacon West in Harrison, Ohio. Schedule an appointment online to meet with Dr. Rolf.