Edward V. Craig, M.D: Surgical: Acromioclavicular (AC) Separation
Injuries and Conditions : Shoulder : Acromioclavicular (AC) Separation : Treatment : Surgical : Shoulder A-C Joint Separation
 
Evaluation of Patient for Surgery
  • Patients are given a complete physical examination that provides an assessment of the individuals overall health.
  • Additionally, the physician will perform a comprehensive examination of the shoulder, including an examination of the degree of flexion, extension and range of motion measurements for each shoulder.
  • Diagnostic imaging studies will be performed to determine the extent of the injury to the joint capsule and to evaluate any underlying conditions.

    Pre-Operative Instructions:

  • Continue all other regular medications, such as high blood pressure, heart or diabetes medication.
  • Report any infections, such as urine or teeth infections.
  • Do not eat or drink anything after midnight the night before surgery.
  • Remove any makeup, nail polish, hairpins, jewelry, hairpieces, dentures, eyeglasses, contact lenses, and hearing aids.
  • Have another individual drive you to and from the hospital or surgery center the day of your surgery.

  • Expectations for Recovery
    A full return to athletic activities, including contact and overhead sports, can be expected.
    Post Operative Recovery
  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
  • Post-operative pain will be present and may require over-the-counter or prescription medication to control the pain.
  • Passive range of motion exercises are begun on the first post-operative day to maintain shoulder flexibility.

    Postoperative instructions:
    Activity

  • Follow general postoperative guidelines provided by your physician. Be wary of any signs of infection, including swelling and redness, persistent wound drainage, elevated temperature (greater than 101 degrees).
  • No driving until instructed by your physician
  • Do not engage in activities that increase pain or swelling.
  • Maintain your arm in a sling at all times until instructed otherwise by your physician.

    Ice Therapy

  • Begin ice therapy immediately after surgery.
  • Manual icing should be performed every two hours for twenty minutes until your swelling is controlled.

  • Rehabilitation Program
  • A critical part of a successful recovery from an AC Joint seperation involves the active participation in a rehabilitation program.
  • To reduce the risk for a second seperation, strengthening the muscles that hold the head of the humerus in contact with the glenoid (shoulder socket) is of great importance. These muscles are called the rotator cuff muscles. Working against progressive resistance strengthens them.
  • Physical therapy will work to provide the shoulder with strength and functional range - forward motion, elevation, and internal and external rotation.

    Phase I
    Gentle passive range of motion exercises with the assistance of a therapist.

  • A sling will usually be used to immbolize the shoulder until the fifth post-opertaive week.
  • Pendulums to warm up
  • At the fifth week, typically, passive exercises begin, focusing on exercises in elevatiion, external and internal rotation.

    Phase II
    Active range of motion exercises typically begin on the sixth week.

  • Pendulums to warm up
  • Active motion for phase I exercises

    Phase III
    Resistance exercises typically begin on the seventh week.

  • Pendullums to warm up
  • Continue Phase II exercises
  • Forward punch exercises, internal and external rotation
  • Shrugs, rows
  • patient may progress to weight training as tolerated if cleared by M.D.
  • No long levere-arm exercises, no abducted positions, no impingement positions.

    Return to activities

  • Golf: 3 months
  • Tennis: 4 months
  • Contact sports: 5 months
  • Possible Complications and Risks
  • Risks during and after surgery include problems that may develop in relation to bleeding, infection, and/or anesthesia.
  • Injury to blood vessels and nerves within the shoulder region.
  • The possibility of experiencing unforeseen complications
  • The development of a stiff shoulder (frozen shoulder) following surgery.
  • Recurrent dislocation of the shoulder in the future.