Surgery for Acromioclavicular Separation

with Rehab

INDICATIONS

  • ExitCare ImageAthletes with severe sprains may be required to undergo surgery, in order to have the best chance of returning to a sport.

  • The goal of surgery is to repair the alignment of the shoulder bone (acromion) with the collarbone (clavicle). It also reduces shoulder droop.

  • Surgery may also be required for less severe sprains, if you do heavy labor or are an athlete in a sport with a throwing motion.

  • Most athletes who participate in contact sports and receive a separated AC joint will be treated non-surgically, with the use of a sling. Non-surgical treatment usually allows for a quicker recovery period. However, athletes who participate in contact sports have a higher likelihood of re-injury.

  • If a person undergoing non-surgical treatment has persistent pain for more than 3 months of physical therapy, anti-inflammatory medicines or activity modification may be needed. He or she may also require surgery.

RISKS AND COMPLICATIONS

  • Infection; bleeding; and injury to nerves (numbness, weakness, paralysis) of the shoulder, arm, forearm and hand.

  • Recurrence of the deformity or continued pain.

  • Screw breaking, or early breakage of man-made (synthetic) material.

  • Erosion or fracture of the collarbone.

  • Shoulder stiffness (uncommon).

PROCEDURE

Do not eat or drink for the period before the surgery, as prescribed by your caregiver. AC separation surgery involves removing part of the collarbone from the end toward the shoulder (distal end). The ligament that usually goes from the top of the shoulder blade (coracoid process) to the shoulder (acromion) is detached from the shoulder and moved to the end of collarbone, and attached there with stitches (sutures). This procedure replaces the torn ligaments that previously held the collarbone to the shoulder blade. Another stitch, wire, pin or screw is used to hold the collarbone to the shoulder blade or shoulder. The ligament then grows into the end of the collarbone. If the surgery is done soon after the injury, the torn ligaments can sometimes also be repaired. If a screw or pin is used to hold the collarbone in the proper position, it is often removed about 6 weeks after surgery.

HOME CARE INSTRUCTIONS

  • Keep the wound clean and dry for the first 10 to 14 days after surgery.

  • Sleeping may be uncomfortable after surgery. Many patients find that sleeping sitting up (on a couch or recliner chair) for the first 1 to 2 weeks after surgery is helpful.

  • Use pain medicines as directed by the caregiver.

  • Keep the affected arm in a sling (usually for 6 weeks or until the screw or pin is removed from the shoulder).

  • Physical therapy may be needed to regain motion and strength.

RETURN TO SPORTS

  • The recovery time for this injury depends on the type of sport, position played and arm injured.

  • A minimum of 4 months is needed after surgery, before returning to sports.

  • Full shoulder motion and strength are needed before returning to sports.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop pain, numbness or coldness in the arm.

  • There is a blue, gray or dark color in the fingernails.

  • You have increased pain, swelling, redness, drainage of fluids or bleeding in the affected area.

  • You develop signs of infection (headache, muscle aches, dizziness, a general ill feeling with fever).

  • You develop new, unexplained symptoms.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES – Surgery for Acromioclavicular Separation

After the caregiver has allowed you to begin moving your arm after surgery, he or she may have you begin these exercises to help restore your shoulder's flexibility. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image ROM – Pendulum

  • Bend at the waist so that your right / left arm falls away from your body. Support yourself with your opposite hand on a solid surface, such as a table or a countertop.

  • Your right / left arm should be perpendicular to the ground. If it is not perpendicular, you need to lean over farther. Relax the muscles in your injured arm and shoulder as much as possible.

  • Gently sway your hips and trunk so they move your injured arm without any use of your shoulder muscles.

  • Progress your movements so that your injured arm moves side to side, then forward and backward, and finally, both clockwise and counterclockwise.

  • Complete __________ repetitions in each direction. Many people use this exercise to relieve discomfort in their shoulder, as well as to gain range of motion.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left hand and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your shoulder, but before you have increased shoulder pain.

  • Avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Flexion, Seated

  • Sit in a firm chair so that your right / left forearm can rest on a table or countertop. Your right / left elbow should rest below the height of your shoulder so that your shoulder feels supported and not tense or uncomfortable.

  • Keeping your right / left shoulder relaxed, lean forward at your waist, allowing your hand to slide forward. Bend forward until you feel a moderate stretch in your shoulder, but before you feel an increase in your pain.

  • Hold __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES –Surgery for Acromioclavicular Separation

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH – Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Internal Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the inside of your wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame as if you were trying to draw the palm of your hand to your stomach. Gradually increase the tension until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – External Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the outside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame as if you were trying to swing the back of your hand away from your stomach. Gradually increase the tension until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – Internal Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your right / left side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it across your body toward your stomach. Be sure to keep your body steady so that the movement is coming only from your rotating shoulder.

  • Hold __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH – External Rotators

  • Secure a rubber exercise band to a fixed object, so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your uninjured side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady, so that the movement is coming only from your rotating shoulder.

  • Hold __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.