Injuries and Conditions: Acromioclavicular (AC) Separation : Acromioclavicular (AC) Separation :
The pain and discomfort experienced with an AC Joint separation can vary based on the severity of the injury. The shoulder joint capsule, ligaments and muscles are all affected by this injury; each of these structures heal at different rates and to different extents. Non-surgical AC separations are usually classified as grades I-III; however, the surgical/non-surgical treatment decision of a grade III seperation depends upon the judgement of the physician.
An AC separation may result in different types of seperation. Each type, or grade of seperation, requires a specific surgical procedure for treatment.
Grades IV, V and VI utilize particular surgical techniques and surgical hardware for treatment.
The decision to treat type III injuries with surgery is dependent on the physician's assessment of the particulars of the injury; many grade III injuries can be treated with non-surgical measures with good results.
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.
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.
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
A full return to athletic activities, including contact and overhead sports, can be expected.
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.
For grades I-III, non-surgical treatment is typicaly the recommended course of therapy for AC Joint sepeartion.
Grade I and grade II seperations are generally treated with medication, cold and hot packs, and the use of a sling to hold the clavicle in position which allows the ligaments to heal.
Grade III seperations that involve actual tearing and a seperation may require surgery to re-attach the ligaments and stabilize the clavicle. Although, the majority of grade III injuries are treated with non-surgical methods.
Non-surgical treatment initialy focuses on range of motion, followed by strengthening and weight training.
Stretching
Week 1: Passive range of motion
No limit for forward elevation, external rotation or internal rotation.
Week 2-3: Active range of motion with terminal stretch
Forward elevation
External rotation
Internal rotation
Strengthening
Week 4 onward (if pain permits): Resistance training and stretching
Continue above stretches
Elastic resistance exercises
Scapular exercises: shrugs, rows
Forward flexion/punch
Biceps curls
Patient's goals and lifestyle may need to be altered, with normal activity levels being modified.
Sustaining a complete recovery is dependent on the severity of the injury, the health and habits of the patient and underlying shoulder disorders or conditions.
Maintaining an active exercise program is the best recommendation for recovery.
The development of an unstable or arthritic AC joint.
Delayed healing may occur if shoulder activities are begun to soon or too vigorously after injury.
Participation in repetitive motion activities like football, tennis, and baseball increase the risk for recurrence of pain in the AC Joint.
Recurrent inflammation at the point where the muscle attaches to bone.
| No surgical hardware is typically used for A-C joint reconstruction.
Not applicable.