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Acromioclavicular joint resection

The acromioclavicular joint

The acromioclavicular joint (ACJ) provides an articulation between the clavicle (collar bone) to the shoulder blade, this can become problematic and a source of pain. In some instances removing this joint can improve the function at the shoulder joint as well as decreasing the pain.
Post operative information

Following this procedure it will be necessary to wear a sling for 1-2 weeks; this is primarily due to the fact that with little muscle bulk covering the area and therefore a slightly limited blood supply, the wound can be slow to heal. This is therefore the priority during the first 10 days after the operation.

The sling needs to be worn throughout the day and during the night also. The sling can be removed for washing and dressing. You will need to avoid actively lifting the arm for the above reasons. Also, in the evening the sling can come off and the arm can be rested on pillows when watching television.

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Any shoulder operation carries with it certain risks, one of which is shoulder stiffness and in some instances this can lead to a frozen shoulder (capsulitis), therefore during the period of immobilisation, physiotherapy and home exercises are recommended to prevent this complication.

Pain Control

Pain should be controlled with prescription drugs. On leaving the ward you will have a 5-day prescription, after this time you may be able to downgrade to over the counter analgesics which can be discussed with the pharmacist or you may need to visit your GP to continue with the prescription drugs. Ice can be used at home as a useful adjunct or alternative.

Milestones

Driving You may begin driving 1week after your operation or when you feel comfortable.
Returning to work Dependent on occupation. If you are in a sedentary job you may feel happy to resume work after 1 week.
Leisure activities You should avoid sustained, repetitive overhead activities for 3 months 
Swimming You may begin breaststroke as soon as comfortable (approximately 6 weeks). However wait 3 months prior to commencing front crawl.
Golf 12 - 16 weeks post surgery.

Approximately 3 months after your surgery your symptoms should be 80 % better and will continue to improve up to 9 months post op.

The Early Goals of Rehabilitation

1) Prevent shoulder stiffness during the initial stages of healing.
2) Maintain shoulder movement without strong muscle contraction pulling on the wound area.

Exercise Protocol


Weeks 1 - 2: Sling for 1-2 weeks post surgery.
Pendular exercises out of sling.
Active assisted exercises Flexion, Abduction as comfort allows,
External Rotation as comfortable, aim for midline.
Neck stretches as required.
Scapula setting in sling to neutral.
Weeks 2 - 4: Cease with sling.
Continue with active assisted exercises as previous.
Increase External Rotation beyond midline (neutral)
Introduce Hand behind back assisted with walking stick.
Continue scapula setting and postural awareness.
Weeks 4 - 6: Increase Active Range of Movement (AROM) as able.
Aim for full AROM by 6 weeks.
Commence light resistance exercises at 6 weeks.
Flexion, Abduction pulls with theraband.
External Rotation with theraband.
Weeks 8 - 12: Focus on increasing cuff power and resistance.
Introduce combined movements - external rotation with abduction patterns to 45°, 90°.
Proprioception exercises with scapula positioning.

Early Phase ACJ Excision Shoulder Exercises

These exercises are designed to complement your ACJ Excision Information Sheet.

Shoulder pendular exercises
Position: Step standing. With arm out of sling lean your body forward. Support your body weight resting the un-operated arm on a table.
Action: Gently rock your weight from your front foot to your back foot, enabling the arm to move back and forth using your body weight.
Reps: Repeat x6-10 x 3 per day

Assisted flexion <90°
Position: Lying on your back.
Action: Hold your operated arm around the wrist using your unoperated arm. Raise both arms up towards your head using your unoperated arm to assist the exercise. Avoid moving beyond 90 for the first 2 weeks.
Reps: Repeat x6-10 reps x3 per day.

Assisted External rotation to neutral
Position: Lying on your back, hold a stick or similar.
Action: Start with your elbows tucked in at sides of body. Use un-operated arm to help move the operated arm, by pushing the stick rotating the arm away from body. Keep elbows tucked in. Move the arm as far as comfortable, aim for midline, as demonstrated by the picture.
Reps: Repeat x6-10 x 3 per day.

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For further information and advice:
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info@shoulder-and-bone.co.uk
 

Alternatively, please call Michele Murphy:
T: 02392 352 206

 
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