Acromioclavicular (AC) Joint Reconstruction Rehab Protocol

General Considerations

  • DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks post-op (active/passive range of motion). Arm sling is used for 4 weeks post-op.
  • Regular manual treatment should be conducted.
  • Avoid direct palpation and mobilization on incisions/portals for 4 weeks.
  • DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks.
  • AVOID EXCESSIVE reaching and external/internal rotation for the first 6 weeks.
  • Maintain good upright shoulder girdle posture at all times and especially during sling use.

Weeks 1 - 4

  • Max protection phase
  • Nurse appt post op day 2 to check dressings.
  • Nurse appt for suture removal on day 14.
  • Use sling for 4 weeks.
  • Ice every 2 hours for 15 minutes to minimize edema and promote healing.

Manual

  • Soft tissue treatment to biceps, triceps, posterior RTC, cervical/scapular/forearm musculature, and hand -Avoid direct scar mobilization.
  • Passive range of motion to shoulder: all directions under 70 degrees.
  • PNF for elbow and wrist flexion/extension.
  • Manual resisted scapular isometrics performed.

Exercise performed 3x day:

  • Pendulun, ball squeezes.
  • Starting at week 2- begin light resistance pain-free strengthening for triceps and biceps training with theraband in neutral.
  • Shoulder isometrics in neutral; external rotation, internal rotation, shoulder abduction, adduction, extension and flexion.
  • Well body exercises: squats, lunges, step ups, bridges, stationary biking.

Goals

  • Pain <3/10, minimal edema. Passive range of motion at 70 degrees in flexion, scaption, and abduction.

Weeks 4 - 8

  • Moderate protection phase
  • MD visit at 4 weeks.
  • Discontinue sling.

Manual

  • Continue with soft tissue mobilization.
  • Apply gentle scar tissue mobilization; can use instruments/tools for scar mobilization towards week 6.
  • Initiate active and light manual resistance exercises: mid-range external/internal rotation (without shoulder elevation; DO NOT go into end-range of motion.

Goals

  • No pain, no edema.
  • Active/passive range of motion : shoulder flexion, scaption and abduction to 90 degrees, external rotation to 70 degrees in neutral, internal rotation full range of motion in neutral.

Weeks 8 – 12

  • Return to functional mobility phase
  • MD appt at 12 weeks, no overhead lifting.

Manual

  • Continue soft tissue mobilization as needed.
  • Manual mobilization to glenohumeral and scapulothoracic joint as needed.

Exercises

  • Wand exercises.
  • Shoulder pulley/range of motion exercises.
  • Scapular training: rows, protraction, lower trapezium work.

Goals

  • Near-full shoulder range of motion in all planes.
  • Good scapular strength and stability demonstrated with range of motion.

Weeks 12

  • Return to strengthening phase
  • MD appt at 1 year post-op.

Manual

  • Continue soft tissue mobilization as needed.
  • Manual mobilization to glenohumeral and scapulothoracic joint as needed, continue with full range of motion goals.

Exercises

  • Initiate rotator cuff strengthening: resisted, begin weight bearing activities in prone and quadruped.
  • 4 months: triplanar/sport-specific strengthening at a low intensities: Thrower’s program.

Goals:

  • Full range of motion achieved in all planes of shoulder.
  • Strength and stability achieved for sport.
  • Full weight-bearing tolerated in shoulder by 6 months.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

Need help recovering from surgery? Our Stone Fit Physical Therapy San Francisco team can help with customized one-on-one programs to return you to full activity fitter, faster, and stronger than you’ve been in years.