ACROMIO-CLAVICULAR JOINT INJURY

Postoperative recovery protocol for acromioclavicular joint injury

Treatment:

Type I

• Orthopedic treatment. Usually, the symptoms disappear after 7-10 days of rest; local ice, in the first 12-24 hours; scarf immobilization. Sports activities and weight lifting are interrupted for a longer period (until the disappearance of symptoms and palpable pain).
• Surgical treatment.  It is indicated when symptomatic arthritis develops 6 months after type I acromioclavicular disjunction. The failure of conservative treatment 3-6 months recommends surgery, which consists of resection of the last 5 mm from the distal end of the clavicle.

Type II

• Orthopedic treatment, common with type I disjunction, 14 days of immobilization in a Desault bandage, after 7 days of immobilization, if the symptoms attenuate, light arm movements are indicated, for necessary daily activities. Heavy activities, lifting, contact sports, are not recommended for 6 weeks.
• Surgical treatment, has indications as in the case of type I disjunction.

Type III

• Orthopedic/surgical treatment depending on the patient's level of activity. In the case of orthopedic treatment, the period of immobilization is 14-21 days, resumption of normal activities after 21 days (to alleviate symptoms). At 4 weeks the mobility is 80% compared to the healthy shoulder. Total recovery is obtained in 3 months.
• The surgical treatment consists of fixing the clavicle in a normal position with anchors or by muscle plasty. Recovery after surgery is 1 month, until complete recovery of mobility and 6 months until sports activities.

Types IV, V, and VI always have a surgical indication.

Phase 1: Protection phase (0-6 weeks)

Objectives:

• Ensure the protection of the operation
• Prevent shoulder stiffness

Auxiliary methods

• Use the analgesic medication as needed
• The shoulder orthosis should be worn for 6 weeks

Exercises:

• Elbow, fist, and hand movements: flexion and active extension of the elbow, fist, and fingers is encouraged. Hand prehension exercises are allowed.
• Shoulder mobilization: Start passive shoulder movements, but not higher than 90 degrees. Below the 90 degrees limit, you can also start active shoulder movements.

Caution methods:

• Do not use your operated arm to push or lift objects.
• Do not raise your arm above shoulder level.
• Movements from the table/desk are allowed: writing, dining, using the computer.

Phase 2: Movement phase (7-12 weeks)

Objectives:

• Start active, complete shoulder movements

Auxiliary methods:

• Remove the shoulder orthosis
• You can still use the analgesic medication if needed

Exercises:

• Continue the exercises during the first phase
• Shoulder mobilization: begin passive and active arm lift movements over the shoulder
• Isometric exercises of the shoulder: isometric exercises of flexion, extension, abduction, internal and external rotation of the shoulder can be initiated
• Isotonic strengthening of the shoulder with Theraband: Attach the tape to a handle or hook so that you can stretch the tape until you feel resistance. For starters use low strength tape. Do 5 repetitions 3 times a day. Gradually increase the number until you reach 20 repetitions per day. Once you have reached 20 repetitions, change the band with one with a higher resistance, start with 5 repetitions per day, then increase the number to 20 repetitions. Strengthening exercises should include flexion, extension, abduction, and internal/external shoulder rotation.

Caution methods:

• No sports activities
• No weight lifting
• Avoid local trauma to the shoulder

Phase 3: Strengthening phase (13-18 weeks)

Objectives:

• Shoulder strengthening
• Maintain a full, painless range of shoulder movements
• Strengthen the deltoid, rotator cuff and stabilizing muscles of the scapula

Exercises:

• Continue all the exercises in the first and second phases, described above. Add the following exercises under the direct guidance of a professional physical therapist:
• Isotonic strengthening of the shoulder with weights/dumbbells: Advance the use of light dumbbells (not heavier than 1.5 kg) after finishing the Theraband phase.
• Aggressive stretching: Self-stretching can be helpful before starting strengthening exercises. Do adduction stretching (posterior capsule), external and internal rotation (using a towel or a backstrap) to maximize shoulder mobility.

Caution methods:

• No lifting heavy weights
• No sports activities
• Avoid local trauma to the shoulder

Phase 4: Advanced strenghtening phase (19-26 weeks)

Objectives:

• Functional improvement (if necessary)
• Preparation for sports activities
• Preparing for intense work

Exercises:

• Continue the exercises from phase 3, which you can perform now even without the supervision of a physical therapist
• You can start exercises specific to the sport practiced

Caution methods:

• No weight lifting above the head
• No contact sports

Phase 5: maintenance phase (27+ weeks)

Objectives:

• Return to work without restrictions
• Return to sports activities without restrictions
• Maintaining optimal functionality

Exercises:

• Continue the isotonic strengthening exercises of the shoulder, 3 times a week
• Continue the exercises specific to the sport practiced