AC Joint Reconstruction
Goals:
- Protect the surgical repair
- Ensure wound healing
- Prevent shoulder stiffness
- Regain range of motion
- Control pain and swelling
Phase I (1-5 days )
Sling:
Broad arm sling worn continuously except in therapy or during exercise sessions until 4 weeks.
ROM
Scapular retractions
A/PROM of the elbow, wrist, and digits
Strengthening
Isometric grip strengthening
Modalities: PRN for pain & inflammation
Phase II (5 days – 4 weeks post-op.)
Edema: Edema control interventions
Sling: Ultrasling worn continuously except in therapy or during exercise sessions until 4 weeks.
ROM
Continue Phase I
Initiate shoulder pendulums avoiding horizontal add/abd swinging
Phase III (4 wks – 10 wks post-op.)
Wound: Monitor site / scar management techniques
Edema: Edema control interventions
Sling: D/C pillow on sling at 4 weeks. Sling continue to be worn outdoors or in public settings for an additional 2 weeks. D/C sling at 6 weeks post op.
Week 6
ROM
Begin PROM of the shoulder to flexion 90 degrees and abduction 90.
o PROM IR and ER: begin as tolerated in pain free range with arm at 0-45 degrees of abduction, progress to 90 degrees abduction at 8 weeks postop.
o Begin pulleys to 90 degrees of flexion only.
o Note: Restrict horizontal abduction and adduction of the shoulder.
Strengthening
o Isometric strengthening : IR, ER, abduction, extension and bicep/tricep. No resisted shoulder flexion.
Week 7
ROM
A/AAROM may begin within the same range as allowed for PROM week 7 (flexion 90, abd 60).
A/AAROMIR/ER in neutral or 0 degrees of abduction.
Weeks 8-10
ROM
o Gradually progress to full painfree PROM
o Begin PROM IR /ER stretching at 90 degrees of abduction
Strengthening
o Gradually progress to full AROM
Begin light resisted shoulder flexion
Begin rhythmic stabilization exercises for the shoulder for flexion and extension avoiding resisted horizontal add and abd.
o IR/ER strengthening below 90 degrees of shoulder elevation.
o Initiate light isotonic resistance program.
o No shoulder press, benchpress, pectoral deck, pullovers, resisted horizontal abduction and adduction.
Phase IV (10 wks + post-op.)
Week 10
Strengthening
o Continue to progressive resisted strengthening for the shoulder.
o Initiate light benchpress and shoulder press with dumbbells (progress weight slowly).
o Initiate lat pulldowns and rows.
o Initiate strengthening of external and internal rotation at 90 degrees of abduction.
Week 12
Strengthening
Progress resistance exercise levels and stretching.
Progress to closed chain strengthening activities.
o Transition to weightroom strengthening and initiate interval sports program.
o Progress to Work Conditioning Program or Sports Specific Training.