Acromioclavicular (A-C) Joint Reconstruction

Part Two

Procedure and Instructions

Ligament reconstruction involves a special incision being made over the front and the top of the AC joint.  The collar bone is then reduced into position and the torn tendons replaced (reconstructed) with the use of a tendon graft and small biodegradable screws supplemented with heavy duty sutures (Fiberwire ™ and Ethibond™).  

Dr Reznik performs this surgery under a light general anesthesia with a Marcain (long lasting Novocain like drug) filled pain reducing pump for post op pain relief on an out-patient basis. You expect to have some post op soreness and you will also have oral pain medications for extra comfort. (To learn more- Click here to see step by step photos from a real surgical repair performed by Dr. Reznik.)

Your physical therapy will begin 3-4 days after surgery.  The physical therapist will guide you in your shoulder rehabilitation program.  It is very important for you to start therapy when recommended.

To avoid complications, postoperative follow up appointments with your physician are also required to monitor your progress.

A-C Joint Reconstruction Recovery Plan and Post-Op instructions:

Day 1 Post Op: arriving home from the surgery center: Maintain dressing add 4x4 bandages if needed for drainage through dressing. Use ice pack for 20 minute periods throughout today. (Do not place ice directly on skin to avoid frostbite.)  Keep pillow sling on at all times. Move fingers and wrist often. Expect some swelling, if you have any change in skin color or sensation in arm, notify our office. When sleeping, most patients find sleeping in a semi-upright position is more comfortable for the first few weeks after shoulder surgery.  Begin Hand Squeezing and Wrist range of motion exercises at home after surgery. (See exercise list) The arm sling with its pillow must remain on at all other times, including bedtime.

Day 2:  The Day after Surgery : Same as Day 1

Day 3: (usually about 48 hours after surgery): Continue same activities, including using ice for 20 minute periods as needed.  You should remove your dressing. You may remove the sling to shower today, supporting the affected arm with the opposite hand.  You may wash the skin around the incisions as long as you keep the white Steri strips dry. When washing the under arm, do not use a large amount of soap.  It may dry out the skin and cause a rash. After a short shower, dry the shoulder well and place Band-aids over incisions.

Day 4: Start Therapy with a physical therapist. This is to help avoid a frozen shoulder. The range of motion will be limited at first. The goal is to start motion while protecting the repair.            

Diet: You may resume a regular diet when you return home. Most patients start with tea or broth adding crackers or toast, then a non-spicy sandwich.. If your stomach feels acidy, try Tums, Zantac or Pepcid AC to settle it and drink some clear liquids.

Lungs: After surgery you are encouraged to deep breathe and cough frequently (at least (3-4 times per day). This will reduce mucous from building up in your lungs, and will reduce the risk of developing a post anesthetic pneumonia.

Pain Control: Take medication as prescribed by Dr Reznik.  Please call our office with any questions regarding your medication. Use Ice pack for 20 minutes periods throughout the first 24 hours after surgery and then as needed.

Dressing:  The dressing is to remain clean and dry.  After 48 hours you may remove all  dressings. You may shower today and after gently patting the incision dry, replace the dressing with Band-Aids.  

Sling: Patients are to wear the pillow sling at all times (including while sleeping) for the first 3 weeks. Move fingers and wrist often. Expect some swelling. Patients should then wear the sling with the pillow removed when going out and in public places for the next 3 weeks. The sling will help to alert others to avoid the affected arm during this healing period. 

Driving:   Patient cannot drive until they are off all pain medications, completely out of the sling, and can easily place hands at 12:00 position on the steering wheel and can move hands freely from the 9:00 – 3:00 position. 

Airline Flights: Patients may fly 2-3 weeks after surgery on short flights (up to 2 hours) but should in general wait 6-8 weeks for longer flights. You should get up and walk frequently to avoid blood clots and take an aspirin (unless allergic.)

Returning to Work: A patient with low demand work can usually return to work within 3 weeks. They will still have restrictions on lifting and overhead use. Patients with higher demand jobs or repetitive arm use need at least 6 weeks. And heavy labor with overhead lifting can take at least 4-6 months. 

Blood Clots:

Patients at high risk for blood clots include:

Those with long car or train commutes
May be overweight* BMI>30
Have a history of having cancer
Females on birth control pills
Males over the age of 40 

These patients should be taking 1 aspirin per day for 6 weeks after surgery unless allergic to aspirin.

*BMI  or Body Mass index  is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body composition. A muscle/fat ratio if you will. The index is used to screen for weight categories that may lead to health problems:
Body Mass Index Calculator

Call the physician or go to the ER if:

• You develop excessive, prolonged nausea or vomiting;
• You develop a fever above 101.
• You develop any type of rash;
• You experience calf pain.

Dental Work:

***YOU CANNOT HAVE ANY ROUTINE DENTAL WORK (INCLUDING CLEANING) FOR AT LEAST 3 MONTHS AFTER YOUR SURGERY OR YOU RISK INFECTING THE SUTURES, SCREWS AND MOST IMPORTANTLY THE TENDON GRAFT. AN INFECTED GRAFT MAY NEED TO BE REMOVED IF THE INFECTION DOES NOT RESPOND TO QUICK TREATEMENT.  

AFTER 3 MONTHS YOU MAY SEE THE DENTIST BUT YOU WILL NEED TO TAKE ANTIBIOTICS BEFORE AND AFTER DENTAL WORK FOR ONE YEAR FROM DATE OF SURGERY, DR. REZNIK WILL GIVE YOU A PRESCRIPTION***

Physical Therapy:

It is vital to your recovery of good shoulder function is a graduated activity and exercise program to increase muscle strength and motion. You will begin simple exercises AT HOME the day of surgery. Wrist range of motion, gripping the squeeze ball supplied with the sling and simple elbow motion to reduce pain and swelling. They should be done every day for at least the first 3 weeks post-op, to maintain blood flow and help prevent blood clots.

Post Operative Exercises

Do three times each day as directed

Starting Day 1:

Hand Squeezes or Grip Strengthening: Using a small soft rubber ball or soft sponge, squeeze your hand. When in the shower, you can use a sponge filled with water. Do this for 3-5 sets of 10-20 repetitions each day. If this is too easy, later in the rehab course you can use a grip strengthener.

Wrist Range of Motion: Roll your wrist in circles for 30 seconds after each round of grip exercises.

Day 3 add:

Elbow Range of Motion: Turning your palm inward, towards your stomach, flex and extend the elbow as comfort allows.  This will decrease pain and prevent elbow stiffness. Physical therapy usually begins today. It is a key part of your post op care. The physical therapist will guide you in your rehabilitation program.

Day 7 add:

Pendulum Exercise: Holding the side of a table with your good arm, bend over at the waist, and let the affected arm hang down.  Swing the arm back and forth like a pendulum. Then swing in small circles and slowly make them larger. Do this for a minute or two at a time, rest, then repeat for a total of 5 minutes, 3 times per day

Biceps Curls: Curl the arm up and down 12 times; rest for one minute and repeat for a total of 3 sets of 12. When comfortable try it holding a very small can to start, in a few days you can increase can size only as comfort allows. This exercise should not be painful. If painful decrease or eliminate the weight.

Not before Day 10 add:

Wall Walking: Stand facing a blank wall with your feet about 12 inches away.  “Walk” the fingers of the affected hand up the wall as high as comfort allows. Mark the sot and try to go higher next time. Do at least 10 repetitions, 3 times per day.  When more comfortable and stronger (not before three weeks) do these exercise sideways, with the affected side facing the wall. Do not let the hand drop down from the wall- walk your fingers down as well as up. Dropping the arm will strain the repair and be painful. If having weakness on the way down, feel free to use the other arm to help.

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