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Acromioclavicular (AC) Joint Reconstruction Rehab Protocol

Acromioclavicular (AC) Joint Reconstruction Rehab Protocol

General Considerations

  • DO NOT elevate the surgical arm above 70 degrees in any plane (active or passive ROM) during the first 4 weeks post-op.
  • Use an arm sling for 4 weeks post-op.
  • Manual treatment should be performed regularly.
  • Avoid direct palpation or mobilization over incisions/portals for 4 weeks.
  • Do not lift objects over 5 pounds with the surgical arm for the first 6 weeks.
  • Avoid excessive reaching and internal/external rotation during the first 6 weeks.
  • Maintain good upright posture, especially while using the sling.

Weeks 1 – 4: Max Protection Phase

Day 2: dressing check

Day 14: suture removal

  • Continue sling use for 4 weeks.
  • Ice every 2 hours for 15 minutes to minimize edema and promote healing.
  • Manual Therapy
  • Soft tissue work to:
  • Biceps, triceps, posterior rotator cuff
  • Cervical, scapular, forearm muscles, and hand
  • Avoid direct scar mobilization
  • Passive range of motion (PROM):
  • All directions, but limited to under 70 degrees
  • Proprioceptive neuromuscular facilitation (PNF):
  • Elbow and wrist flexion/extension
  • Manual resisted scapular isometrics
  • Exercises – 3x/day
  • Pendulum exercises
  • Ball squeezes
  • From Week 2:
  • Light, pain-free theraband resistance for biceps and triceps in neutral
  • Shoulder isometrics in neutral:
    External rotation, internal rotation, abduction, adduction, extension, flexion
  • Well-body exercises:
    Squats, lunges, step-ups, bridges, stationary biking
  • Goals
  • Pain level < 3/10
  • Minimal edema
  • PROM to 70° in flexion and abduction

Weeks 4 – 8: Moderate Protection Phase

  • Discontinue sling
  • Manual Therapy
  • Continue soft tissue mobilization
  • Begin gentle scar tissue mobilization
  • Use tools/instruments as needed (start ~Week 6)
  • Exercises
  • Begin active ROM and light manual resistance:
  • Mid-range ER/IR (in neutral, no shoulder elevation)
  • Avoid end-range movements
  • Goals
  • No pain, no edema
    AROM/PROM:
  • Shoulder flexion, scaption, abduction to 90°
  • External rotation to 70° in neutral
  • Full internal rotation in neutral

Weeks 8 – 12: Return to Functional Mobility Phase

  • Visit at 12 weeks
  • No overhead lifting
  • Manual Therapy
  • Continue soft tissue mobilization as needed
    Add joint mobilization to:
  • Glenohumeral joint
  • Scapulothoracic joint
  • Exercises
  • Wand exercises
  • Shoulder pulley and ROM drills
  • Scapular strengthening:
  • Rows, protraction, lower trapezius activation
  • Goals
  • Near full shoulder ROM in all planes
  • Demonstrate strong, stable scapular control during ROM

Week 12 Onward: Return to Strengthening Phase

  • Follow-up visit at 1 year post-op
  • Manual Therapy
  • Continue soft tissue mobilization as needed
  • Continue joint mobilization to GH and ST joints
  • Focus on achieving and maintaining full ROM
  • Exercises
  • Begin rotator cuff strengthening with resistance
  • Add weight-bearing drills in prone and quadruped positions
    At 4 months:
  • Begin triplanar/sport-specific strengthening(low intensity)
  • Start Thrower’s Program(if applicable)
  • Goals
  • Full ROM in all planes
  • Achieve strength and stability for return to sport
  • Full shoulder weight-bearing tolerance by 6 months

Contact us for the best physiotherapy treatment appropriate for your condition and get treated today.

Dr. Girinivasan Chellamuthu is an accomplished orthopaedic surgeon specialising in Sports Surgeries,  Upper Limb Surgeries and Complex Trauma Cases. Renowned for his patient-centred approach, he is deeply invested in advancing regenerative orthopaedic solutions and translational research to enhance outcomes and patient care.

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Dr. Girinivasan Chellamuthu is an accomplished orthopaedic surgeon specialising in Sports Surgeries,  Upper Limb Surgeries and Complex Trauma Cases. Renowned for his patient-centred approach, he is deeply invested in advancing regenerative orthopaedic solutions and translational research to enhance outcomes and patient care.

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