Post-Operative Therapy AC Joint Reconstruction

 

Note: This pathway is designed to serve as a guide to rehabilitation. Indications for progression should be based on patient’s complete operative procedure, functional capacity and response to treatment.

Initiation of PT:

• 2-4 weeks PO
• Dictated by surgeon

Sling Wear

• 24/7 x 4 weeks

Rehabilitation Phase | Phase 1 | Weeks 1-6 Post-Operative

• PROM guided by pain
• Supine self PROM flexion (90 deg)
• Table wash
• AROM Elbow/wrist/hand
• Continue modalities (reduce inflammation and pain)

Precautions/Limitations

• No lifting
• External rotation at 90 degrees abduction limited to 45 degrees through 6 weeks
• No push-up type exercises/bench press/military press x3 months. Then start light and slow as tolerated
• Forward flexion limited to 90 degrees thru 6 weeks

Goals

• Pain-free AAROM
• Reduce muscle atrophy
• Decrease pain and inflammation

Rehabilitation Phase | Weeks 4-6 Post-Operative

• PROM progressed as tolerated
• AAROM progressed as tolerated
• Prone Clocks
• CKC exercises
  • Horizontal (table)
  • Vertical (wall)
• Scapular stabilization exercises
• Continue GH inferior mob (grade 2)
• Continue wrist and elbow PRE’s
• Sub maximal isometrics
• Initiate trunk exercises
• Continue modalities as necessary
• UBE 0 resistance

Goals

• Pain-free PROM/AAROM
• Decrease pain and inflammation

Rehabilitation Phase | Phase II | Weeks 6-8 Post-Operative

• DC sling, start AROM
• Normalize AROM (full in all planes)
• Low resistance UBE forwrd/backward
• Scapular stabilization exercises: elevation, depression, retraction, protraction in lateral stance position with involved hand on wall
• Initiate tubing 6 weeks (punch, pull, ER, and IR)
• Protected loading (modified push-ups on wall, ball on wall)
• Initiate isotonic (increase wt) ER at 0
• Continue inferior mob (+and/posterior mob as indicated)
• Prone Clock (start without wt first)
• Proprioceptive and manual control drills
• Continue modalities pro
• Instruct postural exercises

Goals

• Increase muscular strength
• Min-0/10 pain
• Improve neuromuscular and proprioceptive control (i.e. body blade)
• Normal scapulohumeral rhythm

Rehabilitation Phase | Phase III | Weeks 8-12 Post-Operative

• Eccentric cuff and scapular exercise as need
• Forward elevation to 170 (full can-thumb up)
• UE plyometric drills (2 handed)
• Chest press, push-ups, serrates push-ups in protected ROM
• Diagonal patterns with LE reaches
• UE endurance exercises
• Running/treadmill running progressions (if appropriate)

Rehabilitation Phase | Phase IV | Weeks 12-16 Post-Operative

• Start functional activities/exercises
  • Overhead sport program initiated 12-14 weeks per approval of physician
• Advance 1 arm plyometrics
• Weight training, light weight
• Return to sport programs 4-6 months
• Contact sports 8-12 months, or on physician clearance

DC Goals

• 0-3/10 pain scale
• Min-to-0 palpable tenderness on clinical exam
• Transition to home/gym HEP
• AROM WFL all planes
• Strength 4 to 4+/5 depending on skill level and ADL’s