After your operation
Acromioclavicular
Joint Excision
An Elective Orthopaedic Centre patient
information booklet for you to take home
Acromioclavicular Joint Excision
This booklet has been produced to enable you to gain the from your
Acromioclavicular Joint Excision operation. It is not a substitute for
professional medical advice and should be used in conjunction with out
patient physiotherapy. Be aware that this booklet is for guidance only as your
rehabilitation may need to vary depending on specifics of your operation.
Shoulder Anatomy
The shoulder is a ball and socket joint, this is where the movement occurs as
you lift your arm. The head of the humerus (the ball) fits into the glenoid
(socket) which is part of the shoulder blade. The clavicle (collar bone) runs
from the top of your shoulder to the breastbone and helps to keep the
shoulder joint to the side of the body. The acromioclavicular joint is at the top
of your shoulder and formed by the top of the shoulder blade (acromion) and
the outer end of the collar bone (clavicle). This joint moves as the arm is lifted
and over time it may become arthritic (just like knee or hip arthritis).
Consequently it can become very painful when the arm is lifted to the top. The
joint may also become problematic if it is dislocated or subluxed (part
dislocated) following trauma e.g. a fall.
Acromioclavicular Joint Excision
If the pain does not settle with physiotherapy or steroidal injections then
surgery may be performed. Surgery involves shaving all rough edges from the
outer end of the collar bone (clavicle). This allows better movement at the
acromioclavicular joint, which in turn reduces pain.
Pain
Although there are only 2-3 small incisions the surgery can often be painful
due to the work carried out within the joint. After the surgery your arm will feel
numb and this may remain for 24 hours. Pain relieving medication will be
given to you whilst you are in hospital and supplies will be arranged for you to
take home. If you require further medication seek advice from your GP.
Ice packs are also important in relieving swelling as well as pain. Apply ice
over the operated shoulder at least 4 times a day. Use a frozen pack of peas
with a tea towel between your skin and the ice pack. Apply the ice for 15
minutes at a time. A layer of cling film between the ice and your skin is
recommended.
Exercises
In order to aid the healing of the acromioclavicular joint surgery it is important
not to lift your arm above shoulder height for the first two weeks. You are free
to use your arm below shoulder height but avoid lifting heavy weights. It is
very important to continue with these exercises for several months and get
used to doing them at least three times a day. On the day of your surgery you
may start doing hand, wrist, elbow and pendular exercises to prevent shoulder
stiffness. These exercises are explained below and must be carried out until
you attend out-patient physiotherapy.
Wrist Exercises
Move wrist forwards and backwards and side to side. Hold each position for 5
seconds. Repeat 10 times for each movement.
Elbow exercises.
Bend elbow so that you touch your nose with your thumb. Straighten elbow
out fully.
Repeat 10 times.
With elbow bent and arm by side, turn palm up, hold for 5 seconds. Turn palm
down, hold for 5 seconds. Repeat 10 times.
Shoulder exercises
Pendular Exercises
1. Standing, lean forwards and support yourself with your non-operated arm
on a table. Let your operated arm hang by your side. Gently swing your arm
forwards and backwards.
2. Standing, lean forwards and support yourself with your non-operated arm
on a table. Let your operated arm hang by your side. Gently move your arm in
a circular motion.
In addition to these simple exercises you must start
lifting your arm forwards to shoulder height, help
may be given by the non operative arm. If you find it
is too painful to go beyond 90 degrees then this
movement may be limited to that point.
Bend your elbow to right angles and keep it by your
side. Use your non operative are or a stick to help
push the operated arm out to the side in an arch.
The Sling
The sling is for comfort only and should be removed as soon as possible.
Most people wear the sling for 2-3 days following surgery.
Sling application:

If fitting the sling without assistance, ensure that you are seated, with
your elbow bent to 90 degrees. You will find it more comfortable if your
arm is supported on a pillow

Fasten the strap across your forearm, it should be approximately one
inch below your elbow crease

Attach the wrist strap approximately one inch from your wrist (towards
your elbow). The lower 'D' ring should rest against your body and the
higher 'D' ring should face upwards.

Take the shoulder strap over the opposite shoulder and feed it through
the upper 'D' ring

Attach the strap back onto itself so that your elbow is held at right
angles (90 degrees flexion)
Wound Care
The wound is closed with small plaster strips. You will return from surgery with
a bulky dressing over your shoulder. This bulky dressing may be taken off the
day after the operation. You can shower but keep the clear adhesive dressing
in place (extra dressings will be provided on discharge) Between 10 - 14 days
the wound should be healed and you can remove the clear adhesive dressing
and the plaster strips will fall off naturally.
Follow Up appointments
An appointment may be made for you to see a physiotherapist after your
discharge or your surgeon will do this from clinic when you see him at 3-4
weeks. If an appointment was made and you have not heard about your
appointment within 10 days contact your local physiotherapy department or
the EOC physiotherapy.
Daily Activities
You will be able to commence all activities of daily living e.g. feeding, dressing,
cooking etc as soon as you feel able to. However the operated arm can only be
used below shoulder height for the first two weeks. After this you will be able to
start increasing the movement of your shoulder above shoulder height.
Leisure Activities
Your physiotherapist and surgeon will advise you when it is safe to resume
your leisure activities. This will vary according to your leisure activity as well as
the period required to retrain your shoulder muscles with physiotherapy.
Driving /returning to work
You will be able to drive as soon as you are able to move your operated arm
comfortably and can use all controls safely. If you have any queries your
surgeon will be able to confirm when you may begin. Your return to work will
depend upon your occupation. Office workers may start as soon as the
operated arm feels comfortable, where as manual workers will have to regain
good shoulder movement and muscle strength especially where overhead
tasks are carried out. In these situations be advised by your physiotherapist
when you may return to work.
For more information contact:
Physiotherapy Department
Derby Ward
Denbies Wing
The Elective Orthopaedic Centre
Epsom General Hospital
Dorking Road
Epsom
KT18 7EG
01372 735843
Email: enquiries@eoc.nhs.uk
www.eoc.org
The EOC does not accept responsibility for the misuse of this information.