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AC joint dislocations (shoulder separations) are common shoulder injuries and in most cases can be managed without surgery. When indicated, surgery produces a more reliable outcome for younger patients and for those who work overhead or in a manual capacity.
Patients stay in hospital overnight and wear a sling for 6 weeks. A day surgery procedure is required at 3 months to remove hardware; and strengthening is commenced just after 3 months postoperatively.
The principle of ACJ stabilisation surgery is to bring the acromion and distal clavicle (end of the collarbone) back into alignment and hold them in that position to allow the torn ligaments to heal over 3 months. There are various techniques to stabilise the AC Joint.
Generally speaking, Grade I and II injuries do NOT need surgery and will do fine with a sling, analgesia and physiotherapy.
Grade III injuries are often managed without surgery; however, in select cases, they may do better with surgery – this is a case by case decision.
Grade IV, V and VI injuries should be stabilised. This is because they are inherently unstable and if left untreated will reliably result in loss of shoulder function, particularly with overhead activity.
Sportspersons and those with occupations that require their arm to be at chest height or higher should be treated with more consideration and offered earlier surgery when appropriate.
Most patients report a sense of “relief” after their AC joint is stabilised and can commence light activity with the operated arm (such as self-care, feeding, and using a mobile phone) immediately.
There are three essential components to a good outcome from surgery:
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
A sling is required for the first 6 weeks after your surgery. The following 6 weeks it is worn as required.
The plate is routinely removed at 3 months post-surgery. It is important that while the hook plate is in your shoulder that you do NOT raise your arms above shoulder height. Once the plate is removed there are no restrictions to your shoulder range of motion or activity.
Driving after shoulder surgery
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.
The risk of complications after Acromioclavicular Joint stabilisation surgery is less than 1% in the Sydney Shoulder Unit experience. General risks include:
Reoperation and failure of Acromioclavicular Joint stabilisation surgery
Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with ACJ stabilisation shoulder surgery and are unlikely to have complications.
The outcome after Acromioclavicular Joint stabilisation surgery is excellent; most patients report a feeling of the shoulder being stable and secure the day after surgery; and by two weeks they are back to basic things around the house. At 3 months, after the plate is removed, patients can commence overhead shoulder activity and strengthening exercises. Contact sport is allowed 4-6 months from surgery.
Dr Sushil Pant is a leading Australian trained orthopaedic shoulder surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
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Alternatively, if you have any further questions or would like a consultation with Dr Pant get in touch:
Dr Sushil Pant is a leading Australian trained Orthopaedic Shoulder Surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
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