Arthroscopic AC Joint Repair

Arthroscopic AC Joint Repair Overview

The acromioclavicular (AC) joint is the area where the clavicle (collarbone) attaches to the acromion (roof of the shoulder). The AC joint is stabilized by strong ligaments, coracoclavicular (CC) ligaments, which attach the clavicle to the front of the scapula (shoulder blade). The AC joint and the surrounding structures can become injured from a direct blow to the area during sports activities, a fall or automobile accident. The trauma can cause the collarbone and roof of the shoulder to no longer sit next to each other, referred to as an AC separation. While mild AC separations can be treated with rest, physical therapy and a sling, more severe cases may require an arthroscopic AC joint repair.

Dr. Nikhil Verma, orthopedic shoulder surgeon serving the Chicago, Westchester, Oak Brook and Hinsdale, Illinois area, specializes in AC joint repair and AC revision surgery.

AC joint injuries are measured based on grades. A grade 1 or 2 AC injury will cause pain and is commonly caused by a sprain or stretch. A grade 3, 4, 5 or 6 AC injury typically means a ligament tear is present and an arthroscopic AC joint repair will be needed to alleviate chronic shoulder pain and weakness.

Dr. Verma typically performs an AC joint repair arthroscopically on an out-patient basis. The goal of the shoulder surgery is to secure the collarbone back to its normal position by attaching strong sutures to the front of the shoulder blade and to the collarbone. This technique is often accompanied by reconstruction of the CC ligaments, which involves looping a donated graft from the front of the shoulder blade to the top of the collarbone.

AC revision surgery is also performed as an arthroscopic technique by Dr. Verma and is reserved for patients who have experienced a failed AC joint repair. The exact AC revision surgery varies for each patient since each case has a unique original injury and failed treatment.

Recovery and Rehabilitation after Arthroscopic AC Joint Repair

All patients will be expected to wear a sling for numerous weeks to protect the arm and keep it immobile following surgery. Physical therapy focused on shoulder range of motion will begin shortly after AC joint repair or AC revision surgery. As the ligaments heal, a physical therapist will progressively strengthen the joint and discard the sling. Patients can expect a full recovery and return to sports activities in three to four months in many cases.

What are the symptoms of an AC joint injury?

An AC joint injury, also known as a separated shoulder, is an injury to the acromioclavicular joint. The symptoms include: Intense pain as soon as the injury occurs. Joint pain ranging from mild tenderness to intense, sharp pain felt primarily on the top of the shoulder. Bruising and swelling in the shoulder. Weakness and visible deformity.

What are some good AC joint injury exercises?

AC joint exercises involve range of motion and strengthening activities as advised by Dr. Verma and his specialized team of physical therapy experts. Depending on the grade of AC joint separation or shoulder separation, exercises may begin with simple range of motion such as rotating the shoulder and working up to lifting the arm forward and to the side. Under the direction of Dr. Verma’s team, patients can begin wand or stick exercises, holding a light-weight object and lifting the arm in various positions. Please see Dr. Verma’s team before attempting AC joint injury exercises on your own, to assure proper healing of the shoulder separation.

What is the recovery time from an AC joint repair?

The typical recovery time for patients in good health is usually around 6 months after surgery. At this time, patients are allowed to return to sporting and regular activities.  Initially, following surgery, patients are asked to wear a sling for several weeks to protect the healing AC joint. After the six weeks, full range of motion is quickly re-established with the help of physical therapy and special exercises. After the ligaments have healed, patients will be allowed to use strengthening exercises to restore normal function.

Can a separated Shoulder heal without surgery?

The short answer is yes, patients can heal from a separated shoulder without surgery.  A large percentage of patients may be able to avoid surgery and function normally, although some cosmetic deformity may remain.  Non-surgical treatment may include use of a shoulder sling and shoulder immobilization.  The use of a shoulder sling will help with pain and proper healing. A combination of ice, rest and physical therapy may be used to help strengthen the muscles around the shoulder joint.  Some patients have benefited from the use of non-steroidal anti-inflammatory medication to reduce swelling and aid in healing. Corticosteroid injections may also help with pain management and healing of the shoulder joint in certain situations.

How do you treat an AC joint separation?

AC joint separations can be treated surgically or non-surgically, depending on the amount of damage the shoulder has sustained with the separation.

Surgical treatment can often be done arthroscopically, with minimally-invasive surgery. If the AC separation is complex, involving torn muscles and ligaments, open surgery is also a viable option for complete repair.

Non-surgical treatment involves rest, ice and immobilization of the shoulder joint with the use of a sling. Physical therapy is recommended by Dr. Verma to avoid further dislocations and to strengthen the surrounding shoulder ligaments and muscles.

Does the AC joint bump go away?

An AC joint bump is caused by the separation of the shoulder joint, when the edge of the scapula is separated from the shoulder blade. This can cause a visible bump, or malformation on the shoulder. In the case of a sprain, the ligaments heal in this position, so the bump does not go away. It is possible to have surgery to correct the bump, but normal shoulder function will usually return even without surgery.

What is a failed AC joint?

A failed AC joint can occur if the patient continues to experience pain and overall a low functioning level following AC joint surgery. Since AC joint injuries, including those requiring surgical intervention, are highly common, complications are also commonly seen. Revision AC joint repair is reserved for patients who have experienced a failed surgery in the past. Often, patients may require a revision procedure if poor rehabilitation efforts were involved after the first AC joint treatment.

For more information on AC joint injuries, or to learn more about arthroscopic AC joint repair and AC revision surgery, please contact the office of Dr. Nikhil Verma, orthopedic shoulder surgeon treating patients in the Chicago, Westchester, Oak Brook and Hinsdale, Illinois area.