AC Joint Stabilisation
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What’s the Problem?
The collarbone has a joint at its far end with the acromion – this is called the acromio-clavicular joint (ACJ). Falls or traumatic accidents like a bike crash can lead to dislocation of this joint. There are different grades of dislocation, and surgery is usually reserved for the more severe injuries.
How can you treat it?
In some instances, non-surgical treatment is appropriate. This includes:
- Taking pain relief
- Wearing a sling for 6 weeks
- Physio to mobilise the shoulder and arm once the fracture has healed
Ultimately, surgery is only reserved for patients whose injury is severe enough that they would have symptoms of severe shoulder pain, stiffness and immobility without it.
The Operation
The ACJ can be stabilised in a number of ways. A plate with a hook on its end can be inserted, which stabilises the dislocation but requires removal after around 6 months to prevent rotator cuff irritation.
Another technique which Mr Lau uses is called a CC-ligament repair. It involves an incision over clavicle and stabilisation of the clavicle to the coracoid (another bony prominence within the shoulder) with tapes. This surgery generally does not open the ACJ itself and does not require additional surgery to remove metalware.
The Anaesthetic
You will be asleep for the duration of the operation (ie a general anaesthetic). The anaesthetist may talk to you about a nerve block before the operation, which helps with pain relief and generally lasts 24-48 hours. Alternatively, Mr Lau can put local anaesthetic into the wound whilst you are asleep, which can also help reduce pain.
What are the Risks of this Operation?
- Infection:
Usually only a superficial wound infection to the top-most layer of the skin. In rarer cases a deep infection can develop and this is a serious complication that may require further surgery and exchange of the implants. Rare but serious, <1%. - Stiffness and ongoing pain:
It is common to have shoulder stiffness for a few months after the operation. This is because your clavicle and shoulder need to be immobilised in a sling to allow the bone to heal. Physio after surgery will help with improving movement, but some shoulder rehabilitation will be required. - Damage to the nerves and blood vessels around the shoulder.
Rare but serious, <1% - Numbness:
It is not uncommon to develop numbness over the top of the wound, and occasionally down the front of the chest beneath the scar. This is because the nerves that provide sensation to that area pass along the incision site. Usually, the numbness resolves but this can take months. - Creep:
Although the tapes are tightly secured, occasionally some creep or stretching occurs as the ligaments heal. This can lead to a slight lifting of the clavicle, but does not result in any functional impairment.
Benefits
If Mr Lau recommends surgical stabilisation of your ACJ, it is because he feels you will have a better outcome with surgery. In particular, your shoulder will be more pain free, have a greater range of motion and have greater functional improvements.
What can I expect?
You will wake up with your arm in a sling after your surgery. If you have had a nerve block, you shouldn’t feel any pain till the next day. The nurses will provide you pain relief and the next morning a physio will see you to go through some exercises you can do to mobilise the fingers, wrist and elbow to prevent excessive stiffness in these joints. These exercises will change over the next few weeks to months but you should try to do them regularly to maximise your rehabilitation.
Most patients spend 1 day in hospital after surgery, before going home. A number of allied health staff (physios, occupational therapists) will make sure you have adequate support at home before discharge. An appointment will be made for you for a wound check at 2 weeks. Another appointment with Mr Lau will be at 6 weeks with repeat XRs
What should I avoid doing?
- In the first 2 weeks:
Keep your wound dry. Try to mobilise your fingers and elbow as much as possible but generally remain in the sling except for exercising and hygiene - Between 2 and 12 weeks:
Gradually use the sling less and less. You will have no restrictions in moving your shoulder but should limit lifting to lighter objects like a phone or cup. - After 12 weeks:
No restrictions including no lifting restrictions.
Return to…?
- Work
Depends what you do. Desk based work can be done from 2 weeks post operatively, if you can do these tasks single handedly. Otherwise generally 6 weeks before you can use both arms freely whilst seated.
For manual work, it depends on what kind of lifting/pushing you do, but generally not before 3 months - Drive
In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst you’re in a sling, you cannot drive. Generally 6 weeks post operatively. - Sports/Hobbies:
- Gentle swimming: after 6 weeks (breaststroke, not freestyle)
- Gardening (light tasks only): 8-12 weeks
- Bowls: after 3 months
- Golf, tennis, badminton, squash: after 4-6 months
- Weights: commence after 3 months
Concerns or questions?
If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au
If you need urgent medical help, call 000 or go to your nearest emergency department.
Rehabilitation protocols
These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.