Arthroscopic Assisted Acromicoclavicular/Coracoclavicular Joint Reconstruction

Initial recovery after shoulder surgery entails healing, controlling swelling and discomfort and regaining some shoulder motion. The following instructions are intended as a guide to help you achieve these goals until your 1^stpostoperative visit.

COMFORT
- Cold Therapy
  - If you elected to receive the circulating cooling device, this can be used continuously for the first 3 days, (while the initial post-op dressing is on). After 3 days, the cooling device should be applied 3 times a day for 20-30 minute intervals.
  - If you elected to receive the gel wrap, this may be applied for 20 minutes on, 20 minutes off as needed. You may apply this over the post-op dressing. Once the dressing is removed, be sure to place a barrier (shirt, towel, cloth, etc.) between your skin and the gel wrap.
  - If you elected to use regular ice, this may be applied for 20 minutes on, 20 minutes off as needed. You may apply this over the post-op dressing. Once the dressing is removed, be sure to place a barrier (shirt, towel, cloth, etc.) between your skin and the gel wrap.
- Medication
  - Pain Medication-Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication.
    - You have been provided a narcotic prescription postoperatively. Use this medication sparingly for moderate to severe pain.
    - You are allowed two (2) refills of your narcotic prescription if necessary.
    - When refilling pain medication, weaning down to a lower potency or non-narcotic prescription is recommended as soon as possible.
    - Extra strength Tylenol may be used for mild pain.
    - Over the counter anti-inflammatories (Ibuprofen, Aleve, Motrin, etc.) shoulder be avoided for the first 4 weeks following surgery.
  - Anti-coagulation medication: A medication to prevent post-operative blood clots has been prescribed (Aspirin, Lovenox, etc.) This is the only medication that MUST be taken as prescribed until directed to stop by Dr. Forsythe.
  - Nausea Medication – Zofran (Odansetron) has been prescribed for nausea. You may take this as needed per the prescription instructions.
  - Constipation Medication -Colace has been prescribed for constipation. Both your pain medication and the anesthesia can cause constipation. Take this as needed.
- Driving – Driving is NOT permitted as long as the sling is necessary.

ACTIVITIES
- You are immobilized with a sling and abductor pillow, full time, for approximately the first 6 weeks. Your doctor can tell you when you can discontinue use of the sling at your 1^stpostoperative visit. The sling may be removed for exercises.
- Range-of-Motion Exercises – Your sling may be removed for gentle elbow and wrist range-of-motion exercises.
  - While your sling is off you should flex and extend your elbow and wrist – (3x a day for 15 repetitions) to avoid elbow stiffness.You can shrug your shoulders.
  - Ball squeezes should be done in the sling (3x a day for 15 squeezes).
  - You may NOT move your shoulder by yourself in certain directions. NO active flexion (lifting arm up) or abduction (lifting arm away from body) until Dr. Forsythe or your therapist gives permission. These exercises must be done by someone else (Passive Range of Motion).
  - Physical therapy will begin approximately 2-4 weeks after surgery. Make an appointment with a therapist of your choice for this period of time. You have been given a prescription and instructions for therapy. Please take these with you to your first therapy visit.
  - Athletic activities such as throwing, lifting, swimming, bicycling, jogging, running, and stop-and-go sports should be avoided until cleared by Dr. Forsythe.

WOUND CARE
- Bathing - Tub bathing, swimming, and soaking of the shoulder should be avoideduntil allowed by your doctor - Usually 2-3 weeks after your surgery. Keep the dressing on, clean and dry for the first 3 days after surgery.
  - You may shower 3 days after surgery with band-aids on. Apply new band-aids after showering.
- Dressings - Remove the dressing 3 days after surgery. You may apply band-aids to the small incisions around your shoulder

EATING
- Your first few meals, after surgery, should include light, easily digestible foods and plenty of liquids, since some people experience slight nausea as a temporary reaction to anesthesia

CALL YOUR PHYSICIAN IF:
- Pain in your shoulder persists or worsens in the first few days after surgery.
- Excessive redness or drainage of cloudy or bloody material from the wounds (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor.
- You have a temperature elevation greater than 101°
- You have pain, swelling or redness in your arm or hand.
- You have numbness or weakness in your arm or hand.

RETURN TO THE OFFICE
- Your first return to our office should be within the first 1-2 weeks after your surgery. Call your physician’s office to make an appointment for this first post-operative visit.

REHABILITATION PROGRAM:

Arthroscopic Assisted Acromicoclavicular/Coracoclavicular Joint Reconstruction

SLING:8 Weeks in sling with 30 degree abduction pillow and support under elbow to keep repair without stress

0 to 6 Weeks:

PROM: ER in the plane of scapula, forward elevation (FE) to 90°

Avoid – Any position or motion that causes accessory movement of the scapula (IR, elevation past 90°, and horizontal adduction)

6 to 12 Weeks:

PROM: FE past 90° as tolerated and IR in the plane of the scapula supervised to prevent any accessory motion of the scapula (no IR towel stretching)

AAROM: ER as tolerated FE to 90°

ISOMETERICS: Initiated at 10 weeks

Avoid – towel IR stretching (stressful to reconstruction), horizontal abduction