AC Joint Dislocation & Reconstruction
Guidelines for patients following Modified Weaver-Dunn procedure
for Reconstruction of the Acromioclavicular joint
Introduction
The Acromioclavicular joint (ACJ) is part of the shoulder complex. It is situated on
top of the shoulder joining the clavicle (collar bone) to the scapular (shoulder
blade).The joint can be separated (dislocated) as a result of injury. Ligaments are
torn and in severe cases surgery is required to stablise the joint.
The operation
The Modified Weaver-Dunn procedure involves utilising sound ligaments (Coraco
Acromial Ligament) to reconstruct and stabilise the joint. This reconstruction is
supported by an absorbable cord.
The operation can be performed using mini-open surgery through small 5cm incision over the top-front of the shoulder, or through keyhole surgery using 5-6 4mm stab incisions. The surgeon will suggest the most suitable technique for you.
Complications
As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation.
They include:
- Complications relating to the anaesthetic.
- Infection.
- Failure to achieve successful result.
- A need to redo the surgery.
- Injury to the nerves or blood vessels around the shoulder.
- fracture
- Prolonged stiffness and or pain.
- Implant failure
- Re-tear of the ligaments.
If you require further information please discuss with the doctors either in clinic or on admission.
You will usually be in hospital either for a day or overnight. A doctor/physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery.
GENERAL GUIDELINES
Pain
A nerve block may be used during the procedure, which means that immediately
after the operation the shoulder and arm can feel numb for a few hours. The
shoulder will be sore when this wears off and this may last for the first few weeks.
It is important that you continue to take the painkillers. Ice packs may also help
reduce pain. Wrap frozen peas/crushed ice in a damp, cold towel and place on the
shoulder for up to 15 minutes.
Wearing a sling
You will return from theatre wearing a sling with a body belt. It should be worn
under your clothes for three weeks. Only very gentle movements will be allowed
under the guidelines of your physiotherapist i.e. for hygiene. After three weeks the
body belt will be removed and you will continue to wear the sling over the clothes
for a further three weeks. At this time you will start formal physiotherapy.
The wound
Open repair: there is an incision of 5cms over the top of the shoulder. The stitch is dissolvable but may require trimming at 3 weeks. Keep the wound dry until it is well healed.
Arthroscopic (keyhole) repair: This keyhole operation usually done through five to six 4mm puncture wounds. There will be no stitches; only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.
If your wound changes in appearance, weeps fluid, pus, or you feel unwell with a high temperature, contact immediately your GP.
Posture
Before starting any activity/exercise it is important to position your shoulders
correctly. This allows normal shoulder function. Gently move your shoulder blades
down and in towards the spine but not in a braced back position.
Driving
You will not be able to drive for a minimum of 8 weeks. Your surgeon will confirm
when you may begin.
Returning to work
This will depend upon your occupation. You will need to discuss this with your
surgeon. Remember you will be completely one-handed for the first 6
weeks and all movements or activities above shoulder level should be
avoided for at least 12 weeks from your operation.
Leisure activities
Your physiotherapist and surgeon will advise you when it is safe to resume your
leisure activities.
Follow up appointments
You will be asked to make an appointment to be reviewed at The Shoulder Unit
approximately three weeks after your procedure. You will be reviewed by your
surgeon/specialist physiotherapist who will check your progress.
Progression
This is variable. Following discharge your pain will slowly decrease and you will
become more confident. After 6 weeks your physiotherapist will guide you through
an appropriate exercise programme to help you regain full function.
Exercises
You will perform only elbow, wrist and hand exercises for the first 3 weeks.Your
physiotherapist will teach you the following excursuses.
1. Keep your arm in the sling and move your hand up and down at the wrist.
2. With your arm in the sling and the elbow bent at your side, turn the hand to
face the ceiling and then the ground.
3. With arm in the sling regularly shrug shoulders up and down and circle
forwards and backwards
4. In sitting, take your arm out of the sling, bend and straighten the elbow on to
your lap.
Repeat each exercise 10 times hourly. Continue these exercises until otherwise
advised by your physiotherapist.
Download a PDF leaflet
|
