Arthroscopic ACJ Excision

 The operation aims to remove the painful and damaged Acromioclavicular Joint (ACJ) without destabilising it. This may be damaged from injury or arthritis.

Below is an Animation of the procedure showing the bone removed from the collarbone:

Below is a view of the joint at surgery (move the mouse over the image to see the camera view):

Arthroscopic view of AC Joint

Excised AC Joint

GENERAL GUIDELINES

PAIN

A nerve block is used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes. In order to maintain a dry wound cover the dressing / wound with some cling film before applying the ice pack.

THE WOUND

 This is a keyhole operation usually done through two or three 5mm 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.

WEARING A SLING

You will return from theatre wearing a sling. This is for comfort only and should be discarded as soon as possible (usually within the first 2 to 4 days). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.

SLEEPING

• Sleeping can be uncomfortable if you try and lie on the operated arm. We recommend that you lie on your back or on the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support.

• If you are lying on your side one pillow slightly folded under your neck gives enough support for most people.

• A pillow folded in half supports the arm in front and a pillow tucked along your back helps to prevent you rolling onto the operated shoulder during the night.

• If you are lying on your back, tie a pillow tightly ion the middle (a "butterfly pillow") or use a folded pillow to support your neck. place a folded pillow under the elbow of the operated arm to support that.

DRIVING

You may begin driving one week after your operation or when you feel comfortable.

RETURNING TO WORK

This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.

LEISURE ACTIVITIES

You should avoid sustained, repetitive overhead activities for three months. With regard to swimming you may begin breaststroke as soon as you are comfortable but you should wait three months before resuming front crawl. Golf can begin at six weeks. For guidance on DIY and racquet sports you should speak with your physiotherapist.

FOLLOW UP APPOINTMENT

An appointment will be made for you to see the outpatient physiotherapist after you are discharged home and your exercises will be progressed. The amount of physiotherapy will depend on your individual. A follow up appointment with the shoulder team will be made for three weeks after your operation.

PROGRESS

This is variable. However experience shows us that by 3 weeks movement below shoulder height becomes more comfortable. By this stage you should have almost full range of movement although there will probably be discomfort when moving the arm above the head. At three months after your surgery your symptoms should be approximately 80% better and you will continue to improve for up to a year following the procedure.

POSTURE

Correct posture is one of the most important things to achieve following your surgery. It allows the shoulder to move in the way it was supposed to do without placing stresses and strains on the joint and muscles. See diagram for correct posture position.

23/03/2004