Acromioclavicular (AC) Joint Reconstruction Rehabilitation
What is the acromioclavicular joint?
The acromioclavicular (AC) joint sits at the top of the shoulder, where the outer end of the clavicle (collarbone) meets the acromion — the bony projection of the shoulder blade. It is stabilised by the acromioclavicular ligament and the coracoclavicular ligaments (conoid and trapezoid), which together maintain the normal relationship between the clavicle and the scapula and allow the shoulder to transmit forces between the arm and the trunk.
AC joint injuries — commonly called a separated shoulder — are graded from type I (mild sprain of the AC ligament) through to type VI (severe disruption with significant displacement), with the Rockwood classification system most widely used. Type I and II injuries are managed conservatively. Type III injuries are debated — conservative management is appropriate for most patients, with surgery considered selectively. Type IV, V and VI injuries — involving significant displacement and disruption of the coracoclavicular ligaments — generally require surgical reconstruction.
What does reconstruction involve?
AC joint reconstruction aims to restore the normal relationship between the clavicle and the coracoid process of the scapula by reconstructing the coracoclavicular ligaments. Various techniques exist, including use of a synthetic ligament, a tendon graft (either from the patient or from a donor), or anatomical reconstruction using the patient's own tissue. The clavicle may be reduced to its normal position and held temporarily with a hook plate that is removed in a second procedure, or stabilised with ligament reconstruction alone.
The specific technique used by your surgeon influences the rehabilitation protocol — hook plate reconstructions have specific precautions around shoulder elevation during the period the plate is in situ, and anatomical ligament reconstructions may have different loading progression timelines. Your physiotherapist will work within the framework your surgeon provides.
Why is physiotherapy essential after AC joint reconstruction?
The surgery restores the structural anatomy — but the surrounding rotator cuff, deltoid, periscapular and upper limb muscles have been through significant trauma, surgical disruption, and immobilisation. The shoulder's complex movement system needs systematic rehabilitation to restore the strength, neuromuscular control and movement quality needed for functional return to daily life and sport.
AC joint injuries also frequently disrupt the normal force couple between the rotator cuff and deltoid that governs glenohumeral joint mechanics, and the normal rhythm between the glenohumeral and scapulothoracic joints that allows smooth, pain-free shoulder elevation. Restoring these patterns is central to rehabilitation — a shoulder that achieves full range of motion but with poor muscle coordination and scapular control is not a well-rehabilitated shoulder.
What does rehabilitation involve?
In the first four to six weeks, the arm is typically held in a sling and shoulder movement is restricted to protect the reconstruction while early healing occurs. Physiotherapy during this phase focuses on hand, wrist and elbow range-of-motion exercises to prevent stiffness spreading beyond the shoulder, pendulum exercises for gentle shoulder movement, and isometric exercises for the muscles that can be activated without stressing the reconstruction. Postural education and positioning advice reduce discomfort and prevent the forward-rounded posture that develops rapidly when a shoulder is immobilised.
From six to twelve weeks, as the reconstruction gains strength and sling use is discontinued, active shoulder range-of-motion is progressively restored. Rotator cuff strengthening begins gently — initially with the arm at the side and limited elevation — and scapular stabilisation work begins in earnest. This phase requires careful progression — too aggressive an approach risks reconstruction failure, too conservative an approach allows shoulder stiffness and muscle wasting to become established.
From three to six months, progressive strengthening through increasing ranges of shoulder motion, proprioceptive and neuromuscular control training, and sport-specific upper limb conditioning are introduced. Return to contact sport — which is the context in which most AC joint injuries occur — requires specific clearance from the surgeon and objective demonstration that the shoulder has adequate strength and stability to withstand the demands of the sport.
Clinical Pilates integrates well into the mid and later rehabilitation phases, providing controlled shoulder and scapular strengthening in positions that can be precisely progressed. Real time ultrasound assists in retraining rotator cuff and lower trapezius activation where inhibition from pain and surgery is affecting movement quality.
For patients whose AC joint injury occurred in a workplace accident or motor vehicle incident, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have post-surgical shoulder rehabilitation experience and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
The acromioclavicular (AC) joint sits at the top of the shoulder, where the outer end of the clavicle (collarbone) meets the acromion — the bony projection of the shoulder blade. It is stabilised by the acromioclavicular ligament and the coracoclavicular ligaments (conoid and trapezoid), which together maintain the normal relationship between the clavicle and the scapula and allow the shoulder to transmit forces between the arm and the trunk.
AC joint injuries — commonly called a separated shoulder — are graded from type I (mild sprain of the AC ligament) through to type VI (severe disruption with significant displacement), with the Rockwood classification system most widely used. Type I and II injuries are managed conservatively. Type III injuries are debated — conservative management is appropriate for most patients, with surgery considered selectively. Type IV, V and VI injuries — involving significant displacement and disruption of the coracoclavicular ligaments — generally require surgical reconstruction.
What does reconstruction involve?
AC joint reconstruction aims to restore the normal relationship between the clavicle and the coracoid process of the scapula by reconstructing the coracoclavicular ligaments. Various techniques exist, including use of a synthetic ligament, a tendon graft (either from the patient or from a donor), or anatomical reconstruction using the patient's own tissue. The clavicle may be reduced to its normal position and held temporarily with a hook plate that is removed in a second procedure, or stabilised with ligament reconstruction alone.
The specific technique used by your surgeon influences the rehabilitation protocol — hook plate reconstructions have specific precautions around shoulder elevation during the period the plate is in situ, and anatomical ligament reconstructions may have different loading progression timelines. Your physiotherapist will work within the framework your surgeon provides.
Why is physiotherapy essential after AC joint reconstruction?
The surgery restores the structural anatomy — but the surrounding rotator cuff, deltoid, periscapular and upper limb muscles have been through significant trauma, surgical disruption, and immobilisation. The shoulder's complex movement system needs systematic rehabilitation to restore the strength, neuromuscular control and movement quality needed for functional return to daily life and sport.
AC joint injuries also frequently disrupt the normal force couple between the rotator cuff and deltoid that governs glenohumeral joint mechanics, and the normal rhythm between the glenohumeral and scapulothoracic joints that allows smooth, pain-free shoulder elevation. Restoring these patterns is central to rehabilitation — a shoulder that achieves full range of motion but with poor muscle coordination and scapular control is not a well-rehabilitated shoulder.
What does rehabilitation involve?
In the first four to six weeks, the arm is typically held in a sling and shoulder movement is restricted to protect the reconstruction while early healing occurs. Physiotherapy during this phase focuses on hand, wrist and elbow range-of-motion exercises to prevent stiffness spreading beyond the shoulder, pendulum exercises for gentle shoulder movement, and isometric exercises for the muscles that can be activated without stressing the reconstruction. Postural education and positioning advice reduce discomfort and prevent the forward-rounded posture that develops rapidly when a shoulder is immobilised.
From six to twelve weeks, as the reconstruction gains strength and sling use is discontinued, active shoulder range-of-motion is progressively restored. Rotator cuff strengthening begins gently — initially with the arm at the side and limited elevation — and scapular stabilisation work begins in earnest. This phase requires careful progression — too aggressive an approach risks reconstruction failure, too conservative an approach allows shoulder stiffness and muscle wasting to become established.
From three to six months, progressive strengthening through increasing ranges of shoulder motion, proprioceptive and neuromuscular control training, and sport-specific upper limb conditioning are introduced. Return to contact sport — which is the context in which most AC joint injuries occur — requires specific clearance from the surgeon and objective demonstration that the shoulder has adequate strength and stability to withstand the demands of the sport.
Clinical Pilates integrates well into the mid and later rehabilitation phases, providing controlled shoulder and scapular strengthening in positions that can be precisely progressed. Real time ultrasound assists in retraining rotator cuff and lower trapezius activation where inhibition from pain and surgery is affecting movement quality.
For patients whose AC joint injury occurred in a workplace accident or motor vehicle incident, WorkCover and CTP funded rehabilitation is available.
Our physiotherapists Bethany Kippen and Emma Cameron both have post-surgical shoulder rehabilitation experience and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
