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Ligament Reconstruction and or Clavicle Fractur

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					                   Dr. Crawford’s Post-Operative Rehabilitation Guidelines
        Acromioclavicular (AC) Ligament Reconstruction and/or Clavicle Fracture Repair

This is an approximate schedule for rehabilitation progression; it may be modified with details shortly
  after surgery to reflect specific anatomical findings and surgical repair. See your PT description.

Phase         *Timeline                      Focus/Goals______________
Phase I       (0 to 4-8 wks)         Healing, restore joint motion (sling except for exercise)
Phase II      (4-8 to 12-16 wks)     Isometric strengthening, full joint motion (out of sling)
Phase III     (12-16 to 20 wks)      Improve strength, add isokinetics, focus on endurance
Phase IV      (20-30 weeks)          Sport/Return to specific high level activity training
*For guidelines on return to everyday activity (e.g. driving), see “General Injury Information” about
AC ligament reconstruction/Clavicle fracture repair on the website (www.crawfordsportsmedicine.com).

REMEMBER, this is a guideline for the progression of rehabilitation following this procedure(s).
Progression should take into account patient specifics including (injury type, age, size and location of
repair). For patient SPECIFIC details, consult “operative note” & most recent PT/Rehab prescription.

Phase I (0 to 4-8 weeks): Healing, pain control, and range of motion restoration
General:
       Office visit by 10-14 days with MD/PA to: check wound, provide operative note, update Rx
       Sling at all times (other than motion exercises) until indicated in operative note
       Ice, anti-inflammatories and pain medication as needed
Range of Motion:
      Active assisted shoulder motion is restricted (review OP NOTE rehab plan for exact details)
      Goal is range of motion within and to SPECIFIC limits.
      NO supine Range of motion as Scapula is fixed and may stress AC or Clavicle repair
      Limit ABDuction to ____ o x____ weeks then progress ____ o every ___week(s).
      Limit Forward Flexion to ____ o x____ weeks then progress ____ o every ___week(s).
      No limits of external rotation / internal rotation range of motion
      Elbow, wrist, hand- passive & active motion to control swelling
      May use pulleys, no pendulums
      Otherwise active motion is permitted and encouraged at:
          o Rhomboids  peri-scapular strengthening is essential
          o Biceps, triceps, wrist and hand movement to control swelling
Muscle Activation:
      Begin with RC isometrics at neutral with resistance bands
      Avoid “sling shoulder/neck pain” by focusing on good posture
      Avoid resistance more than 1-2 lbs
      Avoid internal rotation strengthening

Phase II (4-8 to 12-16 weeks): Start RC tendon strengthening, achieve full motion of shoulder
General:
       Office visit @ 8 weeks with MD/PA to: check progress, update Rehab Rx
       Sling is discontinued for daily use by this time, and often sooner, per Operative report
       Ice and anti-inflammatory medication as needed. Taper off medications
                   Dr. Crawford’s Post-Operative Rehabilitation Guidelines
        Acromioclavicular (AC) Ligament Reconstruction and/or Clavicle Fracture Repair
Range of Motion:
       Goal is normal motion; most restrictions are lifted in this period, with above progressions.
       Specific daily home stretches to allow full external/ internal rotation, abduction, and forward
       flexion as instructed by a physical therapist/trainer
Strengthening:
       Progress to active RC strengthening using band and weights at neutral
       Initiate forward flexion, scaption - low resistance, high repetitions
       Biceps/triceps strengthening – low resistance, high repetitions
       Serratus strengthening
       Push-up progression (counter, on knees, full)
       External rotation at varying degrees of ABDuction
       Prone shoulder extension, rows, and peri-scapular strengthening
       Active Diagonal 1 and 2 patterns
Criteria for progressing to Phase III:
       Shoulder range of motion 90% of uninvolved arm/normal for patient
       No signs of shoulder hiking with arm elevation
       Good scapular control

Phase III (12-16 to 20 weeks): Full strength, improve endurance and return to all activities
Office visit @ 16 weeks with MD/PA to: check progress, update Rx, clear for activities
Strength & Endurance:
       Continue with daily stretches from previous phases
       Progress resisted multi-planar strengthening (Diagonal 1 and 2 patterns)
       Progress resistance and High speed repetitions
       Internal and external rotation exercises at 90º of abduction
       Rhythmic stabilization activities
       Upper extremity weight bearing stabilization exercises
            o Latissimus pulls, bench press, flys, presses, etc. Do not break plane of body.
Criteria for progressing to Phase IV:
       Full active range of motion (more external rotation in throwing arm)
       90% strength uninvolved arm (isokinetic test for external rotations: 10 rep max)
       No impingement or compensatory movement with elevation
       Pass OHSU Shoulder Sport Test

Phase IV (20-30 weeks): Sport specific training and return to throwing
Under the direction of your PT/Trainer once cleared for all activities
Continue with maintenance strengthening and stabilization program (2-3x/week)
        Sport specific exercises
        Plyometric program (plyo-ball toss, push-up jumps, etc)
        Begin and progress throwing program (see “Throwing Program” on the website)
For instructions on definitions of exercises, please see the “Exercise Movement” section on the website