AC Joint Reconstruction Surgery Rehab Protocol & Recovery

Acromioclavicular (AC) joint reconstruction rehab protocol

General Considerations

  • DO NOT elevate surgical arm above 70 degrees in any plane for the first 4 weeks post-op (active/passive range of motion). Arm sling is used for 4 weeks post-op.
  • Regular manual treatment should be conducted.
  • Avoid direct palpation and mobilization on incisions/portals for 4 weeks.
  • DO NOT lift any objects over 5 pounds with the surgical arm for the first 6 weeks.
  • AVOID EXCESSIVE reaching and external/internal rotation for the first 6 weeks.
  • Maintain good upright shoulder girdle posture at all times and especially during sling use.

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Weeks 1 - 4

  • Max protection phase
  • Nurse appt post op day 2 to check dressings.
  • Nurse appt for suture removal on day 14.
  • Use sling for 4 weeks.
  • Ice every 2 hours for 15 minutes to minimize edema and promote healing.


  • Soft tissue treatment to biceps, triceps, posterior RTC, cervical/scapular/forearm musculature, and hand -Avoid direct scar mobilization.
  • Passive range of motion to shoulder: all directions under 70 degrees.
  • PNF for elbow and wrist flexion/extension.
  • Manual resisted scapular isometrics performed.

Exercise performed 3x day:

  • Pendulun, ball squeezes.
  • Starting at week 2- begin light resistance pain-free strengthening for triceps and biceps training with theraband in neutral.
  • Shoulder isometrics in neutral; external rotation, internal rotation, shoulder abduction, adduction, extension and flexion.
  • Well body exercises: squats, lunges, step ups, bridges, stationary biking.


  • Pain <3/10, minimal edema. Passive range of motion at 70 degrees in flexion, scaption, and abduction.

Weeks 4 - 8

  • Moderate protection phase
  • MD visit at 4 weeks.
  • Discontinue sling.


  • Continue with soft tissue mobilization.
  • Apply gentle scar tissue mobilization; can use instruments/tools for scar mobilization towards week 6.
  • Initiate active and light manual resistance exercises: mid-range external/internal rotation (without shoulder elevation; DO NOT go into end-range of motion.


  • No pain, no edema.
  • Active/passive range of motion : shoulder flexion, scaption and abduction to 90 degrees, external rotation to 70 degrees in neutral, internal rotation full range of motion in neutral.

Weeks 8 – 12

  • Return to functional mobility phase
  • MD appt at 12 weeks, no overhead lifting.


  • Continue soft tissue mobilization as needed.
  • Manual mobilization to glenohumeral and scapulothoracic joint as needed.


  • Wand exercises.
  • Shoulder pulley/range of motion exercises.
  • Scapular training: rows, protraction, lower trapezium work.


  • Near-full shoulder range of motion in all planes.
  • Good scapular strength and stability demonstrated with range of motion.

Weeks 12

  • Return to strengthening phase
  • MD appt at 1 year post-op.


  • Continue soft tissue mobilization as needed.
  • Manual mobilization to glenohumeral and scapulothoracic joint as needed, continue with full range of motion goals.


  • Initiate rotator cuff strengthening: resisted, begin weight bearing activities in prone and quadruped.
  • 4 months: triplanar/sport-specific strengthening at a low intensities: Thrower’s program.


  • Full range of motion achieved in all planes of shoulder.
  • Strength and stability achieved for sport.
  • Full weight-bearing tolerated in shoulder by 6 months.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.