What is the Surgery for Acromioclavicular Separation

Acromioclavicular separation is an injury to the small joint at the top of the shoulder (acromioclavicular joint or AC joint). The AC joint connects the outer tip of the collarbone (clavicle) to the top of the shoulder blade (acromion).

Two strong cords of tissue (acromioclavicular ligament and coracoclavicular ligament) stretch across the AC joint to keep it in place. An AC joint separation happens when one or both ligaments stretch or tear, causing the joint to separate.

You may need surgery to repair acromioclavicular separation if your condition is severe, or if other treatment methods have not helped you. The surgery may include using a piece of tissue from your arm (tendon graft) to strengthen the AC joint.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Development of arthritis in your shoulder.
• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to blood vessels or nerves.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Other instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• An incision will be made on the top of your shoulder.
• If you are having a tendon graft:
  • An incision will be made in your forearm.
  • A piece of a tendon in your forearm will be removed to use as the graft.
  • This incision will be closed with stitches (sutures) and covered with a bandage (dressing).
• An incision will be made in the tissues that surround your AC joint (shoulder capsule).
• Ligaments that can be repaired may be stitched together or attached (anchored) to each side of your AC joint with screws.
• A small portion of bone at the tip of your clavicle may be removed.
• Holes may be made through the end of your clavicle and through your acromion.
• A suture, or the tendon graft, or both will be threaded through the holes and tightened across your AC joint to hold your joint together.
• The incision in your shoulder capsule will be closed with sutures.
• The incision in your skin will be closed with sutures or staples and covered with a dressing.
• Your arm will be placed in a sling.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may have some pain. Medicines will be available to help you.
• Do not drive for 24 hours if you received a sedative, or until your health care provider approves.

Surgery for Acromioclavicular Separation, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

Follow these instructions at home:

If you have a sling:

• Wear the sling as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the sling if your fingers tingle, become numb, or turn cold and blue.
• Do not let your sling get wet if it is not waterproof.
• Keep the sling clean.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• Keep your bandage (dressing) dry until your health care provider says it can be removed.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
• Check your incision area every day for signs of infection. Check for:

Managing pain, stiffness, and swelling

• If directed, put ice on your shoulder area.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) your shoulder above the level of your heart while you are lying down.

Driving

• Do not drive for 24 hours if you received a medicine to help you relax (sedative) during your procedure.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Do not use your arm to support your body weight until your health care provider approves.
• Do not lift or hold anything with your arm until your health care provider approves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises only as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You continue to have pain and stiffness after 6 weeks.
• You cannot do your physical therapy exercises.
• You have a fever.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You have pain that gets worse or does not get better with medicine.

Get help right away if:

• Your arm becomes numb.
• Your arm turns cold and blue.