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Pag-aalis ng Distal Clavicle

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Rehabilitation after isolated arthroscopic distal clavicle excision; combined cases follow the rotator cuff repair protocol.

Updated Jun 2026
Ilustrasyon ng panlabas na dulo ng collarbone kung saan ito ay nagtatagpo sa shoulder blade.
Ang panlabas na dulo ng collarbone sa acromioclavicular joint. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay gabay sa iyong paggaling pagkatapos ng arthroscopic distal clavicle excision (tinatawag din na AC joint excision o Mumford procedure) kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton. Ang bawat yugto sa ibaba ay nagsisimula sa simpleng paliwanag kung ano ang pinakamahalaga, kasunod ng istrukturadong protocol na nakasulat para sa iyong physiotherapist; dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa physiotherapy upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong physiotherapist ay magpapatuloy sa iyo sa mga yugto batay sa kung paano gumagaling ang iyong balikat, hindi batay sa kalendaryo.

Ang protocol na ito ay para sa isolated distal clavicle excision. Kung ang iyong operasyon ay kasama rin ang rotator cuff repair, sundin ang rotator cuff repair protocol sa halip, dahil mas mabagal ang takbo ng repaired tendon. (Karaniwang pinagsasama ang distal clavicle excision sa subacromial decompression; ang protocol sa ibaba ay kumakatawan din sa kaso na iyon.)

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa clinic. Madalas na nakakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang distal clavicle excision ay nag-aalis ng ilang milimetro ng buto sa dulo ng collarbone, upang ang mga nasirang ibabaw ng AC joint (ang maliit na kasukasuan sa itaas ng iyong balikat) ay hindi na magkagaspang sa isa’t isa. Walang ginagamot na bahagi na nangangailangan ng proteksyon habang ito ay gumagaling, kaya mabilis ang rehabilitasyon: ang sling ay para sa kaginhawaan lamang at karamihan sa mga tao ay nasa labas nito sa loob ng unang isang o dalawang linggo, ang paggalaw ay nagsisimula agad, at ang mga publikadong protokol para sa operasyong ito ay lahat ay nagtutulak sa maagang paggalaw imbes na pahinga.

Dalawang bagay ang partikular sa operasyong ito at bumubuo sa protokol:

  • Ang pag-abot sa ibabaw ng katawan ang mabagal na gumagalaw. Ang mga galaw na cross-body (horizontal adduction) ay nagpapigil sa lugar kung saan tinanggal ang buto, kaya madalas silang huling mga galaw na nagiging komportable. Sa maagang yugto, ito ay disenyadong iwasan, pagkatapos ay dahan-dahang ipinapakilala muli.
  • Ang mabigat na pagpindot ang huli. Ang mga ehersisyo na naglo-load ng AC joint nang malakas (bench press, dips, at push-ups) ang huling mga bagay na babalik, karaniwan sa loob ng tatlo hanggang apat na buwan. Karamihan sa ibang mga aktibidad ay bumabalik nang mas maaga pa rito.

Ang paglalakbay sa isang tingin:

  • Yugto I — Maagang paggaling at paggalaw — linggo 0–2
  • Yugto II — Pagpapanumbalik ng iyong saklaw — linggo 2–6
  • Yugto III — Pagpapalakas at pagbabalik sa aktibidad — linggo 6–12
  • Yugto IV — Pagbabalik sa buong aktibidad — linggo 12 pataas

Karamihan sa mga tao ay gumagamit na ng braso para sa magaan na mga pang-araw-araw na gawain sa loob ng unang ilang linggo, bumabalik sa karamihan ng normal na mga aktibidad sa loob ng apat hanggang anim na linggo, at bumabalik sa sports at mas mabigat na trabaho sa pagitan ng walo hanggang labindalawang linggo. Ang mga atleta sa mga repetitibong overhead na sports (paghahagis, paglangoy, tennis) ay karaniwang kailangan ng medyo mas matagal, sa saklaw ng dalawa hanggang apat na buwan.

Yugto I — Maagang paggaling at galaw (Linggo 0–2)

Ang unang dalawang linggo ay tungkol sa pagpapababa ng sakit at pamamaga habang pinapagalaw ang balikat. Gumamit ng yelo nang regular: tatlo o apat na beses sa isang araw ang karaniwan sa unang isang o dalawang linggo. Ang sling ay para sa kaginhawaan lamang: isuot ito nang kailangan para sa kaginhawaan, palayain ang braso nang madalas, at itigil ang paggamit nito sa sandaling komportable ka nang walang ito. Maraming tao ang nakikita itong pinakamagagamit kapag nasa labas ng bahay, upang maiwasan ang pagbangga ng braso sa iba. Huwag magmaneho ng hindi bababa sa anim na linggo pagkatapos ng anumang operasyon sa balikat, kahit na matanggal na ang sling; magbibigay ng pahintulot ang iyong doktor na magmaneho, karaniwan sa pagsusuri sa ika-anim na linggo.

Magsimula agad ng paggalaw: ang iyong siko, pulso, at kamay ay dapat gumalaw mula sa unang araw, kasama ang mahinang mga ehersisyo ng pendulum at tulungan ang mga galaw ng balikat (gamit ang iyong ibang braso, isang baston, o pulley upang tulungan ang operadong braso na umangat at lumabas). Kumain ng gamot sa sakit bago ang iyong mga ehersisyo at bago ang mga appointment sa pisikal na terapiya. Ang iisang galaw na dapat iwasan sa ngayon ay ang pag-abot patungo sa kabilang balikat sa ibabaw ng katawan.

Para sa iyong pisikal na terapeuta:

Mga Layunin

  • Pagpapababa ng sakit at pamamaga
  • Maagang saklaw ng galaw: humigit-kumulang 140° ng forward flexion at 40° ng external rotation sa gilid sa pagtatapos ng yugtong ito
  • Kalayaan sa pagganap ng home exercise program

Pamamahala

  • Sling para sa kaginhawaan lamang: unahan at itigil sa loob ng unang 1–2 linggo, depende sa kaginhawaan
  • Cryotherapy 3–4 na beses sa isang araw, lalo na pagkatapos ng ehersisyo
  • Agad na aktibong saklaw ng galaw ng leeg, siko, forearms, pulso, at kamay
  • Mga ehersisyo ng pendulum mula sa unang araw
  • Passive at active-assisted na saklaw ng galaw ng balikat ayon sa kakayahan: forward elevation, external rotation, at behind-the-back internal rotation, gamit ang mga pulley, wand, o cane, at supine gravity-assisted na mga posisyon
  • Scapular setting at periscapular na saklaw ng galaw; pagtuon sa scapulohumeral rhythm mula sa simula
  • Pagpapalakas ng hawak; mahinang shoulder isometrics ayon sa pagpapababa ng sakit
  • Analgesia bago ang mga ehersisyo at sesyon ng pisikal na terapiya
  • Home program na ginagawa 3–5 na beses sa isang araw

Mga Paalala

  • Iwasan ang cross-body (horizontal) na adduction
  • Walang resisted na ehersisyo sa balikat maliban sa mahinang isometrics
  • Walang pag-angat maliban sa mga magaan na pang-araw-araw na bagay; walang weight-bearing sa pamamagitan ng braso (pagtutulak pataas mula sa upuan o kama)
  • Walang pagmamaneho sa loob ng anim na linggo (itong ito ay tumutukoy sa anumang operasyon sa balikat)

Mga Pamantayan upang magpatuloy

  • Itinapon ang sling at nagpapababa ang sakit
  • Komportableng assisted elevation hanggang humigit-kumulang 140° at external rotation hanggang humigit-kumulang 40°

Yugto II — Pagbabalik ng saklaw ng galaw (Linggo 2–6)

Kapag wala na ang sling, ang yugtong ito ay naglalayong paandarin ang balikat patungo sa ganap na paggalaw sa lahat ng direksyon: nagsisimula sa mga tinutulungan na galaw, at susunod ay sa sariling lakas ng braso. Kapag ang iyong paggalaw ay malapit na sa ganap, ang banayad na pagpapalakas ng mga kalamnan ng rotator cuff at scapula ay magsisimula gamit ang mga elastic band at magagawang bigat. Gamitin ang braso nang normal para sa mga pang-araw-araw na gawain, ngunit panatilihin ang pag-angat ng mabigat na bagay na modest (hindi hihigit sa humigit-kumulang 5 kg) at iwasan ang anumang gawain na nagpapabigat o naglalagay ng malakas na pressure sa braso. Ang pag-abot sa ibang panig ng katawan ay dahan-dahang ipinapakilala sa yugtong ito ayon sa kaginhawahan; karaniwan ang ilang pakiramdam ng pagpipitsil sa dulo ng galaw na ito at ito ay aalis sa paglipas ng panahon. Maraming tao ang nakakakita ng tulong sa pag-init bago ang pag-stretch at pag-yelo pagkatapos, at ang mas magaan na ehersisyo sa ibabang bahagi ng katawan tulad ng paglalakad, pagbibisikleta sa ehersisyo, o pagtakbo ay karaniwang muling sisimulan mula sa humigit-kumulang ika-apat na linggo.

Para sa iyong physiotherapist:

Mga Layunin

  • Ganap, o halos ganap, na aktibong saklaw ng galaw sa lahat ng mga plano sa dulo ng yugto
  • Normalisadong kinematiks ng scapulohumeral
  • Simulan ang pagpapalakas ng rotator cuff at mga kalamnan sa paligid ng scapula kapag ang aktibong saklaw ng galaw ay malapit na sa ganap

Pamamahala

  • Ipagpatuloy ang passive at active-assisted na saklaw ng galaw patungo sa aktibong saklaw sa lahat ng mga plano: flexion at elevation sa scapular-plane patungo sa ganap, external rotation sa gilid at sa 90° ng abduction ayon sa kakayahang tanggapin, internal rotation sa likod ng likod na may banayad na posterior capsular na pag-stretch
  • Dahan-dahang ipakilala ang saklaw ng cross-body adduction, gabay sa pamamagitan ng mga sintomas
  • Manual therapy at glenohumeral mobilization ayon sa kinakailangan
  • Ipagpatuloy mula sa isometrics patungo sa pagpapalakas ng rotator cuff at scapular stabilizer gamit ang elastic band kapag ang aktibong saklaw ng galaw ay malapit na sa ganap: mataas na paulit-ulit, mababang load
  • Init bago at yelo pagkatapos ng mga sesyon ayon sa kagustuhan; analgesia bago ang mga ehersisyo
  • Graduated na pagbabalik sa normal na mga pang-araw-araw na gawain; magaan na kondisyon ng ibabang bahagi ng katawan (paglalakad, stationary bike, pagtakbo) mula sa humigit-kumulang ika-apat na linggo

Mga Paalala

  • Panatilihin ang pag-angat ng magagaan na bagay: humigit-kumulang 5 kg o mas mababa sa operated na gilid
  • Iwasan ang loaded na end-range horizontal adduction at mga posisyon ng impingement
  • Walang mga ehersisyong pampindot: bench press, dips, push-ups
  • Ipagpaliban ang combined abduction–rotation (90/90) na pag-stretch kung ang balikat ay irritable

Mga Kriteryo para sa Pag-progres

  • Ganap o halos ganap na aktibong saklaw ng galaw nang walang malaking hindi komportableng pakiramdam
  • Tinatanggap na pagpapalakas gamit ang band nang walang pagtaas ng sakit

Yugong III — Pagpapalakas at pagbabalik sa aktibidad (Linggo 6–12)

Kapag bumalik na ang buong galaw, ang pokus ay naging sa pagpapatibay ng lakas at pagbabalik sa iyong ginagawa. Unti-unting pinapalalim ang resistance training mula sa bands patungo sa dumbbells para sa rotator cuff, deltoid, at mga kalamnan ng balikat, at ang mga ehersisyo ay naging mas functional: ehersisyo sa gym, paglangoy, isang gradwal na programa ng pagtatapon para sa mga thrower, at isang yugto-yugtong pagbabalik sa mga tungkulin sa trabaho at isport. Karamihan sa mga tao ay bumabalik sa isport at mas mabibigat na trabaho sa yugtong ito, sa pagitan ng humigit-kumulang walo at labindalawang linggo, na pinamumunuan ng kaginhawaan at lakas imbes na ng kalendaryo. Ang mga ehersisyong pampindot na naglalagay ng pinakamabigat na load sa AC joint (bench press, dips, at push-ups) ang huling ibabalik, na nagsisimula nang magaan at sa maikling range.

Para sa iyong physiotherapist:

Mga Layunin

  • Ibalik ang lakas, endurance, at neuromuscular control ng shoulder girdle
  • Gradwal na pagbabalik sa mga tungkulin sa trabaho, recreational na aktibidad, at sport-specific na pagsasanay

Pamamahala

  • Progressive resistance para sa rotator cuff, deltoid, at mga scapular stabilizer: mula sa bands patungo sa magagandang dumbbells, karaniwang 2–3 sets ng 8–15 repetitions
  • Magdagdag ng eccentric work, closed-chain exercise, at, sa huling bahagi ng yugong ito, mga plyometric drill kung angkop sa isport ng pasyente
  • Functional at sport-specific na pagsasanay: paglangoy, interval throwing program para sa mga thrower, mga drill ng isport sa ilalim ng controlled na kondisyon
  • Gradwal na pagbabalik sa buong mga tungkulin sa trabaho at isport, base sa mga kriterya

Mga Paalala

  • Ibalik ang mga press na naglo-load sa AC joint (bench press, dips, push-ups) sa huli: magsimula nang magaan, na may reduced na range, at iwasan ang pagbaba ng mga siko sa ibaba o sa likod ng linya ng katawan
  • Ang pag-unlad ay nananatiling nakabase sa sintomas: ang isang irritable na AC joint ay aayusin sa pamamagitan ng maikling pagbabalik sa load, hindi sa pagpilit na lumampas dito

Mga Kriteriya para Magpatuloy

  • Buong, walang sakit na functional na range of motion
  • Walang sakit o tenderness sa operated na bahagi kapag may load
  • Lakas na humahantong sa kabilang bahagi sa pagsubok

Yugong IV — Pagbabalik sa buong aktibidad (Linggo 12 pataas)

Ang huling yugong ay ang pagbabalik sa walang limitasyong aktibidad. Ang pang-araw-araw na pamumuhay at karamihan sa mga palakasan ay karaniwang naibabalik nang malayo pa bago ang puntong ito; ang natitira ay ang pinakamabigat na bahagi ng pagpapabigat. Ang lakas sa pagpindot (pressing) sa gym ay binubuo muli nang unahan-unahan, at ang pagbabalik sa dating pagganap sa bench press ay maaaring kumuha ng hanggang humigit-kumulang apat na buwan. Ang mga atleta sa mga palakasan na paulit-ulit na nakahawak sa itaas (overhead) ay dinadala pabalik sa loob ng humigit-kumulang dalawa hanggang apat na buwan mula sa operasyon. Ang buong pagbabalik sa palakasan at mabibigat na trabaho ay kumpirmado sa iyong follow-up review, batay sa buong galaw, komportableng pagpapabigat, at kasiya-siyang pagsusuri.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Walang limitasyong pagbabalik sa trabaho, gym, at palakasan
  • Panatilihin ang lakas at mekanika ng balikat (shoulder girdle) sa pangmatagalan

Pamamahala

  • Ituloy ang kondisyon na espesipiko sa gym at palakasan ayon sa kakayahang tanggapin, kabilang ang unahan-unahang mabibigat na pagpindot na may pansin sa teknik na nagbabawas ng tensyon sa AC joint (kontroladong lalim, hindi lumalampas ang mga siko sa linya ng katawan)
  • Kumpletuhin ang interval throwing at mga progresyon para sa mga palakasan sa itaas kung kinakailangan

Mga Paalala

  • Ang progresyon ay nananatiling gabay ng sintomas: ang paulit-ulit na pananakit sa lugar ng AC kasama ang isang partikular na lift ay isang senyales na baguhin ang bigat o teknik bago magpatuloy

Pagkatapos ng iyong protocol

Ang mga yugto sa itaas ay naangkop mula sa mga publikadong rehabilitation protocol para sa distal clavicle excision (Saint Louis University Department of Orthopaedic Surgery, University of Utah Sports Medicine, Sports Surgery New York, Palm Beach Orthopaedic Institute, OrthoVirginia at Specialty Physicians of Illinois), kung saan ang mga saklaw ng linggo ay inihayag bilang tipikal imbes na nakatakda. Ang iyong rehabilitation ay indibidwal na pinamumunuan ng iyong physiotherapist, na nagtatrabaho kasama ang practice, batay sa kung paano ang iyong balikat ay nagre-recover. Ang pahinang ito ay nagtatrabaho kasama ng pangkalahatang payo sa pag-recover ng practice; tingnan ang managing post-operative pain at wound care. Para sa operasyon mismo, tingnan ang distal clavicle excision.

Ang ebidensya sa klinika sa likod ng operasyong ito at ang rehabilitation nito (kasama ang paghahambing ng open-versus-arthroscopic, kung gaano karaming buto ang tinatanggal at bakit, at ang mga publikadong protocol na ginamit ng pahinang ito) ay buod sa seksyon ng ebidensya, na may buong mga sanggunian, na available bilang isang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Distal Clavicle Excision (Mumford) — Surgical Rationale & Post-operative Rehabilitation

Topic scope: the evidence underpinning distal clavicle excision (DCE) — also called distal clavicle resection, AC joint excision, or the Mumford procedure — for the two main indications (acromioclavicular [AC] joint osteoarthritis and distal clavicular osteolysis, the "weightlifter's shoulder"), and the post-operative rehabilitation that follows. Covers open vs arthroscopic technique, direct vs indirect (bursal) approach, how much bone to resect, the iatrogenic-instability risk of over-resection, and the (consensus-based) phased rehab timeline.

Defining principle of the rehab here: DCE removes a few millimetres of worn bone from the end of the collarbone and repairs nothing that needs months of protection — provided the AC ligaments and superior/posterior capsule are preserved. So (like a debridement or subacromial decompression, and unlike a cuff repair, labral repair or AC-joint stabilisation) this is an early-motion pathway: a short sling for comfort only, movement from day one, strengthening as range returns. The single important caveat runs the other way: if the surgeon resects too much bone, or the stabilising AC ligaments/capsule are violated, the joint can become iatrogenically unstable — which is why technique (resection amount, ligament preservation) matters more here than the rehab calendar. The two operation-specific quirks the rehab respects are that cross-body (horizontal adduction) movement compresses the resected area and is the slowest to settle, and heavy pressing (bench press, dips, push-ups) loads the AC joint hardest and returns last.

A. THE OPERATION & ITS INDICATIONS

DCE removes the worn or eroded outer end of the clavicle so the acromion and clavicle no longer grind at the AC joint. Two indications dominate:

  • AC joint osteoarthritis — degenerative wear, often with a history of prior AC injury or simply age-related change. Surgery follows failed non-operative care (activity modification, analgesia, AC joint corticosteroid injection).
  • Distal clavicular osteolysis ("weightlifter's shoulder") — atraumatic, repetitive-microtrauma resorption of the distal clavicle seen in weightlifters and overhead athletes. Activity modification and rehabilitation are first-line; injection or surgery is reserved for refractory cases or athletes unwilling to stop loading [StatPearls 2023; Charron 1998].

DCE is frequently combined with subacromial decompression (for room/co-existing impingement) and the rehab is unchanged by that addition. If a rotator cuff repair is also performed, the slower protected cuff-repair pathway takes over.

B. EVIDENCE BY THEME

1. Open vs arthroscopic — equivalent long-term outcome, faster arthroscopic recovery

A randomised, prospective trial (Robertson et al., corpus, DOI 10.1016/j.jse.2006.10.006) and a systematic review (Pensak et al., Arthroscopy 2010) found similar long-term functional outcomes for open and arthroscopic DCE, with both arthroscopic techniques exceeding 90% good/excellent results. Across measures there was a trend toward earlier or better outcomes after arthroscopic treatment — less post-operative pain and a quicker return to daily activities — without a difference in the final result [Robertson RCT; Pensak SR 2010]. A second comparative cohort reached the same conclusion (corpus, DOI 10.1177/0363546511419633). Moderate (RCT + SR + cohort).

2. Direct vs indirect (bursal) arthroscopic approach — direct is faster

Among arthroscopic techniques, the direct (superior, top-down) approach permits a quicker return to athletic activity than the indirect/bursal approach, with equivalent long-term results — one comparison reporting a mean return to sport of ~21 days (direct) vs ~42 days (indirect) [Pensak SR 2010; arthroscopic-approach comparison]. Moderate.

3. How much bone to resect — and why over-resection is dangerous

This is the central technical controversy and the reason DCE rehab cannot be reduced to a calendar:

  • The stabilising superior and posterior AC ligament/capsule runs from the anterior acromion to the posterior distal clavicle, and the coracoclavicular (trapezoid) ligament inserts on the clavicle undersurface roughly 22–25 mm from the tip [Renfree; capsule/ligament-insertion cadaveric study, corpus DOI 10.1016/j.arthro.2009.04.072; clavicular-strut cadaveric study, corpus DOI 10.1016/j.jse.2013.01.004].
  • Anatomic work suggests as little as ~2.3–2.6 mm of resection can begin to violate the superior AC ligament [Renfree, via PMC6930955]; biomechanical models show AC joint anteroposterior translation increases after either open or arthroscopic excision, and stability falls as the resection lengthens [Blazar; resection-length biomechanical model, corpus DOI 10.1016/j.arthro.2007.07.004; DCE-vs-symmetric-resection biomechanics, corpus DOI 10.1177/0363546512469873].
  • The practical consensus is to resect enough to abolish bony contact but no more — commonly quoted as ~5 mm (sufficient to clear contact in cadaveric models) up to ~8 mm, and not beyond ~8 mm, preserving the posterior/superior capsule and AC ligaments [PMC6930955; StatPearls 2023; resection-length biomechanics, corpus DOI 10.1016/j.arthro.2007.07.004].
  • Over-resection or capsular violation can produce iatrogenic AC instability — a recognised (though uncommon) cause of persistent pain after DCE that may itself require ligament reconstruction [iatrogenic-instability case, PMC6930955; Painful Conditions of the AC Joint, corpus DOI 10.5435/00124635-199905000-00004].

Moderate (cadaveric/biomechanical + anatomic + expert consensus); exact safe threshold is debated.

4. Outcomes & return to activity

DCE is a reliable, high-satisfaction operation for the right indication — arthroscopic series report >90% good/excellent results [Robertson RCT; Pensak SR 2010]. For osteolysis in weightlifters, an arthroscopic-resection series reported return to sport at a mean of ~3 days and to the preoperative weight-training program at ~9 days, remaining asymptomatic and able to progress load beyond pre-operative levels at ~19-month follow-up [Charron, Am J Sports Med 1998, PMID 9548111]. Across the literature, most everyday activity returns within weeks and heavy pressing/overhead sport over ~3–4 months, consistent with the published rehab protocols. Moderate (cohort). A noted exception: worse ("poor") results cluster in patients with pre-existing post-traumatic AC instability or Workers'-Compensation claims [Pensak SR 2010] — DCE alone does not fix an unstable joint.

C. PHASED POST-OPERATIVE TIMELINE (isolated DCE ± subacromial decompression)

Week ranges are typical, not fixed — progression is criteria-based, guided by the physiotherapist.

Phase Window Sling ROM / use Strengthening Operation-specific notes
I — Early recovery & movement Week 0–2 Comfort only; weaned/discarded within 1–2 weeks Elbow/wrist/hand + pendulums from day 1; passive + active-assisted shoulder elevation/ER/behind-the-back IR; scapular setting Grip; gentle isometrics as pain allows Avoid cross-body (horizontal) adduction — it compresses the resected area. No driving in the sling; no weight-bearing through the arm
II — Restoring range Week 2–6 Off Progress assisted → active ROM to full in all planes; reintroduce cross-body adduction gradually (end-range pinching is common, settles) Begin cuff + scapular band work once active range near full; lifting ≤ ~5 kg Light lower-body conditioning (walk/bike/jog) from ~wk 4
III — Strengthening & return Week 6–12 Off Full functional ROM Bands → dumbbells; functional + sport-specific; most return to sport/heavier work ~8–12 wk Reintroduce AC-loading presses (bench/dips/push-ups) last — light, shallow depth, elbows not behind the body line
IV — Return to full activity Week 12+ Off Full Progressive heavy pressing; return to previous bench performance can take ~4 months; overhead athletes progressed over ~2–4 months Symptom-guided — recurrent AC ache with a lift = adjust load/technique before progressing

The phased structure is drawn from published surgeon/physiotherapy protocols (Saint Louis University; University of Utah Sports Medicine; Sports Surgery New York; Palm Beach Orthopaedic Institute; OrthoVirginia; Specialty Physicians of Illinois — see Citations). These are consensus/expert documents; no rehab RCT defines the optimal post-DCE regimen.

D. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. How much bone to resect is the real debate, not the rehab. Too little leaves residual bony contact; too much risks iatrogenic instability. The safe window (~5–8 mm, capsule preserved) is supported by cadaveric/biomechanical and anatomic work, not by an RCT — exact thresholds vary by source. Moderate, technique-dependent.
  2. Open vs arthroscopic, direct vs indirect. Long-term outcomes converge; arthroscopic (and specifically the direct approach) recovers faster. Moderate (RCT + SR).
  3. Patient selection matters more than approach. Pre-existing AC instability and Workers'-Compensation status predict poorer results — DCE treats a worn/eroded joint, not an unstable one. Moderate.
  4. The rehab protocol itself is consensus. Phase timings come from surgeon patient-guidance protocols, not a rehab trial. Weak/consensus.

E. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE (RCT / SR): open vs arthroscopic equivalence with faster arthroscopic recovery (Robertson RCT; Pensak SR 2010, >90% good/excellent); direct > indirect for return speed.
  • MODERATE (cadaveric / biomechanical / anatomic): resection-length vs stability relationship and the iatrogenic-instability mechanism (resection-length model, corpus DOI 10.1016/j.arthro.2007.07.004; DCE-vs-symmetric biomechanics, corpus DOI 10.1177/0363546512469873; capsule/ligament insertions, corpus DOI 10.1016/j.arthro.2009.04.072).
  • MODERATE (cohort): osteolysis-in-weightlifters return-to-sport (Charron 1998); high overall satisfaction; poorer results with pre-existing instability / WorkCover.
  • WEAK / CONSENSUS: the post-operative rehabilitation protocol (surgeon patient-guidance documents; no defining rehab RCT); the exact "safe" resection threshold.

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Robertson WJ, et al. Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg. 2007. DOI: 10.1016/j.jse.2006.10.006
  • Arthroscopic versus open distal clavicle excision (comparative cohort). Am J Sports Med. 2011. DOI: 10.1177/0363546511419633
  • The biomechanical stability of distal clavicle excision versus symmetric acromioclavicular joint resection. Am J Sports Med. 2013. DOI: 10.1177/0363546512469873
  • Arthroscopic distal clavicle resection: a biomechanical analysis of resection length and joint compliance in a cadaveric model. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.07.004
  • Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.072
  • Acromioclavicular joint ligamentous system contributing to clavicular strut function: a cadaveric study. J Shoulder Elbow Surg. 2013. DOI: 10.1016/j.jse.2013.01.004
  • Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg (JAAOS). 1999. DOI: 10.5435/00124635-199905000-00004

Literature (URLs)

Published rehab protocols (patient-guidance — basis for the phase structure)

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