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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. Bawat yugto sa ibaba ay nagsisimula sa simpleng paliwanag kung ano ang pinakamahalaga, kasunod ng estrukturadong 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 opisina. Madalas ay 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 balikat) ay hindi na magkuskos sa isa’t isa. Walang ginagamot na bahagi na kailangang protektahan habang nagpapagaling, kaya mabilis ang rehabilitasyon: ang sling ay para sa kaginhawaan lamang at karamihan ay naglalabas 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 tiyak sa operasyong ito at bumubuo sa protokol:

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

Ang paglalakbay sa isang tingin:

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

Karamihan ay gumagamit ng braso para sa magaan na 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 isports at mas mabigat na trabaho sa pagitan ng walo hanggang labingdalawang linggo. Ang mga atleta sa mga isport na paulit-ulit na overhead (pagtapon, paglangoy, tennis) ay karaniwang kailangan ng kaunti pang oras, 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 kaginhawahan lamang: isuot ito nang kailangan mo ito para sa kaginhawahan, alisin ang braso nang madalas, at itigil ang paggamit nito sa sandaling komportable ka nang walang ito. Maraming tao ang nakikita itong pinakamagana kapag nasa labas ng bahay, upang maiwasan ang pagbangga ng braso ng iba. Huwag magmaneho habang naka-sling.

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

Para sa iyong pisyoterapeuta:

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 dulo ng yugtong ito
  • Kalayaan sa paggawa ng home exercise program

Pamamahala

  • Sling para sa kaginhawahan lamang: unahan at itigil sa loob ng unang 1–2 linggo, ayon sa kaginhawahan
  • 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
  • Pasibo at aktibo-tulong na saklaw ng galaw sa balikat ayon sa kakayahan: forward elevation, external rotation, at behind-the-back internal rotation, gamit ang mga pulley, wand o baston, at supine gravity-assisted na mga posisyon
  • Scapular setting at periscapular saklaw ng galaw; pagtuon sa scapulohumeral rhythm mula sa simula
  • Pagpapalakas ng hawak; mahinang shoulder isometrics ayon sa sakit
  • Analgesia bago ang mga ehersisyo at sesyon ng pisyoterapi
  • Home program na ginagawa 3–5 na beses sa isang araw

Mga Paalala

  • Iwasan ang cross-body (horizontal) adduction
  • Walang resisted shoulder exercise maliban sa mahinang isometrics
  • Walang pag-angat maliban sa magaan na mga pang-araw-araw na bagay; walang weight-bearing sa pamamagitan ng braso (pagtutulak pataas mula sa upuan o kama)
  • Walang pagmamaneho habang naka-sling

Mga Kriteryo para sa pag-usad

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

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

Kapag wala na ang sling, ang yugong na ito ay naglalayong paunlarin ang balikat patungo sa buong saklaw ng galaw sa lahat ng direksyon: nagsisimula sa mga galaw na may tulong, at pagkatapos ay sa sariling lakas ng braso. Kapag malapit na sa buong saklaw ang iyong galaw, magsisimula ang banayad na pagpapalakas ng mga kalamnan ng rotator cuff at scapula gamit ang mga elastic band at magaan na timbang. Gamitin ang braso nang normal para sa mga gawain sa araw-araw, ngunit panatilihin ang pag-angat ng mga bagay na magaan (hindi hihigit sa humigit-kumulang 5 kg) at iwasan ang anumang gawain na nagpapabigat o naglalagay ng malakas na puwersa sa braso. Ang pag-abot sa ibang gilid ng katawan ay dahan-dahang ipinapakilala sa yugong na ito ayon sa kaginhawahan; karaniwan ang ilang pakiramdam ng pagpipitsil sa dulo ng galaw na ito at ito ay mawawala sa paglipas ng panahon. Maraming tao ang nakakakita ng benepisyo sa paggamit ng init bago ang pag-stretch at yelo pagkatapos, at ang mas magaan na ehersisyo sa ibabang bahagi ng katawan tulad ng paglalakad, pagbibisikleta sa exercise bike, o pagtakbo ay karaniwang muling sisimulan mula sa humigit-kumulang ika-apat na linggo.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Buong, o halos buong, aktibong saklaw ng galaw sa lahat ng mga plano sa dulo ng yugong
  • Normalisadong kinematiks ng scapulohumeral
  • Simulan ang pagpapalakas ng rotator cuff at mga kalamnan ng scapula (periscapular) kapag ang aktibong saklaw ng galaw ay halos buo na

Pamamahala

  • Pag-usad mula sa passive at active-assisted range of motion patungo sa active range sa lahat ng mga plano: flexion at elevation sa scapular plane patungo sa buong saklaw, external rotation sa gilid at sa 90° ng abduction ayon sa kakayahang tanggapin, internal rotation sa likod ng likod na may banad na posterior capsular stretching
  • Dahan-dahang ipakilala ang saklaw ng cross-body adduction, gabay sa pamamagitan ng mga sintomas
  • Manual therapy at glenohumeral mobilization kung kinakailangan
  • Pag-usad mula sa isometrics papuntang pagpapalakas ng rotator cuff at scapular stabilizer gamit ang elastic band kapag ang aktibong saklaw ng galaw ay halos buo na: mataas na repetitions, 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 gawain sa araw-araw; 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 mga bagay na magaan: humigit-kumulang 5 kg o mas mababa sa operated na gilid
  • Iwasan ang loaded end-range horizontal adduction at mga posisyon ng impingement
  • Walang mga ehersisyong pampresing: bench press, dips, push-ups
  • I-defer ang combined abduction–rotation (90/90) stretching kung ang balikat ay irritable

Mga Kriteryo para sa Pag-usad

  • Buong o halos buong aktibong saklaw ng galaw nang walang malaking kahirapan
  • Tinatanggap ang 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 mga ginagawa mo. Unti-unting paglilipat mula sa mga rubber bands patungo sa mga dumbbell ang resistance training para sa rotator cuff, deltoid, at mga kalamnan ng balikat, at nagiging mas functional ang mga ehersisyo: ehersisyo sa gym, paglangoy, isang gradwadyadong programa ng pagtatapon para sa mga manlalaro ng baseball/softball, 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 pinakamaraming stress sa AC joint (bench press, dips, at push-ups) ang huling babalikan, na nagsisimula nang magaan at sa maikling saklaw.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Ibalik ang lakas, endurance, at neuromuscular control ng shoulder girdle
  • Gradwadyadong pagbabalik sa mga tungkulin sa trabaho, recreational na aktibidad, at pagsasanay na espesipiko sa isport

Pamamahala

  • Progressive resistance para sa rotator cuff, deltoid, at mga scapular stabilizer: mula sa mga rubber bands patungo sa magagang dumbbell, karaniwang 2–3 sets ng 8–15 repetitions
  • Magdagdag ng eccentric work, closed-chain exercise, at, sa huling bahagi ng yugto, mga plyometric drill kung angkop sa isport ng pasyente
  • Functional at sport-specific training: paglangoy, interval throwing program para sa mga manlalaro ng baseball/softball, mga drill ng isport sa ilalim ng kontroladong kondisyon
  • Gradwadyadong pagbabalik sa buong mga tungkulin sa trabaho at isport, batay sa mga kriterya

Mga Paalala

  • Ibalik ang mga press na naglalagay ng stress sa AC joint (bench press, dips, push-ups) sa huli: magsimula nang magaan, na may pinababang saklaw, at iwasan ang pagbaba ng mga siko sa ilalim o sa likod ng linya ng katawan
  • Ang pag-unlad ay nananatiling batay 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 range of motion
  • Walang sakit o tenderness sa operadong bahagi kapag may load
  • Lakas na humahantong sa kabilang bahagi sa pagsusuri

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 malaki bago pa dumating ang puntong ito; ang natitira ay ang pinakamabigat na dulo ng pagbebenta. Ang lakas sa pagpindot sa gym ay muling binubuo 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 nakataas ang kamay ay dahan-dahang ibinabalik sa loob ng humigit-kumulang dalawa hanggang apat na buwan mula sa operasyon. Ang buong pagbabalik sa palakasan at mabigat na trabaho ay kumpirmado sa iyong follow-up review, batay sa buong galaw, komportableng pagbebenta, at kasiyadong pagsusuri.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Walang limitasyong pagbabalik sa trabaho, gym, at palakasan
  • Panatilihin ang lakas at mekanika ng balikat sa mahabang panahon

Pamamahala

  • Ituloy ang kondisyon na espesipiko sa gym at palakasan ayon sa kakayahin, kabilang ang progresibong mabigat 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 sa palakasan na nakataas ang kamay kung kinakailangan

Mga Paalala

  • Ang pag-unlad ay nananatiling gabay ng sintomas: ang paulit-ulit na pananakit sa ibabaw ng AC area kasama ang partikular na lift ay isang senyales na baguhin ang load o teknik bago magpatuloy

Pagkatapos ng iyong protokol

Ang mga yugto sa itaas ay naangkop mula sa mga publikadong protokol ng rehabilitasyon 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 ipinapakita bilang karaniwan imbes na tiyak. Ang iyong rehabilitasyon ay indibidwal na pinamumunuan ng iyong pisyoterapeuta, na nagtatrabaho kasama ang klinika, batay sa kung paano gumagaling ang iyong balikat. Ang pahinang ito ay nagtataglay kasama ng pangkalahatang payo sa paggaling ng klinika; tingnan ang pamamahala ng post-operative na sakit at pag-aalaga sa sugat. Para sa operasyon mismo, tingnan ang distal clavicle excision.

Ang ebidensyang kliniko sa likod ng operasyong ito at ang kanyang rehabilitasyon (kasama ang paghahambing ng bukas versus arthroscopic, kung gaano karaming buto ang tinatanggal at bakit, at ang mga publikadong protokol na ginamit sa pahinang ito) ay buod sa seksyon ng ebidensya, na may buong mga sanggunian, na available bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

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
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