Periscapular isometric exercises12/27/2022 The authors will present their updated rehabilitation algorithm to highlight patient-specific obstacles. The presented data will be used to portray current deficiencies in rehabilitation protocols. The purpose of this study is to perform a systematic review of the literature in regards to rehabilitation protocols for operative and nonoperative management of acromioclavicular joint injuries that are based on physiologic rationale. Additionally, there are limited studies attempting to evaluate the efficacy of a robust rehabilitation protocol. Moreover, there are no randomized controlled trials comparing different rehabilitation protocols, for both operative and nonoperative care. 16 The role of rehabilitation is further blurred by an abundance of surgical techniques and differing rehabilitation protocols amongst surgeons. 13–15 However, best practice guidelines considering rehabilitation protocols for AC joint injuries, are yet to be clinically validated. 11, 12 Contrarily, the prevalence of scapular dyskinesis following AC joint injury suggests that physical therapy and rehabilitation have a significant role to address the ensuing muscular imbalance. Some authors have demonstrated satisfactory outcomes of lower grade injuries by allowing patients to increase activities as tolerated, without strict rehabilitation. Nonoperative modalities of care following AC joint injuries include rest, non-steroidal anti-inflammatory medications, local anesthetics, kinesiology tape, and various forms of rehabilitation. 8–10 However, the role of physical therapy and effective rehabilitation during definitive nonoperative care or following surgical intervention has yet to be substantiated. Furthermore, there have been many recent investigations and comprehensive reviews comparing operative and nonoperative management for patients with Type III injuries. 5 However, there is significant controversy regarding Type III injuries, with many practitioners opting for a trial of nonoperative therapy and reserving surgical intervention for those who remain symptomatic. 5–7 Historically, these injuries have been classified using the Rockwood classification, in which Types I and II are treated nonoperatively and Types IV–VI are generally treated operatively. 4 The most common mechanism of injury is a direct force to the shoulder during a fall with the arm in an adducted position. 2, 3 Additionally, AC joint injuries have also been observed in high numbers during noncontact sports such as cycling or triathlon. 1 Reports have shown that 41% of collegiate football players and 40% of National Football League quarterbacks experience AC joint dislocations during their careers. Acromioclavicular (AC) joint injuries are common in young athletes and are one of the most prevalent shoulder injuries in contact sports.
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