Recovery after AC joint reconstruction (acromioclavicular joint reconstruction) is slower than many people expect. Most protocols keep the arm in a sling for about 4 to 6 weeks and limit lifting for about 3 months, because the new ligament or graft needs time to take hold. Everyday use of the arm often returns by about 3 months. Heavy lifting usually returns around 4 to 6 months, and contact sport often around 6 months, sometimes later. Your surgeon’s protocol comes first. If their timings differ from these ranges, use theirs.
The AC joint sits at the top of the shoulder, where the collarbone meets the tip of the shoulder blade (acromion). An AC joint reconstruction rebuilds the ligaments that hold the collarbone down, usually with a tendon graft, strong suture tape, or both. Unlike a broken bone, which typically heals in 6 to 12 weeks, a reconstructed ligament keeps strengthening for months. The weight of the arm hanging down is what pulls on it most.
Key takeaways
- Sling time: most protocols use a sling for about 4 to 6 weeks to support the weight of the arm.
- Lifting limits: lifting and carrying with the operated arm are usually limited for about 3 months while the reconstruction strengthens.
- Contact sport: often returns around 6 months, sometimes later, after the surgeon’s clearance.
- The bump: a small amount of the bump at the top of the shoulder returning is fairly common. A large or sudden change should be checked.
- Surgeon first: your surgeon’s protocol comes first on sling time, movement and lifting.
Where are you right now?
- First 2 weeks: read days 1 to 3, weeks 1 to 2 and “Is this normal?”. Support the arm, control pain, sleep propped up.
- Weeks 2 to 6: gentle movement within limits, arm still supported most of the time. Read weeks 2 to 6.
- 6 to 12 weeks: out of the sling and building range. Lifting is still limited. Read weeks 6 to 12 and “If it isn’t going to plan”.
- 3 months on: strengthening and return to heavier tasks. Read the month-by-month section and the “When can I” table.
Week by week
- Days 1 to 3: the arm rests in a sling, often with a support under the elbow to take the weight off the joint. Hand, wrist and elbow movement often starts straight away.
- Weeks 1 to 2: the wound is checked and stitches are usually removed around day 10 to 14. The sling is usually worn most of the day and at night.
- Weeks 2 to 6: gentle shoulder movement, often assisted and kept below shoulder height, starts on your surgeon’s timeline. Letting the arm hang heavy, carrying anything, or pushing up from a chair with this arm is usually avoided.
- Weeks 6 to 8: the sling usually comes off. Active movement builds and reaching above shoulder height is often introduced gradually.
- Weeks 8 to 12: range continues to improve. Light strengthening for the shoulder blade muscles and rotator cuff often begins. Lifting stays light, around the weight of a full kettle or less.
Month by month
- Month 3: light to moderate lifting is often introduced, if the surgeon is satisfied. Most daily tasks are manageable. Push-ups, bench press and dips are usually still off the list.
- Months 4 to 6: strengthening progresses toward full load. Return to contact sport, sport with a risk of falls and heavy manual work usually falls in this window, after clearance from the surgeon.
- Months 6 to 12: strength and confidence keep building. Some people notice an ache at the top of the shoulder with heavy pressing or carrying for several months.
Is this normal?
- Night pain: yes, for the first few weeks. Many people sleep propped up with the elbow supported on a pillow.
- Swelling and bruising: bruising at the top of the shoulder and down the upper arm is common in the first 2 weeks.
- Stiffness: yes, after 4 to 6 weeks of protection. It usually improves steadily once you are allowed to move further.
- Clicking: painless clicking around the shoulder as you move is common. A clunk at the top of the shoulder with sudden pain should be checked.
- Numbness near the scar: a numb patch around the incision is common and often shrinks over months.
- The bump: a small rise at the end of the collarbone can reappear as the reconstruction settles. It does not always affect how the shoulder works. Tell your surgeon if it changes quickly.
- Low mood: yes. A long protected phase, poor sleep and time away from sport wear on most people.
If it isn’t going to plan
It is week 10. The sling is long gone and you can reach the top shelf, but lifting a bag of groceries into the car still aches across the top of the shoulder. The shoulder feels strong, and you are tempted to test it in the gym. The belief that no sling means the repair is ready for full load is common at this stage. It is usually too early.
A reconstructed ligament gains strength slowly over months. Loading it heavily before then can stretch the reconstruction, and the bump can return. Stiffness that stops improving, pain rising after week 6, or weakness that is not getting better can also come from the shoulder blade muscles, the rotator cuff, or, less often, the reconstruction itself.
Out of the sling is not the same as ready for load.
The route is a review with your surgeon or physical therapist. Ask: Is the reconstruction holding the collarbone where you want it? What load am I cleared for now, and when does that change? Which muscles are weak, and what is the plan for them? What test decides my return to sport?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Often from about 3 to 14 days, once the wound dressing allows it. Keep the arm supported. |
| Sleep in bed | Often 2 to 4 weeks, propped up at first. |
| Drive | Often 6 to 8 weeks, once out of the sling and able to control the wheel safely. |
| Desk work | Often 1 to 3 weeks. |
| Lift | Light objects from about 8 to 12 weeks. Moderate loads from about 3 to 4 months. Heavy loads usually after 4 to 6 months. |
| Reach overhead | Often from about 6 to 10 weeks, without load. |
| Manual work or sport | Usually 4 to 6 months. Contact sport often around 6 months, sometimes later. |
Your surgeon’s protocol comes first.
Call your local emergency number or go to the emergency department if
- Sudden breathlessness or chest pain: especially with one calf swollen, hot or painful.
- The hand turns pale, cold or blue: or the whole arm becomes suddenly numb and heavy.
- Fever with a spreading red wound: together with shivering, confusion or feeling very unwell.
See a doctor today if
- Wound changes: redness spreading from the scar, increasing heat, discharge, a bad smell, or the wound opening.
- Fever: a temperature of 38°C (100.4°F) or above.
- Spreading numbness or weakness: numbness, tingling or weakness spreading down the arm or into the hand.
- Uncontrolled pain: pain getting worse each day or not controlled by the medication you were given.
Get it checked soon if
- The bump changes quickly: the end of the collarbone rises noticeably, especially after a fall, a lift or a sudden pop.
- Sharp pain at the collarbone or front of the shoulder: with a new clunk, after a fall or a heavy load.
- Pain rising after week 6: rather than easing.
- A plateau: no gain in range for 3 to 4 weeks after the sling has come off.
More on this area: surgery recovery guides.
The sling protects the reconstruction for the first 4 to 6 weeks. Patience with load protects it for the months after.
Written by Louise Yow, Neck & Shoulder Physio.