Distal Clavicle Resection

FAQs on Distal Clavicle Resection

 

Distal clavicle resection is a proven procedure to successfully treat acromioclavicular (AC) joint problems. Also known as the Mumford procedure and used since 1940s, the surgery is performed using both open arthrotomy and arthroscopic techniques and quoted to be 95% successful in relieving AC joint pain.

What is distal clavicle resection?

Distal clavicle resection is a surgical method to treat painful conditions in the AC joint associated with osteoarthritis, inflammation, traumatic injury, or swelling.

Clavicle or collarbone links scapula with sternum. Its distal end or outer tip connects to the acromion, the top shoulder blade point, at the AC joint. Resection means surgical removal of a part of body organ. Distal clavicle resection stands for “surgery that removes a tiny fraction of the collarbone to decompress the AC joint and end bone rubbing within it.” The procedure, thus, relieves chronic shoulder pain and joint movement limitations caused by AC joint inflammation.

What are conditions treated with distal clavicle resection?

Distal clavicle resection is used to treat AC joint problems causing inflammation, swelling, shoulder impingement, and arthritis. The AC joint, the second shoulder joint after the glenohumeral ball and socket, is the confluence of the shoulder blade top or acromion and the collarbone or clavicle.

It allows the sliding of the shoulder blade and rotation of the collarbone to facilitate glenohumeral motion and arm movement. When there is inflammation due to injury, arthritis, bone spurs, shoulder impingement or damage to the articular cartilage positioned between acromion and collarbone like a shock absorber, the gap between the bones decreases and boneheads rub against one another as we move the shoulder. The condition causes pain and forces restricted movement.

How does it relieve AC joint pain?

Distal clavicle resection reduces the friction between bones inside the AC joint by creating more space to prevent contact between the shoulder blade and the collarbone. No friction means no inflammation, pain, or motion limitation.

 

How is distal clavicle resection performed?

Whether the need is for open or arthroscopic surgery is decided based on the patient requirement. With the latest technological advancement, most cases undergo an arthroscopic distal clavicle resection for reduced complications and faster recovery.

Accessing Shoulder Joint

General anesthesia is usually administered to patients to be treated with the procedure. Some doctors may go for regional interscalene blocks. During an arthroscopic procedure, a small incision is made on the “superior aspect of the distal clavicle” to put a tubular fiber-optic camera into the AC joint to have visual images of the bone heads therein. Surgical instruments are inserted through a few other small incisions.

The Surgery

Surgeons separate the deltotrapezial fascia is separated and the muscles are disconnected from the collarbone. About a half-inch portion of the distal clavicle is removed to prevent contact between the bones. Then, the fascia is restored, the incision is closed with sutures, and shoulder is bandaged. The hand is put in a sling.

Who is a candidate for distal clavicle resection?

Distal clavicle resection is recommended for those

  • with severe pain in AC joint
  • with chronic shoulder impingement
  • with AC joint osteoarthritis
  • not responding to non-surgical treatment

How long does distal clavicle resection surgery take?

The procedure takes about an hour.

Do I need to stay at the hospital after distal clavicle resection?

You are discharged within one or two hours of operation, if no surgical major surgical complication is diagnosed.

Do I need rest after distal clavicle resection?

Rest is recommended for at least two days immediately after the surgery. While the shoulder is kept immobilized in a sling, icing three to four times is advised. Monitor the swelling for two days. You can join desk jobs on the third day.

What are the restrictions following distal clavicle resection?

  • No shower for 48 hours
  • No driving for two weeks
  • Take off from desk work for three to four days and light stress jobs a week
  • No overhead activities for two weeks
  • Wear sling for two weeks except for physical therapy or sedentary activities
  • No activity beyond the tolerance level

What kind of rehabilitation is needed following distal clavicle resection?

  • Day 2 to 5: Start with pendulum exercises and passive motions
  • Day 5 to Week 3: Do active range of shoulder motions with aid a advice of a physical therapist
  • Week 3 to 6: Light resistance exercises and arm rotation
  • Week 6 to 12: Rotator cuff, chest, and back muscle workouts

How long is the recovery period following distal clavicle resection?

  • Significant recovery occurs within 3 months. Complete recovery needs 6 to 9 months depending patient condition and healing ability.
  • You can start doing normal light activities in three weeks.
  • You can return to sports in 3-4 months.

What are the potential complications of distal clavicle resection?

There can be complications due to surgery, including nerve and blood vessel damage, infection, bleeding, etc. But these are avoidable when done by an expert.

References

Alford W, et al. Open distal clavicle resection. Operative Techniques in Sports Medicine. January 2004Volume 12, Issue 1, Pages 9–17

Flatow EL, et al. Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy. 1992;8(1):55-64

Freedman BA, 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. Jul-Aug 2007;16(4):413-8

Mumford, E.B. Acromioclavicular dislocation(A new operative treatment) . J Bone Joint Surg Am. 1941;23:799–802.

Cook, F.F, Tibone, J.E. The Mumford procedurein athletes(An objective analysis of function) . Am J Sports Med. 1988;16:97–100.

Novak, P.J, et al. Surgical resection of the distal clavicle. J Shoulder Elbow Surg. 1995;4:35–40.

Gartsman, G.M. Arthroscopic resection of the acromioclavicular joint. Am J Sports Med. 1993;21:71–77

Gregory N Lervick. Direct Arthroscopic Distal Clavicle Resection: A Technical Review. Iowa Orthop J. 2005; 25: 149–156.

Docimo S Jr, et al; Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Curr Rev Musculoskelet Med. 2008 Jun;1(2):1

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