Distal Clavicle Excision
This minimally-invasive procedure helps to relieve pain and loss of motion in the shoulder from arthritis or impingement. During the procedure, the end of the clavicle closest to the acromion in the shoulder is removed to allow pain-free movement of the joint.
A distal clavicle excision is a surgical procedure performed to relieve pain in the acromioclavicular (AC) joint, which often develops because of a fall or other type of trauma. The AC joint is located between the acromion, the area of the scapula that forms the highest point of the shoulder, and the clavicle, or collarbone. Distal clavicle excision involves removing a small portion of the clavicle to help decompress the joint, relieving pain and limited motion in the joint resulting from shoulder impingement, a common cause of shoulder pain.
Although conservative methods may be used as the initial approach to treating this condition, surgery is needed in many cases to restore the position of the clavicle and allow the patient full function of the shoulder. Distal clavicle excision can either be performed through a traditional open surgery or through arthroscopy. Arthroscopy is a far less invasive surgical technique, requiring smaller incisions and resulting in a shorter recovery time. In both forms of the surgery a small part of the clavicle is re-sectioned to create a space between the two bones. In addition, any bone spurs or damaged tissue within the joint will be removed.
Reasons for Distal Clavicle Excision
Distal clavicle excision is performed to treat pain occurring around the AC joint of the shoulder, usually caused by shoulder impingement or arthritis. Shoulder impingement occurs when the space within the AC joint narrows, causing the acromion to rub directly against the tendons. This can result in severe pain or a persistent pinching sensation. Symptoms of shoulder impingement may include pain that radiates from the shoulder down to the arm, inflammation and limited range of motion in the shoulder.
Shoulder impingement is most commonly found in older adults. However, it may occur in younger patients, especially those who participate in sports that involve repetitive overhead motions, such as swimming, tennis, water polo, baseball or softball. The condition may also arise because of certain conditions, such as degenerative joint disease or osteoarthritis, or damage caused by traumatic injury or infection. Patients are considered good candidates for distal clavicle excision if they are experiencing lingering painful symptoms despite treatment with conservative methods such as physical therapy, resting the joint or injections.
The Distal Clavicle Excision Procedure
Distal clavicle excision is performed in a hospital setting, with the patient under either regional or general anesthesia. During the procedure, the shoulder is cleaned with antiseptic, then a few small incisions are made to gain access to the joint. Although the procedure may be performed through open surgery, it is generally preferred to use the arthroscopic technique for surgery, since it involves smaller incisions, reduces the risk of complications and requires less downtime.
The surgery is performed using an arthroscope, a flexible tube with a small camera on one end, and specialized surgical instruments that are inserted through the incisions. Using the arthroscope to view the targeted area of the joint, the surgeon will excise the end of the clavicle that is causing the impingement. Removing the end of the clavicle helps to create more space within the joint and relieve pain related to shoulder impingement. Once the procedure is completed, the incisions are sutured or stapled shut. The shoulder will then be bandaged, and the arm will be temporarily placed in a sling to keep it immobilized as it heals.
Risks of Distal Clavicle Excision
While an arthroscopic distal clavicle excision is far less invasive than open distal clavicle excision, any form of surgery includes some potential risks. The complications associated with distal clavicle excision may include:
- Shoulder joint stiffness or tenderness
- Post-operative pain
- Limited range of motion in the shoulder
- Shoulder instability
Recovery from Distal Clavicle Excision
After undergoing a distal clavicle excision, physical therapy is typically required to help regain strength and range of motion in the shoulder. Patients may need to take antibiotics following surgery to treat or avoid possible infection. In most cases, patients can resume some activity about a week after surgery, though any strenuous activities should be avoided for approximately one month. Resting the joint and applying ice will also benefit the healing and recovery process. The length of the recovery period after distal clavicle excision varies by the individual patient.