The tip of the shoulder blade (scapula) that forms the roof of the shoulder joint is known as the acromion. Where this bone meets the collarbone (clavicle) is known as the acromioclavicular (or AC) joint. Normally, the tendons of the shoulder and the fluid-filled sac that surrounds it, the bursa, have plenty of room underneath the AC joint. However, overuse of the shoulder may lead to bursitis and tendonitis, collectively known as impingement. Impingement causes the tissues underneath the AC joint to be pinched against the bone, causing irritation and pain. Additionally, arthritis can develop in the shoulder as a result of overuse (Arthrosis) or autoimmune attack (Rheumatoid Arthritis). Physical therapy, medication, or cortisone injections are most often prescribed for shoulder pain; however, if these methods fail to provide relief, arthroscopic surgery may be necessary.
Removing the end of the clavicle closest to the acromion may help alleviate some pain and loss of motion caused by arthritis or impingement. Removing the last third of the clavicle allows it to be replaced by more flexible scar tissue, thereby eliminating the bone-on-bone rubbing that causes pain. The procedure often is accompanied by a bone spur removal, Debridement, or other procedures. A distal clavicle resection is one of the newer additions to shoulder arthroscopy.
Before the Procedure:
The patient's medical history and any possible allergies to medication are determined. The surgeon may order X Rays, an MRI, CT Scan, or EMG to look into the joint before the procedure. The patient is dressed in a hospital gown and anesthetized either locally or generally.
During the procedure:
A number of half-inch incisions will be made to allow the arthroscope to enter the shoulder joint. A sterile saline solution will be pumped into the joint both to cleanse it and to expand it for better visualization. The surgical staff may also pump air into the joint to create more room to see inside the joint. While watching a monitor that shows a magnified image of the inside of the shoulder, the surgeon guides the arthroscope to perform a number of procedures within the joint.
After removing any degenerative or damaged tissue around the AC joint and bursa (see Debridement) bone spurs from the acromion, or repairing the rotator cuff, the surgeon uses a surgical cutter to remove the last half-inch from the clavicle. The surgeon may then move the arm to test for impingement. The patient may be discharged following the procedure, or may remain in the hospital for one or two days.
Recovery from the procedure most likely involves wearing a sling, which is removed for longer periods of time as healing progresses. "Normal" recover can take up to 8 weeks. It really depends on the individual, their rehabilitation and their activity level. The patient may be instructed to perform Codman exercises. In the first Codman exercise, the patient bends at the waist, allowing the arm to hang downward, and makes clockwise and counterclockwise circles with the wrist. In the second, the patient remains bent at the waist, supporting his or her weight with the other hand, and pulls the arm across the body so as to increase the range of motion. The motions are usually preceded or followed by icing the joint. Codman exercises should only be done under the supervision of a physical therapist. Gradually, the patient can expect to work up to shoulder shrugs and weight-bearing exercises, and additional exercises to increase range of motion.
- Blood clots (very rare)
- Surgical wound infection
- Reaction to anesthesia
- Risk of developing arthritis
- Weakening of muscles
- Neurovascular injury
Prescription and non-prescription painkillers, shoulder sling for support.
Tell your doctor if…
You experience increasing pain, prolonged swelling, decreased sensitivity or decreasing joint motion after the procedure. Also, if you experience any symptoms suggestive of infection such as general malaise (tiredness) or fever, notify your doctor.
Last updated: 01-Jan-00