A distal clavicle excision (DCE) is a common surgical procedure performed to alleviate chronic shoulder pain that has not responded to non-surgical treatments. The operation involves the precise removal of a small portion of the collarbone, or clavicle, at its outer end where it meets the shoulder blade. By removing this segment of bone, the surgeon creates a space within the shoulder joint, which eliminates painful friction and bone-on-bone rubbing. This procedure restores comfortable movement and function to the shoulder.
Understanding the AC Joint and Its Function
The shoulder complex contains several joints, one of which is the acromioclavicular (AC) joint, the specific target of a DCE. This small joint is the connection point between the distal end of the clavicle (collarbone) and the acromion, which is a projection of the scapula (shoulder blade) forming the highest point of the shoulder. The AC joint is classified as a plane synovial joint, meaning it allows the two bones to glide smoothly past each other.
The AC joint’s function is to provide stability to the shoulder while also enabling a broad range of motion. It acts as a supporting structure, helping to transfer forces from the arm to the rest of the skeleton. When this joint deteriorates or becomes damaged, the resulting friction and inflammation can cause significant, persistent pain, particularly when lifting the arm overhead or reaching across the body.
Common Causes for Needing the Excision
The primary reason a patient may require a distal clavicle excision is to address chronic pain originating from the AC joint, usually after conservative treatments like physical therapy and injections have failed. The two most frequent conditions leading to this pain are osteoarthritis and distal clavicle osteolysis. Osteoarthritis is a degenerative condition where the cartilage cushioning the joint wears away, leading to painful bone-on-bone contact.
Osteolysis involves the breakdown and dissolution of the bone tissue at the end of the collarbone, often seen in athletes who engage in strenuous overhead or weightlifting activities. This bone resorption can cause swelling and tenderness at the joint, especially during activities that load the shoulder, such as bench pressing. Both conditions cause a narrowing of the joint space, which results in impingement, or painful pinching, of the soft tissues and the joint itself.
The presence of a bone spur, or an osteophyte, forming on the underside of the AC joint is another indication for the procedure, as this can irritate the underlying soft tissues, contributing to shoulder impingement syndrome. The goal of the surgery is to mechanically remove the source of this friction and irritation. By creating a gap, the procedure effectively decompresses the joint, relieving the pressure that causes the persistent pain and restricted movement.
How the Surgical Procedure is Performed
Distal clavicle excision is also known as the Mumford procedure. The procedure can be performed using two main approaches: the traditional open surgery, which involves a small incision over the joint, or the more common arthroscopic method. The arthroscopic technique is minimally invasive, utilizing a tiny camera and specialized instruments inserted through a few small incisions, allowing the surgeon to visualize the joint on a monitor.
Regardless of the approach, the central action is the removal of the outermost portion of the clavicle. Surgeons typically excise between 5 to 10 millimeters of the distal clavicle to create sufficient space between the collarbone and the acromion. This gap is then filled in over time by scar tissue, which prevents the bones from rubbing against each other again. The arthroscopic method is often preferred because it results in less disruption to the surrounding ligaments and soft tissues, which can lead to a faster initial recovery.
Post-Operative Recovery and Rehabilitation
The recovery process following a DCE focuses on pain control, range of motion, and eventual strength restoration. Immediately following the procedure, the shoulder is placed in a sling, primarily for comfort and protection, which may be worn for a few days up to a few weeks. Pain management is addressed with prescribed medication and consistent application of ice to the surgical area to minimize swelling and discomfort.
Physical therapy (PT) usually begins early, often within the first week, initially focusing on gentle passive and active-assisted range of motion exercises, such as pendulum movements, to prevent stiffness. The goal during the first month is to regain full, comfortable motion in the shoulder before advancing to strengthening. Light daily activities can often be resumed within one to two weeks, but strenuous activities and lifting restrictions are enforced for at least four to six weeks.
The next phases of rehabilitation introduce progressive strengthening, beginning with light resistance exercises using bands or small weights to rebuild the rotator cuff and surrounding musculature. Patients can expect a gradual return to heavier activities and sports, which may take anywhere from two to four months, depending on the individual’s progress. Exercises that place an extreme load on the AC joint, such as heavy bench presses, are often the last to be reintroduced.