The distal clavicle excision (DCE) is a common orthopedic surgical procedure performed on the shoulder joint to alleviate chronic pain and restore function. Often referred to as the Mumford procedure, this operation targets the acromioclavicular (AC) joint, which is the junction between the collarbone (clavicle) and the highest part of the shoulder blade (acromion). The primary goal of the DCE is to remove a small portion of the clavicle’s end to create space within the joint and prevent bones from rubbing together. This article will explore the specific conditions that necessitate this surgery, detail the steps of the procedure, and outline the expectations for rehabilitation and recovery.
Understanding the Need for Excision
Distal clavicle excision is needed for painful conditions affecting the AC joint, often due to cartilage degeneration causing bone-on-bone friction. This pathology commonly presents as AC joint arthritis, a wear-and-tear condition seen with aging or following a traumatic injury. Inflammation and spur formation cause tenderness and pain, especially when lifting the arm overhead or performing movements across the body.
Another indication is distal clavicular osteolysis, a condition where the bone at the end of the clavicle breaks down and dissolves. Osteolysis is frequently observed in athletes who engage in repetitive, high-load activities, such as weightlifting or overhead sports. Constant, intense stress on the joint leads to microscopic fractures and bone resorption, resulting in significant outer shoulder pain.
In both conditions, insufficient space within the AC joint leads to painful impingement. Removing a small segment of the distal clavicle effectively decompresses the joint, eliminating friction and providing a permanent space. This excision reduces pressure on surrounding soft tissues, achieving long-term pain relief.
The Distal Clavicle Excision Procedure
The distal clavicle excision is typically performed as an outpatient procedure, allowing the patient to return home the same day. Surgery is generally conducted under general anesthesia, often supplemented with a regional nerve block for extended post-operative pain control. The operation involves the precise removal of bone from the lateral end of the clavicle to create a gap between it and the acromion.
Two main surgical methods exist: the traditional open technique, using a small incision over the shoulder, and the more common arthroscopic, or minimally invasive, approach. Arthroscopic surgery utilizes a small camera (arthroscope) inserted through tiny keyhole incisions, typically five millimeters in size. This allows the surgeon to visualize the joint on a video monitor while using specialized instruments for the excision.
During the procedure, the surgeon removes approximately five to ten millimeters of the distal clavicle bone. This precise removal prevents the bone ends from contacting, even during full shoulder movement. The remaining bone edge is smoothed to ensure no sharp points irritate surrounding tissues. After the bone is excised and the joint space confirmed, instruments are withdrawn, and incisions are closed with sutures or adhesive strips.
Rehabilitation and Recovery Timeline
Rehabilitation is fundamental to recovery, guiding the patient back to full strength and mobility. Immediate post-operative care focuses on managing discomfort using prescribed pain medication and cryotherapy (regular icing). The operated arm is typically placed in a sling for comfort, but its use is often discontinued within the first week or two post-surgery to allow for early motion.
Recovery begins with the Protection and Passive Range of Motion (PROM) phase, spanning the first four to six weeks. During this time, the physical therapist or patient moves the arm without engaging the shoulder muscles, gently restoring joint movement while protecting healing soft tissues. Exercises for the elbow, wrist, and hand are also initiated immediately to maintain circulation and prevent stiffness.
The next stage is the Active Range of Motion and Light Strengthening phase, generally beginning around four to six weeks post-surgery. The patient starts moving the shoulder using their own muscle power, gradually incorporating light resistance exercises with elastic bands or low-weight dumbbells. The focus shifts to strengthening the rotator cuff and the muscles surrounding the shoulder blade (scapular stabilizers), which are essential for proper shoulder mechanics.
The final phase, Advanced Strengthening and Return to Sport, typically begins between eight and twelve weeks after the operation. This stage involves increasing the intensity of resistance training, introducing functional movements, and sport-specific activities. While patients may return to light desk work or driving within a few weeks, a full return to heavy overhead lifting, contact sports, or demanding physical activity usually requires three to six months for complete tissue healing and maximum strength recovery.
Pre-Surgical Treatment Alternatives
Distal clavicle excision is generally considered a last resort, reserved for patients whose AC joint pain has not responded to conservative management. The initial treatment pathway focuses on non-surgical options designed to reduce pain and inflammation. This phase often lasts a minimum of six months before surgery is considered.
Rest and activity modification are primary steps, requiring the patient to avoid pain-provoking activities, particularly heavy lifting or arm movements across the body. Pharmacological interventions include the regular use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to manage pain and reduce joint inflammation.
Targeted physical therapy is a core non-surgical alternative, aiming to improve the strength of surrounding shoulder muscles and restore normal movement patterns. If symptoms persist, a corticosteroid injection may be administered directly into the AC joint for potent, temporary relief from inflammation. Surgery is only recommended when these conservative measures have failed to provide lasting symptom relief.