Distal clavicle resection is a surgical procedure that involves removing a small portion of the outer end of the collarbone, known as the distal clavicle. This surgery aims to alleviate shoulder pain and improve range of motion by creating more space within the shoulder joint. It is considered when conservative treatments, such as rest, ice, anti-inflammatory medications, and physical therapy, have not provided sufficient relief for persistent shoulder issues. The goal of this surgery is to create more space within the shoulder joint, thereby reducing pain and improving the range of motion for individuals suffering from specific conditions affecting this area.
Understanding the Distal Clavicle and AC Joint
The shoulder involves three main bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The distal clavicle, the outer end of the collarbone, connects with a bony projection of the scapula called the acromion. This connection forms the acromioclavicular (AC) joint, a synovial joint.
The AC joint is stabilized by several ligaments, including the acromioclavicular ligaments, which provide horizontal stability, and the coracoclavicular ligaments, which offer vertical stability. This joint allows for additional rotation of the scapula and helps transmit forces from the arm to the rest of the body. Due to its small and sometimes incongruent surfaces, the AC joint is prone to significant forces, making it susceptible to traumatic injuries and degenerative changes over time.
Conditions Leading to Distal Clavicle Resection
This surgery addresses several conditions. One common reason is acromioclavicular (AC) joint osteoarthritis, a degenerative condition often seen with aging, repetitive overuse, or previous injury. This arthritis can lead to pain, swelling, and a feeling of clicking or snapping in the joint, particularly when lifting the arm. Degenerative changes can narrow the joint space and cause bone spurs to develop.
Post-traumatic AC joint injury, such as severe sprains or dislocations, is another indication. These injuries often result from direct impacts to the shoulder, common in contact sports or falls. While many AC joint separations are managed non-operatively, surgical intervention may be considered if conservative treatments fail to alleviate symptoms.
Distal clavicle osteolysis, sometimes called “weightlifter’s shoulder,” is also treated by this procedure. This rare condition involves the development of bone erosions and resorption at the end of the clavicle, often due to repetitive microtrauma from activities like heavy bench pressing or overhead lifting. Patients experience a gradual onset of dull, aching pain over the distal clavicle and AC joint, which worsens with activity.
The Surgical Procedure
Distal clavicle resection can be performed using two main approaches: arthroscopic (minimally invasive) or open surgery. Arthroscopic surgery is preferred due to its advantages, including smaller incisions, reduced complications, and less downtime. Both methods aim to remove a small portion of the distal clavicle, around 1 centimeter, to create space within the AC joint.
During an arthroscopic procedure, the patient receives general anesthesia. The surgeon makes a few small incisions near the AC joint. An arthroscope, a thin tube with a camera, is inserted through one incision to visualize the joint on a monitor, while tiny surgical instruments are used through other incisions to remove the affected bone. For open surgery, a single incision is made over the AC joint to allow direct access for bone removal.
What to Expect During Recovery
Following distal clavicle resection, patients are taken to a recovery room. The shoulder is wrapped with dressings and immobilized in a sling. Pain management, including ice application and pain medications, is initiated to control discomfort and swelling. Many patients are discharged on the same day as the surgery.
The sling is used for three to six weeks, depending on individual recovery and surgeon’s instructions. Physical therapy begins with gentle exercises like pendulum swings in the initial week to regain wrist and elbow motion. Progressive range of motion and strengthening exercises are introduced from weeks two to six. Full return to strenuous activities, such as heavy labor or sports involving overhead motions, may take 6 to 12 weeks, with some activities like bench pressing requiring up to four months before resuming previous levels.