Shoulder > Acromioclavicular Joint Arthrtis (AC Arthritis)
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    Distal Clavicle Excision

If your collarbone (clavicle) and shoulder tip (acromion) has excessive cartilage degeneration or arthritis at the acromioclavicular joint, you may be a candidate for distal clavicle excision surgery. This procedure removes a small piece from the end of your collarbone, where the worn joint surface becomes increasingly arthritic and painful. Scar tissue grows in place of your bone that allows the acromioclavicular (AC) joint to move more fluidly and relatively painlessly.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received all the equipment you will need when you get home from the hospital. This may include a shoulder sling, and ice packs or coolers. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any past medical problems and current medications you are taking.

   Discontinue the use of any anti-inflammatory medicine, especially aspirin, a week prior to surgery, to prevent excessive bleeding during the surgical procedure.

   Getting a second opinion from another surgeon who is as qualified is advisable if you are unsure or want to consider other potential treatment options.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your distal clavicle excision. Most patients leave the hospital the same day, but be sure to ask your physician if an overnight stay might be of benefit. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because the anesthetic and pain medications may make you drowsy and you will be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Distal clavicle excision surgery typically takes one to two hours, as a piece of bone from the end of your collarbone is removed. You are usually given general anesthesia, but some patients are given a regional anesthesia, called an interscalene block, injected above the collarbone, producing a pain-free shoulder region and extremity. The surgery may be performed as either an open procedure, through a single incision approximately 3-4 centimeters long, or as an arthroscopic procedure, through multiple small incisions, each about one centimeter long, that act as portals for a small camera and required micro-instruments.

   A two-inch incision is made next to the bony bump on the top of your shoulder.

   A half-inch of bone is removed from the end of your collarbone, where it formerly joined with your shoulder tip (at the AC joint).

   Your body fills the space left between your collarbone and shoulder blade with scar tissue, which enables the joint to move in a full range of motion and stops the bones from rubbing against each other. It may take up to three weeks for the scar tissue to form in your AC joint.

   The incision is stitched and you are taken to the recovery room.

When you awaken in the recovery room following distal clavicle excision, your shoulder usually is wrapped in gauze, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain, and you will receive pain medication through an IV (intravenous) line. Generally, though, those patients who have received a adequate scalene block will have little or no pain initially. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You should try to move your fingers while you are in the recovery room to improve circulation. Moving your wrist or elbow may be painful but is often controlled with immobilization using a sling. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Generally, most patients are allowed to leave the hospital the same day as surgery if they are considered stable and able to control their pain with oral pain medications. Physicians generally suggest that you use a shoulder sling for about three to six weeks. You will be taught how to remove the sling and perform gentle range of motion exercises. In addition, you will be given an appointment to return for a follow-up and a prescription for pain medicine. You will not be able to drive, so be sure to have arranged for a ride home.

After distal clavicle excision, you will need to take steps to reduce the pain and inflammation in the shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain, as will immobilizing the shoulder in a sling - particularly when you are up and active. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied for 20 minutes at a time, three or four times a day.

   There may be some minor drainage under the bandage since fluid may have accumulated during the surgery. Therefore, some blood may be expected to show through the bandage during the first 24 to 48 hours.

   Physicians generally recommend that you wear the sling for comfort. Most patients wear the sling continuously day and night for at least the first few days. You may remove the sling when you feel comfortable. Intermittent use of the sling may need to continue for three to six weeks.

   You usually can remove the gauze bandage and bathe regularly about seven days after open surgery or two days after arthroscopic surgery. Call your physician if bleeding or drainage continues. You can remove the sling for brief periods to shower, but remember to avoid moving the injured arm if you feel pain.

   Stitches are usually removed about two weeks after open surgery.

   When your shoulder begins to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

You usually can begin gentle range of motion exercises within a few days of surgery. Many patients regain normal use of their arms within three weeks with the help of physical therapy. However, recovery time after distal clavicle excision greatly varies depending on your body’s natural ability to heal and build scar tissue in your AC joint.

A typical physical therapy schedule after open surgery progresses as follows (you can continue to wear your sling as needed to ease your pain and rest your arm):

   Day one – Begin pendulum exercises, swinging your arm in pendulum-like motions. With the assistance of your physical therapist, begin passive motion exercises.

   Days five to seven – Begin active-assisted range of motion exercises to move your arm without the aid of your physical therapist.

   Weeks three to four – Perform light active resistance exercises, moving your arm up to shoulder height and rotating your arm while pulling against elastic bands.

   Weeks six to 12 – Add more resistance, lifting your arm above your head. Work to strengthen rotator cuff, chest, and back muscles.

You may regain normal daily use of your arm in three weeks and return to sports and activities in about two months if you remain dedicated to physical therapy. The recovery time may be slightly faster after arthroscopic surgery.

RELATED TOPIC

   Shoulder strengthening exercises

Maintaining strong and flexible shoulder muscles is the best way to prevent reinjury. You should make the rotator cuff strengthening and stretching exercises you learned in physical therapy part of your regular workout routine. Rotator cuff strengthening helps reduce the risk of overuse problems during athletic or work activities that require repetitive overhead motions. In some cases, your physician may prescribe shoulder braces that are designed to help prevent your shoulder from moving out and back. These braces can help decrease stress on the shoulder ligaments. Having an athletic trainer tape your shoulder may also help to hold it in position. However, braces and taping should never be used as a substitute for strong and flexible muscles. Be sure to warm up before activities by rotating your arms and shoulders in different directions. You should be careful to notice any pain or discomfort in your shoulder during athletics. Avoid playing through shoulder pain. The more often you strain your shoulder’s AC joint, the weaker the ligaments become, and the greater your risk of developing complications such as arthritis.