Joint Arthrtis (AC Arthritis)
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.
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.
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.
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.
the use of any anti-inflammatory medicine, especially
aspirin, a week prior to surgery, to prevent excessive
bleeding during the surgical procedure.
a second opinion from another surgeon who is as qualified
is advisable if you are unsure or want to consider other
potential treatment options.
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:
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.
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.
a soft, comfortable shirt that will not irritate your
skin when worn under a shoulder sling.
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
two-inch incision is made next to the bony bump on the
top of your shoulder.
half-inch of bone is removed from the end of your collarbone,
where it formerly joined with your shoulder tip (at
the AC joint).
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.
incision is stitched and you are taken to the recovery
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.
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:
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.
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.
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.
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.
are usually removed about two weeks after open surgery.
your shoulder begins to heal, your physician may recommend
that you remove the sling for short periods to perform
some light, early-motion exercises.
should move your fingers and hands in the sling as much
as possible to help circulate blood.
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
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
one – Begin pendulum exercises, swinging your
arm in pendulum-like motions. With the assistance of
your physical therapist, begin passive motion exercises.
five to seven – Begin active-assisted range of
motion exercises to move your arm without the aid of
your physical therapist.
three to four – Perform light active resistance
exercises, moving your arm up to shoulder height and
rotating your arm while pulling against elastic bands.
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
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.