Distal Clavicle Excision (Mumford Procedure)

• What is Distal Clavicle Excision?
• Why is a Distal Clavicle Resection Procedure Performed?
• How to Prepare for an Arthroscopic Distal Clavicle Excision
• What Happens During a Distal Clavicle Excision Procedure?
• Are There Risks Associated with Distal Clavicle Resection?
• Post Arthroscopic Distal Clavicle Excision and Recovery
  

Distal clavicle excision, also called distal clavicle resection or the Mumford procedure, is a minimally invasive procedure aimed at alleviating persistent pain caused by shoulder impingement or arthritis. This procedure repairs the acromioclavicular (AC) joint in the shoulder and removes the outer end of the clavicle (or collarbone) closest to the acromion to decompress the joint. By doing so, it alleviates the painful symptoms of arthritis or impingement, common culprits of reduced shoulder mobility and continuous discomfort.

The procedure is done with the help of a small camera known as an arthroscope, alongside miniature surgical instruments used to make precise incisions to access and remove the end of the clavicle bone that is causing rubbing or pinching in the AC joint. The excision (removal) reduces the friction within the joint, which is often the source of pain and restricted motion. The need for a distal clavicle excision typically arises when nagging symptoms prove resistant to more conservative, non-invasive treatments, making it a viable option for those desiring a restoration of pain-free mobility.

Distal clavicle resection, or excision, provides relief for individuals plagued by a few specific shoulder conditions, including:

• Shoulder Impingement: Characterized by the narrowing of space within the shoulder joint, leading to painful pinching or rubbing of soft tissues between the humeral head and acromion.
• Osteoarthritis of the Acromioclavicular (AC) Joint: Aging and frequent shoulder use due to athletic or overhead activities can cause degeneration in the AC joint.
• Rotator Cuff Damage: Abnormal positioning of the humerus head due to rotator cuff injuries exerts undue pressure on the AC joint, inciting arthritis.
• Partial Dislocation of the AC Joint: Misalignment as a result of partial dislocation causes pain, popping, and clicking.
• Unhealed Fractures near the AC Joint: In instances where a fracture close to the AC joint fails to heal properly, excising the fractured fragment and smoothing the end of the collarbone eases pain and discomfort.

When non-surgical treatments yield little to no relief, distal clavicle resection is a viable solution to restore comfort and mobility to the affected shoulder.

Preparing for an arthroscopic distal clavicle excision differs for each individual. To ensure a smooth procedure and recovery, you should adhere to your physician's instructions and guidance before your procedure. However, here are a few things to keep in mind that are commonly addressed before this kind of procedure:

Medical Assessments:

• Discuss your medical history, including any prescriptions, medical allergies, or existing conditions like diabetes or heart disease, with your physician.
• Your physician may order routine tests like X-Rays, MRI, or CT Scans to thoroughly examine the joint.
• Undergo a physical exam and essential blood tests as directed by your physician.

Medication Management:

• Cease anti-inflammatory drugs like aspirin at least a week before your procedure, under your physician's guidance.
• Continue other essential medications with approval from your treating doctor.

Lifestyle Adjustments:

• If you smoke, it's advisable to quit, as it can hinder wound healing.
• Maintain an active lifestyle and adhere to a balanced diet, to aid your recovery and continued comfort after your procedure.

Pre-Procedure Preparations:

• Abstain from eating or drinking 8 to 12 hours before the surgery, though essential medicines may be taken with sips of water as directed by your doctor.
• Prepare your home for post-surgery recovery; have items like a shoulder sling and ice packs ready.
• Arrange for transportation back home post-procedure, and ensure you have assistance at home during the initial recovery phase.

Your physician will provide personalized advice based on your unique needs, ensuring you are adequately prepared for the procedure and recovery.

The distal clavicle excision procedure is methodically performed to ensure precise and favorable results. Here's a breakdown of the steps involved in the procedure:

Step 1: Preparation

• Anesthesia is administered to induce relaxation and numbness.

Step 2: Incision and Arthroscopy

• A few small incisions are made in the shoulder area to facilitate the insertion of an arthroscope—a special camera for viewing the joint interior—and tiny surgical instruments.

Step 3: Excision

• The end of the clavicle at the acromioclavicular joint is carefully excised to create more space, alleviating soft tissue pinching and consequent pain.

Step 4: Inspection and Additional Procedures

• The surgeon may perform additional procedures if necessary, like removing degenerated tissue or bone spurs, and possibly testing for impingement by moving the arm.

Step 5: Closure

• The incisions are closed using sutures, followed by the application of dressings.

Step 6: Recovery

• The patient embarks on the initial recovery phase, which may include a brief hospital stay of one to two days and is followed by a physical therapy regimen to regain shoulder strength and range of motion.

The procedure typically spans a few hours, tailored by the surgeon to meet the patient's specific needs and the complexity of their case. The primary and most preferred method to perform this procedure is arthroscopically. However, more severe or complex cases may require larger incisions.

Like all procedures, distal clavicle resection comes with risks. It's important to have a discussion with your surgeon about these potential risks and how they might relate to your specific circumstances. Below are a few risks associated with this procedure:

• Joint instability
• Inadequate resection
• Weakness
• Shoulder stiffness
• Infection
• Increased scarring
• Continued AC joint tenderness
• Injury to nerves and blood vessels
• Blood clots (very rare)
• Reaction to anesthesia
• Risk of developing arthritis
• Neurovascular injury

Understanding these risks will equip you with the knowledge to make an informed decision regarding the procedure and what to expect during the recovery phase.

Upon completing your distal clavicle excision procedure, you'll be transitioned to a recovery room where your shoulder will be secured in a sling and dressed appropriately. Utilizing an ice pack and adhering to prescribed pain medications will help manage initial discomfort and swelling. Although many patients are discharged on the same day, adherence to your specific recovery guidelines will be crucial for optimal healing.

The sling should be worn continuously for the initial few days, and you'll be able to transition to intermittent use over the next three to six weeks. Bathing is permitted after a week. Avoid scrubbing the incision site, and steer clear of unapproved lotions or creams. You should expect to have to abstain from strenuous activities for at least a month while following your physician's instructions on gentle range of motion exercises to allow for a smoother recovery. In some cases, a physical therapy regimen under the guidance of a physician will be necessary. Should you experience excessive swelling, uncontrolled pain, or signs of infection, contact your physician immediately.