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Distal Clavicle Resection

Definition

Distal clavicle resection is the removal of a piece of the clavicle bone at the top of the shoulder. The clavicle is also known as the collar bone.

Shoulder Anatomy
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Reasons for Procedure

The shoulder is made of the head of the upper arm bone, the acromion process (top projection of the shoulder blade), and the collar bone. There is a space between the upper arm bone and clavicle call the subacromial space that allows the shoulder to move freely. Several muscles, ligaments, and tendons pass through this space to help stabilize and move the shoulder.

The soft tissue that passes through the acromial space can get pinched between the bones of the shoulder. Over time, the pinching causes wear and swelling of the tissue. The swelling decreases the size of the acromial space and makes it painful to move. This is called impingement syndrome. Initial treatment is usually medical and surgery is done if this does not work.

Distal clavicle resection removes a piece of the clavicle to open the area and decrease the pressure on the soft tissue. It can help to decrease pain and increase shoulder function.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Wound healing problems
  • Adverse reaction to anesthesia
  • Excess bleeding
  • Shoulder stiffness
  • Injury to surrounding structures like the nerve, blood vessels, and shoulder joint

Smoking may increase the risk of complications. Talk to your doctor about these and any risks before the procedure.

What to Expect

Prior to Procedure

To make sure you are ready for surgery, your doctor may do the following:

  • Physical exam and medical history
  • Blood tests
  • Imaging studies to evaluate the shoulder

Talk to your doctor about your medications. You may be asked to stop taking some medications up to two weeks before the procedure such as:

  • Anti-inflammatory medications such as ibuprofen and naproxen
  • Blood thinners
  • Anti-platelet medications

Before the procedure, you should:

  • Arranging for a ride home from the hospital.
  • Arrange for help at home as you recover.
  • Eat a light meal the night before your surgery. Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Talk to your doctor if you take any medications, herbs, or supplements.

Anesthesia

Local anesthesia will be used to numb the area. General anesthesia will also be used. You will be asleep during surgery.

Description of the Procedure

Most procedures are done using a special tool called an arthroscope. An arthroscope is a flexible tube with a light at the end and a camera. In arthroscopic surgery, at least two small incisions are made in the shoulder. Air and/or saline will be injected in the area to make it easier for the surgeon to see and work. The arthroscope will be inserted through an incision and into the shoulder joint. The surgeon can view the inside of your shoulder on a monitor.

An open procedure may be needed if your case is more complicated. This will require a larger incision so your surgeon can directly see the shoulder.

With either procedure, the shoulder joint is carefully examined. The surgeon will look for damage that was not visible on scans. Damaged or inflamed soft tissue will be removed or cleaned up. This may include parts of ligaments and the bursa. If there are bone spurs, they may also be removed or smoothed out. The last tip of the clavicle with be cut off with a special tool. Once all the repairs are completed the incisions will be closed and bandaged.

How Long Will It Take?

About 1 hour

Will It Hurt?

Anesthesia will block pain during the procedure. You will be given pain medications after the procedure to manage discomfort.

Post-procedure Care

Your shoulder will be sore after the procedure. It will take three to four months for you to fully recover.

At the Care Center

Right after the procedure, the staff may:

  • Administer pain medications
  • Place a cold pack on your shoulder to reduce swelling and pain

At Home

Exercises are an important part of recovery. Your doctor will refer you to a physical therapist. You will be taught exercises to promote movement and restore muscle strength.

You may need to make some lifestyle changes during recovery:

  • You will not be able to drive until you are able to handle a steering wheel easily with both arms.
  • You will need to stay out of work at least one week. If your job involves heavy lifting or using your arm above your shoulder, you may need to stay out of work longer.
  • Overhead activities should be avoided during recovery.

Call Your Doctor

Call your doctor if any of these occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Numbness or tingling in the arm, shoulder, or hand

If you have an emergency, call for medical help right away.

Revision Information

  • American Academy of Orthopaedic Surgeons

    http://orthoinfo.aaos.org

  • Cleveland Clinic

    http://www.clevelandclinic.org

  • Canadian Orthopaedics Association

    http://www.coa-aco.org

  • Canadian Orthopaedic Foundation

    http://www.canorth.org

  • After arthroscopic subacromial decompression intact rotator cuff (distal clavicle resection). Arlington Orthopedics website. Available at: http://www.arlingtonortho.net/wp-content/docs/2012/04/Rehab-Protocol-After-Arthroscopic-Subacromial-Deompression.pdf. Accessed December 18, 2013.

  • Distal clavicle resection. American Society of Shoulder and Elbow Therapists website. Available at: http://www.asset-usa.org/Guidelines/Distal%5F%20Clavicle%5F%20Excision.pdf. Accessed December 18, 2013.

  • Distal clavicle resection. Hospital for Special Surgery website. Available at: http://www.hss.edu/animation-distal-clavicle-resection.htm. Accessed December 18, 2013.

  • Impingement syndrome. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-impingement-syndrome-of-the-shoulder.aspx. Accessed December 10, 2013.

  • Lervick G. Direct arthroscopic distal clavicle resection. Iowa Orthop J. 2005;25:149-156.

  • Shoulder impingement/rotator cuff tendinitis. American Academy of Orthopaedic Surgeons website. Available at: orthoinfo.aaos.org/topic.cfm?topic=a00032. Updated February 2011. Accessed December 10, 2013.

  • Rotator cuff tears. American Academy of Orthopaedic Surgery website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00064. Updated May 2011. Accessed December 18, 2013.