Distal Clavicle Excision (AC Joint Resection)

Overview

Distal clavicle excision treats pain from the acromioclavicular (AC) joint at the top of the shoulder, caused by arthritis or by distal clavicle osteolysis in weightlifters. A small amount of bone, usually less than a centimeter, is removed from the end of the collarbone so the worn surfaces no longer rub together.

The procedure is usually done arthroscopically through small incisions, which preserves the ligaments that stabilize the collarbone ^[1]. It is often performed together with other shoulder procedures, such as rotator cuff repair, when the AC joint is also painful.

In a prospective series of patients with isolated AC joint problems, arthroscopic distal clavicle excision substantially reduced pain and improved shoulder function, and most patients returned to sport within about two months and to work within about three ^[2]. Removing too much bone can cause instability of the collarbone, so the amount resected is carefully controlled.

Benefits

• Relieves pain at the top of the shoulder
• Minimally invasive arthroscopic approach
• Can be combined with other shoulder procedures

Who is a Candidate?

Distal Clavicle Excision may be appropriate for patients who meet certain criteria. Ideal candidates include:

• AC joint arthritis that remains painful despite injections and activity changes
• Distal clavicle osteolysis in weightlifters
• AC joint pain confirmed by a numbing injection

Recovery & Rehabilitation

This is usually an outpatient procedure. A sling is worn for comfort for a few days, motion begins right away, and most patients return to daily activities within weeks and to lifting and sports over two to three months.

References

1. Flatow EL, Duralde XA, Nicholson GP, et al. Arthroscopic resection of the distal clavicle with a superior approach. J Shoulder Elbow Surg. 1995;4(1 Pt 1):41-50. doi.org/10.1016/s1058-2746(10)80007-2
2. Leon JV, Hermans D, Venkatesha V, et al. Patient outcomes following arthroscopic distal clavicle excision: a prospective case series. JSES Int. 2023;7(6):2400-2405. doi.org/10.1016/j.jseint.2023.07.014