- See:
Modified Weaver Dunn Procedure:
- Discussion:
- patients may note pain with activities that occur in adduction (golf back swing);
- Clinical Findings:
- local tenderness to palpation and to hyper-adduction;
- trapezial spasm;
- patients will often note pain located posterior to the AC joint;
- steroid-lidocaine injection:
- remember that AC joint injections are often a difficult "stick" and are often painful;
- if the diagnosis is in question, consider a subacromial lidocaine-steroid injection on the initial patient visit;
- if the patient recieves good pain relief from the subacromial injection, then AC joint arthrosis is probably not the patient's primary problem;
- if the patient does not receive relief from the subacromial injection, then AC joint arthrosis is a more likely diagnosis;
- Radiographs: (
Zanca view):
-
AC joint subluxation;
- narrowing of the joint space w/ sclerosis of distal end of the clavicle;
- inferior osteophytes;
- in some cases distal clavicular resorption may be present, which might indicate RA,
scleroderma, or which may occur in weight lifters);
- Indications For Excision:
- pts w/ incomplete
AC separation (type I & II) who develop degenerative
changes & persistant symptoms may require excision of distal
Clavicle;
- Contra-indications:
- it is inappropriate to excise the distal clavicle in chronic type III, IV, V or VI AC separations;
- this may increase the patients symptoms, by converting a displaced long clavicle, into a short displaced clavicle;
- Technique:
- consider excising only 1 cm of the distal clavicle;
- excision of the distal 1.5-2.0 cm of the clavicle ensures that impingement will not occur (excision of this fragment may cut trapezoid ligament);
- the remaining conoid ligament is sufficient to anchor the distal
clavicle to the
coracoid process;
- however, as pointed out by Eskola et al 1996, excision of more than 1 cm of the distal clavicle was more often associated with pain;
- with the excision of only a small segment of the distal clavicle and with the time, the distal clavicle may develop a spur;
- in the report by Scott David Martin et al, the authors evaluated the surgical results in 31 consecutive patients (32 shoulders) with
AC pathology with concomitant subacromial impingement;
- mean age of the patients at the time of surgery was thirty-six years (range, 18 to 67 years).
- 25 patients, including four professional athletes, were actively involved in sports activities;
- mean duration of follow-up was four years and ten months (range, three to eight years).
- of 25 patients who participated in sports, 22 (including the four professional athletes) returned to their previous level of sports activity;
- 26 patients had no pain, three reported mild pain on strenuous repetitive overhead activity, two (both weight-lifters) had occasional pain in the AC joint and the lateral
aspect of the shoulder with bench-pressing, and two (both baseball players) had mild pain in the posterior aspect of the shoulder with throwing;
- all of the patients were satisfied with the results;
- no patient had superior migration of the clavicle;
- amount of distal clavicular resection averaged 9 mm (range, 7 to 15 mm).
- 5 patients had calcification at the anterior deltoid insertion into the acromion that was asymptomatic, with no impingement on overhead activity
and no pain on direct palpation;
- Arthroscopic Resection of the Distal Aspect of the Clavicle with Concomitant Subacromial Decompression
Scott David Martin, MD J Bone Joint Surg [Am] 83-A: 328-35, 2001
- Complications:
- lateral elevation of the clavicle:
- lateral elevation is often associated w/ pain;
The results of operative resection of the lateral end of the clavicle. A. Eskola MD, JBJS Vol 78-A, No 4, Apr 1996.
Arthroscopic distal clavicle excision. Technique and early results.
Our technique for the arthroscopic Mumford procedure.
The influence of distal clavicle resection and rotator cuff repair on the effectiveness of anterior acromioplasty.
Long-term Results of Acromioclavicular Joint Coplaning.
A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients.
Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study
