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Open Excision of Distal Clavicle

- See: Distal Clavicle Excision - main discussion

Discussion:
     - 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 Martin SD, 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.
           - The results of operative resection of the lateral end of the clavicle.


- Distal clavicular excision: a detailed functional assessment

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Resection of the lateral end of the clavicle. A 3 to 30-year follow-up