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Distal Clavicle Resection 29824

AC arthritis xray

distal clavicle resection complication xray

synonyms: DCR, Acromioclavicular Joint Resection, ACJ Resection, acromioclavicular joint (ACJ) arthroplasties

DCR Indications

DCR Contraindications

DCR Alternatives

  • Non-operative treatment: NSAIDS, physical therapy, activity modifications, ACJ injections
  • Open Distal clavicle resection

DCR Pre-op Planning / Special Considerations

  • Ensure both 30° and 70° arthroscopes are available.
  • Posterior and superior acromioclavicular ligaments provide restraint to posterior translation of the acromioclavicular joint should be preserved.
  • Direct approach: Sharron, Schepsis 2007

DCR Technique

  • See Shoulder Arthroscopy Technique
  • Ensure that AC joint is not unstable secondary to ACJ separation.  If so concomitant coracoclavicular ligament reconstruction is indicated (Jerosch J, Unfallchirurg 1998;101:691-96).
  • Ensure anterior portal is well aligned with ACJ.
  • Perform subacromial decompressionand remove medial fibrofatty tissue around the distal clavicle and scapular spine.
  • Perform distal clavicle resection through anterior portal using a power burr while viewing from posterior portal usning a 30° scope.
  • Preserve superior ACJ capsule and ligaments. (Levine WN, Arthroscopy 2006;22:516).
  • Evaluate superior cortex posteriorly with a 70° scope, ensure resection is complete.
  • Perform cross-body adduction test confirming no abutment occurs.
  • Resect between 5 and 10mm of distal clavicle or make 5-10mm space by resection of some acromion. (Branch TP Am J Sports Med 1996;24:293-7) (Eskola A, JBJS 1996;78A:584-7).
  • Use rasp or burr of known size to quantitate ACJ space created.

DCR Complications

  • Instability(excessive resection)
  • Continued symptoms (inadequate resection)
  • Ectopic calcification
  • Reactive bursitis
  • Clavicle/acromion fracture
  • Infection
  • Adhesive capsulitis

DCR Follow-up care

  • Post-op: sling as needed with pendulum ROM exercises.
  • See Shoulder Scope Rehab protocol.
  • 1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start at 3 weeks. Avoid cross-body adduction for 6 weeks.
  • 6 weeks: progressive sport specific activity.
  • 3 months: Return to sport / full activities.
  • In in association with SAD, or RTC repair use those rehab protocols.
  • Outcome measures: ASES score, pain scales.

DCR Outcomes

DCR Review References




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