synonyms: DCR, Acromioclavicular Joint Resection, ACJ Resection, acromioclavicular joint (ACJ) arthroplasties
Distal Clavicle Resection CPT
Distal Clavicle Resection Indications
Distal Clavicle Resection Contraindications
Distal Clavicle Resection Alternatives
- Non-operative treatment: NSAIDS, physical therapy, activity modifications, ACJ injections
- Open Distal clavicle resection
Distal Clavicle Resection 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
Distal Clavicle Resection Technique
- See Shoulder Arthroscopy
- 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 Decompression and 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.
Distal Clavicle Resection Complications
- Instability(excessive resection)
- Persistant pain / Continued symptoms (most common complication, possible from inadequate resection)
- Ectopic calcification
- Reactive bursitis
- Clavicle/acromion fracture
- Adhesive capsulitis
Distal Clavicle Resection Follow-up care
- Post-op: sling as needed with pendulum ROM exercises.
- See Shoulder Arthroscopy 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.
Distal Clavicle Resection Outcomes
Distal Clavicle Resection Review References
- Burkhart SS, A Cowboy's Guide to Advanced Shoulder Arthroscopy, 2006
- Strauss EJ, Barker JU, McGill K, Verma NN. The evaluation and management of failed distal clavicle excision. Sports Med Arthrosc. 2010 Sep;18(3):213-9.
- Beaver AB, Parks BG, Hinton RY. Biomechanical analysis of distal clavicle excision with acromioclavicular joint reconstruction. Am J Sports Med. 2013 Jul;41(7):1684-8.