Distal Clavicle Resection 29824

AC arthritis xray

distal clavicle resection complication xray

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

Distal Clavicle Resection CPT

Distal Clavicle Resection Indications

Distal Clavicle Resection Contraindications

  • Acromioclavicular instability: If there is AC instability CA ligament reconstruction +/-Distal Clavicle Resection is indicated
  • Active infection

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
  • Infection
  • 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.