Arthroscopy is a minimally invasive surgical technique used in the treatment of sports medicine injuries. It involves the use of a fiber-optic camera, which we place into a joint through a small incision in order to visualize ligaments, cartilage, and soft tissue. Through another small incision, we can then use small instruments to remove or repair broken or damaged tissue.
Shoulder arthroscopy with a distal clavicle excision is the term used to describe surgery done for patients with a painful acromioclavicular joint (AC joint). The collarbone (clavicle) meets with the tip of the shoulder blade (scapula) and forms the AC joint. In most patients, the AC joint has arthritis but is not painful. Sometimes this joint can become painful due to the arthritis. In order to alleviate the pain, the bone making up the AC joint is removed arthroscopically. This procedure is often done in conjunction with an arthroscopic subacromial decompression for treatment of shoulder impingement.
If your collarbone (clavicle) and shoulder tip (acromion) has excessive cartilage degeneration or arthritis at the acromioclavicular joint, you may be a candidate for distal clavicle excision surgery. This procedure removes a small piece from the end of your collarbone, where the worn joint surface becomes increasingly arthritic and painful. Scar tissue grows in place of your bone that allows the acromioclavicular (AC) joint to move more fluidly and relatively painlessly.
The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.
At most medical centers, you will go to "patient admissions" to check in for your distal clavicle excision. Most patients leave the hospital the same day, but be sure to ask your physician if an overnight stay might be of benefit. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:
Distal clavicle excision surgery typically takes one to two hours, as a piece of bone from the end of your collarbone is removed. You are usually given general anesthesia, but some patients are given a regional anesthesia, called an interscalene block, injected above the collarbone, producing a pain-free shoulder region and extremity. The surgery may be performed as either an open procedure, through a single incision approximately 3-4 centimeters long, or as an arthroscopic procedure, through multiple small incisions, each about one centimeter long, that act as portals for a small camera and required micro-instruments.
When you awaken in the recovery room following distal clavicle excision, your shoulder usually is wrapped in gauze, immobilized in a sling, and covered with an ice pack. You may feel a moderate amount of pain, and you will receive pain medication through an IV (intravenous) line. Generally, though, those patients who have received a adequate scalene block will have little or no pain initially. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You should try to move your fingers while you are in the recovery room to improve circulation. Moving your wrist or elbow may be painful but is often controlled with immobilization using a sling. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Generally, most patients are allowed to leave the hospital the same day as surgery if they are considered stable and able to control their pain with oral pain medications. Physicians generally suggest that you use a shoulder sling for about three to six weeks. You will be taught how to remove the sling and perform gentle range of motion exercises. In addition, you will be given an appointment to return for a follow-up and a prescription for pain medicine. You will not be able to drive, so be sure to have arranged for a ride home.
After distal clavicle excision, you will need to take steps to reduce the pain and inflammation in the shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain, as will immobilizing the shoulder in a sling - particularly when you are up and active. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:
You usually can begin gentle range of motion exercises within a few days of surgery. Many patients regain normal use of their arms within three weeks with the help of physical therapy. However, recovery time after distal clavicle excision greatly varies depending on your body’s natural ability to heal and build scar tissue in your AC joint.
A typical physical therapy schedule after open surgery progresses as follows (you can continue to wear your sling as needed to ease your pain and rest your arm):
You may regain normal daily use of your arm in three weeks and return to sports and activities in about two months if you remain dedicated to physical therapy. The recovery time may be slightly faster after arthroscopic surgery.
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Maintaining strong and flexible shoulder muscles is the best way to prevent reinjury. You should make the rotator cuff strengthening and stretching exercises you learned in physical therapy part of your regular workout routine. Rotator cuff strengthening helps reduce the risk of overuse problems during athletic or work activities that require repetitive overhead motions. In some cases, your physician may prescribe shoulder braces that are designed to help prevent your shoulder from moving out and back. These braces can help decrease stress on the shoulder ligaments. Having an athletic trainer tape your shoulder may also help to hold it in position. However, braces and taping should never be used as a substitute for strong and flexible muscles. Be sure to warm up before activities by rotating your arms and shoulders in different directions. You should be careful to notice any pain or discomfort in your shoulder during athletics. Avoid playing through shoulder pain. The more often you strain your shoulder’s AC joint, the weaker the ligaments become, and the greater your risk of developing complications such as arthritis.