Arthroscopic excision of the end of the collarbone (clavicle)

What is the aim of this surgery?

The aim of this surgery is to remove just enough bone from the end of the collarbone to prevent the worn out arthritic acromio-clavicular (AC) joint surfaces rubbing together. As a result of this, it is intended that the patient will experience an improvement or resolution of their pain in relation to the AC joint.

 

Who might benefit from this procedure?

This surgery is typically recommended when non-operative measures, such as guided steroid injections and physiotherapy, have failed to provide satisfactory relief of symptoms caused by arthritis of the AC joint.

 

Will I need to stay in hospital overnight?

No, not usually. The surgery is typically done as a day case procedure under general anaesthetic with a supplementary nerve block (see other information regarding what to expect before surgery)

 

What does the procedure involve?

A full keyhole (arthroscopic) assessment of your shoulder joint will first be carried out, to exclude any problems within the joint itself that could have caused your symptoms. The camera will then be moved into the subacromial space, which is the space above the rotator cuff tendons. A subacromial decompression will first be carried out (see relevant information sheet on this procedure). The rotator cuff tendons will then be inspected to look for any tears, the majority of which should have been picked up on your MRI scan prior to the surgery. If necessary, a repair of the tendon may be carried out, which will be performed at the same sitting. Approximately 5mm of bone will then be resected from the end of the collarbone using a high speed burr. This effectively removes the arthritic AC joint surfaces and prevents them rubbing together and causing pain. There are usually 3 keyholes required in order to carry out this procedure.

 

What are the chances of an improvement in my symptoms?

The operation has a high chance of success, between 80-90%. Full benefit from the surgery will take at least 3-6 months and even longer than this potentially.

 

What can I expect after surgery?

Your shoulder will be sore, but is not usually very painful after the first few days. Some discomfort on top of the shoulder usually persists for at least 3 months after the surgery, since there is a raw bone surface that needs to heal. During the first 3 months after surgery, therefore, it is best to avoid any repetitive overhead activity or to lift anything to heavy, in order prevent aggravation of your shoulder and setbacks to your progress. A sling is not usually required for any more than a few days after the surgery and movement is as pain allows. Physiotherapy after the surgery is essential in order to restore a good range of motion. Most patients will achieve 80% of their final range of motion at 6 weeks after the surgery, and full range at 3 months following the surgery.

What are the potential complications or risks associated with this surgery?

Bleeding/bruising: Bleeding is typically minimal and occurs in the first couple of days after the surgery. This may necessitate a change of dressings if they come loose. Bruising can be significant but eventually will go away and does not cause any long term problems.

Infection: This is very rare with keyhole procedures and happens in less than 1 in 1,000 procedures. It is a potentially serious complication when it does happen, however. Usually the infection is superficial involving the keyholes and will settle with antibiotics but if it is a deeper infection, this will require further surgical procedures to wash out the shoulder.

Stiffness/frozen shoulder: The risk of developing a frozen (stiff, painful) shoulder after arthroscopic shoulder surgery is significant. Research has found as many as 5% (1 in 20) of patients will develop a frozen shoulder after this type of surgery. This may necessitate further procedures, such as steroid injections or more invasive procedures such as an arthroscopic capsular release (see relevant information page on this procedure). In order to reduce the risk of developing a frozen shoulder, it is important to engage with the physiotherapy programme, and to avoid doing “too much too early” with your shoulder. Even despite these measures however, the risk of a frozen shoulder is still present.

Persistent pain: The causes of this may include a frozen shoulder, complex regional pain syndrome, or failure of the operation to achieve the intended result. Usually this happens when too little or too much bone is resected from the end of the collarbone.

Blood clots in legs or lungs: These complications are very rare (less than 1 in 1,000) in keyhole shoulder surgery, but if you have a susceptibility to blood clots you will be given a blood thinning injection prior to discharge from the hospital as a precaution.

Anaesthetic risks: Modern anaesthesia is usually very safe, but there are small risks associated with general anaesthetics including airway problems and unexpected allergic reactions. There are separate risks associated with receiving the nerve block. The anaesthetist will be able to go through these risks with you prior to the operation.