Arthroscopic resection of the distal clavicle with concomitant subacromial decompression: a case series

Abstract

Abstract: Shoulder impingement syndrome and acromioclavicular joint osteoarthritis often occur simultaneously and easily missed. Kay et al. reported excellent results with combined arthroscopic subacromial decompression and resection of the distal end of the clavicle in patients with both disorders(1). Arthroscopic treatment of these disorders produces more favourable results than open procedures. We report two patients who were not responding to conservative management and were treated with direct arthroscopic distal clavicle excision and subacromial decompression in single setting. Both patients gained good postoperative outcome in terms of pain score, function and strength improvement assessed objectively with visual analogue score (VAS) and University of California Los Angeles Score (UCLA).

Key words: Acromioclavicular joint arthritis, distal clavicle excision, Arthroscopy, Mumford operation.

Fig. 1: Preoperative plain radiograph of left shoulder showing degenerative changes of the cromioclavicular joint with narrowing of joint space(A). Postoperative radiograph of the same patient with distal clavicle resection(B).

Fig. 2: T2-weighted MRI left shoulder (coronal view) showing edema pattern beneath the left acromioclavicular joint (arrow) with arthritic changes.

Fig. 3: Patient demonstrating full range of movement of left shoulder without sign of impingement.

Fig. 4: Preoperative X-ray showing not much acromioclavicular joint narrowing(A) Postoperative, distal clavicle resection.(B)

Fig. 5: MRI right shoulder sagittal view showing marked arthropathic changes and the axial view with oedema below the acromioclavicular joint with supraspinatus impingement.

Fig. 6: View from lateral portal of arthroscope: needle pierced through the acromioclavicular joint. Distal clavicle resected by using burr.