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This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on  any treatment. If you have a problem please consult your doctor or specialist.
Arthroscopic stabilisation    Reverse Replacement    A S D with distal clavicle excision
Acromio-clavicular arthritis & Distal Clavicle excision
If symptoms you have suggest that the epicentre of the pain is over the AC joint, then excision of this joint is recommended. More often than not, this is done in addition to standard decompression of the shoulder especially when there is degeneration and spur formation in this joint.
Sometimes, due to natural progress, arthritis may develop at a later date after decompression and it may be necessary for one to have this as an secondary procedure. Sometimes the problem in this joint becomes unmasked after a more severe impingement is addressed and one presents with pain over the AC joint months later after a successful decompression.  

The aim of the operation is to create more space between the acromion and distal clavicle by removing at least 6mm of the bone from the outer end of the clavicle. In some cases, a wisp of bone is also removed from the acromion at the place where it forms the joint to give a better clearance.

Open or arthroscopic?
While it is possible to clear the joint by either technique, the choice would depend on the exact symptom and the reason for the procedure. If you are troubled with prominent spur on the top of the shoulder and have pain on carrying something over the shoulder like rugsack etc, then open technique will be appropriate. It is also done when one has a very large spur and clavicle which is projecting on both sides.

On the other hand this procedure can be done arthroscopically if the pain is in the joint and spur is placed more downward. The big advantage of doing this arthroscopically is that the top capsule and ligaments are not disturbed and hence the risk of instability is small. Also, scar is small. My observation is that pain is quite a bit of problem after distal clavicle excision even if it is done arthroscopically and will take around 3 to 4 months to settle down.

Refer to ASD section to get a general idea about the  surgery and in particular go to picture story section to understand the difference. Also the rehabilitation very slightly differs between ASD and ASD with DCE. See rehab section for further information.
A S D + D C E

After ASD, distal clavicle is seen devoid of capsule. Close up shows that there is arthritis in the joint with lack of healthy cartilage

A reference cut is made from side portal and one can about 6 mm of bone is remove. Final image showing intact joint capsule on the top with good joint clearance.