Keyhole Distal Clavicle Excision

What is a distal clavicle excision?

This keyhole procedure is performed for Acromioclavicular (AC) Joint arthritis and Distal clavicle osteolysis where non-operative treatment has been unsuccessful. Read more about Acromioclavicular Joint Arthritis here. This operation involves excising or ‘cutting out’ the diseased joint so that the arthritic ends of bone no longer rub against each other. 


What’s involved in a keyhole distal clavicle excision?

The surgery is performed under a general anaesthetic so you are asleep for the operation. A regional block is usually performed by our anaesthetist to give you good post-operative pain relief as well. A shoulder arthroscopy is performed via 3-4 small keyhole incisions. 

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Through these keyhole incisions, an arthroscopic camera and instruments are used to access the shoulder joint and the AC joint. Often acromioclavicular joint arthritis occurs in conjunction with subacromial impingement and rotator cuff tears, and these problems can be addressed during the same keyhole operation. To treat the AC joint arthritis, a motorised burr and electrocautery wand are utilised to progressively trim away the diseased out end of the clavicle. The supporting ligaments above and behind the AC joint are preserved to prevent instability at the AC joint. Approximately 5-10mm of arthritic bone at the AC joint is removed.

Arthroscopic distal clavicle resection - ScienceDirect

Risks

As with any surgical procedure, there is a small risk of:

    • Infection
    • Wound healing problems – very unlikely with keyhole incisions
    • Cardiovascular risks – stroke, heart attack, blood clots
    • Bleeding
    • Swelling of the operated limb – generally subsides within weeks
    • Pain – discomfort is expected after an operation, however pain medications are used in a routine manner to relieve this post-operative discomfort

Specific risks of distal clavicle exicision:

    • Damage to nerves around the shoulder
    • Recurrent pain at the AC joint
    • AC joint instability

What happens after the surgery?

Postoperative instructions and follow up

  • Immediate post-op 

After your operation you will be taken to the recovery room of the hospital, and allowed to have something to drink. When the team is happy the anaesthetic has worn off, you will be transferred to the day surgery area or to your inpatient room depending on whether you will be staying overnight. A sling / shoulder immobiliser would have been placed on your arm in the operating room, and should keep your arm comfortable and safe. If a nerve block has been performed by our anaesthetist, then your arm should feel comfortable but numb for up to 24-36 hours after the operation. When pins-and-needles are felt in the hand and arm then the block is starting to wear off, and your nursing staff will commence pain medication to keep you comfortable. 

  • Discharge from hospital 

On discharge from hospital you will be given:

      • Physiotherapy – instructions on exercises that should commence for the shoulder, elbow and wrist.
      • Sling – instructions on the use of your sling. Typically after a distal clavicle excision, Dr Yu will encourage you to commence mobilising your arm out of the sling early.
      • Dressings – please keep dressings dry and do not remove them. 
      • Follow up appointment time
  • Follow up

A follow up appointment will have been made for you after the operation. This will typically be an appointment around the 2-3 weeks after the surgery to check the surgical incisions. If you have any concerns before this appointment, call Dr Yu’s clinic on (08) 7099 0188 to speak with us.


Preoperative instructions

  • Medication review – As part of your preoperative assessment, your current regular medications will be reviewed. This includes over-the-counter medications as well as supplements eg. Fish oil and glucosamine. You will be able to continue taking the majority of your regular medications, however some medications may be temporarily ceased. These are usually blood-thinning medicines (anti-coagulants) including (but not limited to) aspirin, warfarin, clopidogrel, apixaban. Diabetes medications including tablets and injections can usually be safely continued until the morning of the surgery. We will advise you when to stop taking these medications before the operation, and when to restart them after the operation.
  • Smoking  Smoking greatly impairs the blood supply to healing tissues by constricting the blood vessels, as well as creating problems with anaesthesia. If ever there was a good time to quit smoking, it is before an operation and during the recovery period. You will be advised of options to help ceasing smoking during this period, and ideally beyond.
  • Fasting – No solid food (including drinks containing milk) should be consumed within 6 hours before surgery. Clear fluids (such as cordial and water) may be consumed up to 3 hours before surgery, and then nothing should be taken from then (this includes chewing gum). An exception is made for regular oral medications, which can be taken with a small sip of water.
  • Cardiovascular fitness – An operation most often requires general anaesthesia (meaning you are put to sleep and breathing is assisted). Dr Yu and his anaesthetic team endeavour to make your anaesthetic as safe as possible by ensuring your heart and lungs are in optimal health. This may mean a pre-anaesthetic review by our anaesthetist involving a cardiovascular assessment, with blood tests and heart tracings performed.
  • Skin preparation – You should not shave or wax skin around the surgical area, as this can irritate the skin or cause superficial infections. Please advise us if you notice any skin lesions or abrasions around the operative area in the days before your surgery. Whilst waiting for your operation on the day of surgery, we will prepare the skin with antiseptic, and Dr Yu will mark the limb to be operated on.
  • Illness / colds – Please advise us if you have a cold or flu-like symptoms, or urinary-tract infections. Your surgery may need to be postponed while you recover from these infections. This is to ensure your surgery is performed as safely as possible for you.
  • Imaging – Please bring all relevant imaging with you to hospital (eg. X-rays / CT scans / MRI scans).
  • Arrival to hospital – Please present to the hospital surgical admissions area at least 2 hours before your planned surgery, or as advised by the hospital admission staff. If you are planned for an overnight admission to hospital following the operation, please bring your regular medications with you.
 
"My goals as a surgeon are to relieve pain, restore your function, and return you back to doing what you love."
Adelaide Shoulder Surgeon
Dr Raymond Yu
Shoulder | Elbow | Wrist Surgeon

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