ACJ (Acromioclavicular joint) / distal clavicle excision

If acromioclavicular joint (ACJ) arthritis or a meniscal injury has developed, then ACJ related pain can develop. If the pain is resistant to non-operative treatments, then surgical intervention in the form of an ACJ, or distal clavicle excision, may be necessary.

The aim of the surgery is to arthroscopically remove any degenerative tissue that might be causing pain and irritation to the shoulder. This may involve merely removing any degenerative tissue that has herniated out inferiorly from the joint into the subacromial space, but more commonly the distal clavicle needs to be excised. If there is evidence that the underlying rotator cuff tendons have been aggravated, then a subacromial decompression can also be performed. This ‘key-hole’ procedure is performed using three small incisions, each less than 1cm in length.

Information for patients / operative Information

Risks and complications

• Infection
• Bleeding
• Nerve injury
• Stiffness
• Continued discomfort

Before admission

• Please bring any X-rays or scans with you to the hospital
• No food for 6 hours, or drink for 4 hours, prior to surgery.
• Please avoid smoking for 12 hours prior to surgery

In Hospital

• An arthroscopic ACJ excision is usually performed as a day case or as a single overnight stay.
• Two or three incisions, each approximately 1 cm in length, are made around the shoulder. These are closed with Steri-strips and/or dissolving sutures.
• Splash proof dressings will be applied but the wound should remain dry for 10 days.
• Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

• Swelling; Immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A cryocuff or alternative cold therapy compress can be helpful in minimising swelling and inflammation.
• Pain; An Interscalene block is often used to reduce immediate post-operative pain. If any discomfort arises after 18-24 hours once the block has worn off simple oral analgesics can be taken to manage this.
• Bleeding; There may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

• A sling will be provided to help rest the shoulder. This is usually used for the first 7 - 14 days post surgery. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling can be removed 24 hours after your operation.
• The wound should be kept dry for 10 days.
• At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound. If not, please consult Mr Falworth or your GP for further advice.
• The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will maximise the benefit of your operation and will continue as an out-patient.

Post-operative appointments

• You will be reviewed in clinic approximately 3 weeks following your surgery.

Estimated return to functional activities