Distal clavicle excision

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus). — **Shoulder anatomy.** The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.

The acromioclavicular joint sits at the top of the shoulder where the clavicle meets the acromion. When arthritis develops — from age, old injury, or heavy overhead use — the bones rub together painfully, particularly with cross-body motion and overhead lifting. Removing a small amount of bone from the clavicle side eliminates that painful contact without disrupting the joint's supporting ligaments.

How the Procedure Works

We access the AC joint arthroscopically and use a burr to remove bone from the distal clavicle — typically 5 to 8 mm, enough to eliminate contact but not so much that we destabilize the joint or encroach on the coracoclavicular ligaments below. Removing too little leaves the patient symptomatic; removing too much risks clavicle instability. We confirm the resection with direct visualization and check cross-body motion at the end: if the clavicle still contacts the acromion in that position, we remove a bit more. The inferior capsule and the coracoclavicular ligaments — the main stabilizers of the clavicle — are never touched.

When to Consider Distal Clavicle Excision

Distal clavicle excision is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:

Symptomatic AC joint arthritis
Pain localized to the top of the shoulder, worse with cross-body adduction, and confirmed on imaging.
Failure of conservative care
Activity modification, anti-inflammatories, and at least one AC joint injection that did not provide lasting relief.
Pain with overhead or cross-body use
A functional limitation affecting daily activity, work, or sport.