Variation of the Arthroscopic Mumford Procedure for Resecting the Distal Clavicle

Paul D. Lesko, MD

Disclosures

J South Orthop Assoc. 2001;10(4) 

In This Article

Abstract and Introduction

Abstract

Fifty-seven patients had arthroscopic Mumford procedures for acromioclavicular (AC) pain unresponsive to conservative treatment. Thirty-nine of these patients had concomitant rotator cuff repairs. All had significant improvement of distal clavicular pain. Neither the amount nor the completeness of the distal clavicle resection affected the results. One patient with a significant retained lateral clavicular spike required additional surgery for excision. Arthroscopic distal clavicle resection is a safe and effective method of alleviating AC pain.

Introduction

Acromioclavicular joint symptoms are common in shoulder disorders, resulting from both direct injury to the AC joint and rotator cuff/impingement phenomenon with AC arthrosis. Nonoperative treatments, including physical therapy, anti-inflammatory drugs, and corticosteroid injections can help resolve the symptoms. Certain cases, however, are not responsive to conservative care and require operative intervention. The Mumford arthroscopic procedure, as described by Snyder et al,[1] is a reliable method of resecting the distal clavicle in cases of posttraumatic degenerative disease of the AC joint, distal clavicular fractures, and shoulder impingement syndrome.

Traditionally, distal clavicle resection has been done via open incision over the AC joint with detachment of the deltoid and trapezius muscles and their adjacent fascia. Symptom improvement has been satisfactory in most reported series,[1,2,3,4,5] but significant morbidity can occur with these open procedures. Some complications with distal clavicle resections have included residual AC joint instability, postoperative shoulder weakness, and cosmetic complaints.[6] Arthroscopic subacromial decompression and resection of the distal clavicle can avoid the problems associated with traditional open procedures. Additionally, arthroscopic surgery allows adequate visualization and identification of glenohumeral joint disease (labral tears, loose bodies, chondral injuries),[7] as well as rotator cuff disease.[7,8,9,10]

Several surgical arthroscopic approaches to the AC joint have been proposed. One is the superior approach in which the arthroscope and instruments are inserted through the AC joint from a superior portal.[3] Another approach is the subacromial technique, in which the arthroscope is inserted via a posterior portal and the burr is inserted through a lateral subacromial portal.[1]

In this study, a variation of the subacromial technique for arthroscopic resection of the distal clavicle was used in 57 patients with a clinical presentation of rotator cuff/impingement. In this variation, the arthroscope is placed through a lateral portal, and the burr is placed posteriorly. In all cases, a diagnostic arthroscopy was done, followed by a bursoscopy with acromioplasty and distal clavicle resection. In many patients, mini open procedures for rotator cuff repairs were also done.

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