Arthroscopic Acromioclavicular Joint Excision
Other popular names
- ACJ Excision
- Excision lateral end of clavicle
Who does it affect?
People suffering with Arthritis of the shoulder joint.
Why is this used?
This operation aims to remove the painful and damaged Acromioclavicular Joint (ACJ) without making it unstable. The arthritis may have been caused by injury or general wear and tear. The procedure is often carried out at the same time as an Arthroscopic Subacromial Decompression (ASD) in patients that also have impingement syndrome.
Patients with arthritis of the acromioclavicular joint (ACJ) will classically complain of pain over the top of the shoulder directly over the ACJ. The pain intensifies as the arm is lifted up so the hand points directly upwards. This is classically known as 'high arc pain.' It is common to have interruption of sleep due to the pain.
ACJ osteoarthritis is usually diagnosed by a combination of taking a detailed history and clinical examination. X-rays are usually taken to evaluate the extent of the arthritis.
Pain-killers and anti-inflammatory drugs will also be offered.
Physiotherapy may be used to minimise the symptoms.
Therapeutic steroid injection into the ACJ may be used to reduce inflammation and provide pain relief. These are only performed once or twice and may be done via ultrasound guidance.
Sometimes pain is not improved with physiotherapy or injections and at this time you will be offered surgery.
Surgery is carried out under general anaesthetic and takes about 20 minutes. Three cuts, each about 3-4mm in length are used. A shaver is inserted through the cut in the skin (key-hole surgery) from the front of the AC Joint and the worn surfaces of the joint removed completely. The outer end of the collar bone (clavicle) is removed. The ligaments that stabilise the joint are preserved. In general no stitches are used to close the wounds. At the end of the operation your arm will be placed into a sling.
You will be able to leave hospital soon after the operation. You will return from theatre wearing a sling. This is for comfort only and should be removed as soon as possible, often before you leave hospital. Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.
The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The bulky dressing will be removed after 1 day. The smaller dressing beneath is removed after 12 days. Keep the wound dry until the small dressings are removed after 12 days.
Return to normal routine
The sling should be removed on the day of the operation. I usually advise my patients to start moving the arm and shoulder as soon as the discomfort allows. I encourage the arm to be lifted even if it means lifting it with the other arm. You are allowed to return to any activity that feels reasonably comfortable. Most of the discomfort has usually settled in the first six weeks, often sooner.
Return to driving:
You are advised to avoid driving until full movement in the shoulder has returned. You will be given further advice about this at the time of your operation.
Return to work:
Everyone has different work environments. You will be given advice on your own particular situation. As a general rule, you are allowed to return to work as soon as you are able to do your work comfortably.
I would expect you to have approximately 80% recovery by three months after the operation. You may feel some discomfort in the shoulder for up to 12 months after the operation.
Overall over 97% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any upper limb surgery from a minor procedure to a complex reconstruction).
- Failure to completely resolve the symptoms