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Why would my clavicle bone be sticking out more than the other arm or be sinking inside my shoulder when doing certain exercises? Open surgery is not usually performed as it may be associated with complications such as shoulder weakness, joint instability, infection, tenderness, and cosmetic complaints. Unlike previous reports, we further divided the patients into two groups, those with and those without subacromial impingement, before final evaluation of functional outcome.
An open distal clavicle excision is performed through a small incision on the top of the shoulder. X-rays can show wearing out of the AC joint, with narrowing of the space between the end of the collarbone at the shoulder blade. What is the patient's status with respect to nutrition, pain, medications, smoking, alcohol, and other concurrent health conditions? After the surgery I began Physical Therapy two days later. Many people with AC joint problems also have typical symptoms of rotator cuff impingement, since these conditions go hand in hand. A Mumford distal clavicle excision is commonly performed to treat pain and discomfort associated with acromioclavicular joint disorders such as distal clavicle fractures, AC joint degeneration, etc. Constant CR, Murley AG: A clinical method of functional assessment of the shoulder. The stem is then cut with a high-speed motorized disk and smoothed of any burrs remaining from the cut. Revision Surgery due to Glenoid Componnent Failure - instability. I did however occasionally use it to hold my books and was sometimes bumped into or hit on my shoulder by friends throughout the campus. Excising the Clavicle. Osteolysis of the Acromioclavicular Joint | Shoulder Surgeon | South Windsor, Enfield, Glastonbury CT. The authors declare that they have no competing interests.
No wound breakdown or infection occurred in any of the patients. Re: Pain 10 weeks after Distal Clavicle and Decompression Shoulder Surgery - Please h. Shoulder popping after distal clavicle resection disorder. Hi Lokobreed, I was searching for stuff regarding decompression surgery when I came across you posting, which might has well been written for menu you. Although the underlying causes of these conditions have been generally recognized as multifactorial, the interplay between additional extrinsic compression (hook placement in the subacromial space) and pre-existing degenerative age-related changes of the local bony and soft tissue structures seems to contribute variably to the formation of these shoulder pathologies. All patients were informed that the hook plate was to be removed after bony union and/or ligamentous healing was achieved on radiographs and should not be retained for longer than 6 months.
Sometimes rest and conservative treatment can bring relief of symptoms, but this condition can also lead to more chronic pain in the AC joint. The delayed union resulted from the implant fixation failure. It is most commonly seen when an acromioplasty has been performed, compromising the stabilizing effect of the coracoacromial arch. PKW performed the sonographic evaluation. Lyons FA, Rockwood CA: Migration of pins used in operations on the shoulder. Shoulder popping after distal clavicle resection arthroplasty. For example, a shoulder arthroplasty may be stiff because of adhesions (scar), blocking osteophytes (bone spurs), or overstuffing (too large prosthetic components). The risk is also increased when there has been weakening of the humeral shaft from reaming as explained in a previous post or from loosening of the humeral component. Third, during the operation, shoulder motion, particularly abduction and forward elevation, should be verified to ensure no immediate hook impingement that will increase the risk of subacromial impingement or rotator cuff damage. Inspection of the affected shoulder may reveal joint prominence or asymmetry. Continued AC joint tenderness.
The muscles and ligaments are peeled off the clavicle, a saw is used to remove 5 mm of the end of the clavicle and then the ligaments are repaired. Contact Dr. Kevin Kruse, Your Clavicle Fractures Dallas and Fort Worth Clavicle Trauma Surgeon. None of the 40 patients had previous trauma (fracture or dislocation) or surgery on the affected shoulder. 1988, 150 (2): 343-347. I had surgery on Nov. 24 and then flew back to Florida the following Tuesday, December 1st. Ipsilateral, iliac, crest, and hamstring autograft donor sites are prepped if their possible need is anticipated.
1991, 73 (2): 291-294. A careful history is needed to determine the original diagnosis, the initial result of the joint replacement, the onset of discomfort or loss of function, any injuries, dental or other procedures that may have introduced infection, and any intercurrent diseases. Physical examination and Imaging to Diagnose AC joint problems. Circlage can also be used but care must be taken to protect the radial nerve that can be circlaged in its musculoskeletal groove. Mumford Procedure-Distal Clavicle Resection. According to our data, there was no significant difference in the subacromial impingement rate with respect to the pre-injury shoulder ROM, injury mechanism, surgical method, or duration of hardware retention. Accessing the Shoulder. Do not drive a car or operate machinery while taking the narcotic medication or while in sling. Well I am 2 months out of the capuslar shift and every issue I had prior to this surgery due to my first surgery of a DCR is still there. Passive shoulder exercises were started 2 days postoperatively with the aid of the uninjured arm. 2009, 91 (2): 447-460. Recall that if the subscapularis is to allow a range of rotation of 115 degrees (two radians), it must have an excursion of twice the radius of the humeral head. Diagnosis The diagnosis of an AC joint problem can be made by taking a careful history of the patient's symptoms and examining the affected shoulder. In dynamic sonographic examinations, three patients had their sonographic impingement grading lowered from grade 2 to grade 1 and four patients from grade 3 to grade 2 (Figure 5).
These left 40 patients with a minimum follow-up of 12 months (mean, 13. Revision Surgery due to Superior Instability. Are we the best surgeons to carry out the revision surgery? Bureau NJ, Beauchamp M, Cardinal E, Brassard P: Dynamic sonography evaluation of shoulder impingement syndrome.
The non-impinged patients had significant higher Constant-Murley score (90. The clinical diagnosis of subacromial impingement was further confirmed on dynamic musculoskeletal sonography. 2006, 187 (1): 216-220. Radiological assessment revealed cutout of the two screws from the clavicle and that the hook of the plate had partially disengaged from the acromion. If a shoulder surgery has resulted in stiffness or limited range of motion, stretching exercises or a second surgery to release adhesions may be helpful. Radke S, Kenn W, Gohlke F: MRI of the shoulder. J Bone Joint Surg Br. Ask our community of thousands of members your health questions, and learn from others experiences. High quality and appropriately oriented anteroposterior and axillary radiographs will reveal the glenohumeral relationship (including the superior/inferior and anteroposterior relationship of the center of the humeral head and the center of the glenoid), the integrity of the tuberosities, the orientation of the glenoid, and much about the type and position of the humeral component. We recently completed a study regarding cultures obtained at the time of revision arthroplasty. 1990, 72 (8): 1262-1267. As shown previously, all adhesions in the humeroscapular motion interface are lysed. If the joint is anesthetized, and the pain is completely relieved through the aforementioned tests and maneuvers, then the AC joint is likely the source of the problem. All of the subacromial impingements occurred unilaterally and specifically on the injured shoulder.
If another procedure is performed at the same time, then the postoperative restrictions are based upon the restrictions of the other procedure. These patients may or may not be involved in repetitive physical activity with he affected shoulder. A Mumford procedure (distal clavicle resection) is when the outer portion of the clavicle (or collarbone) is shaved off or removed. Thirty-four patients had injuries resulting from motorcycle accidents or bicycle falls, while six patients suffered the injury from a fall from a height (Table 1). Often these cultures are positive for organisms such as Propionibacterium acnes and Coagulase-negative Staphylococci that are less commonly recovered from revision surgery in other sites of joint replacement such as the hip or knee.
For this reason we do not start antibiotics after an aspiration in the office or emergency room because of the possibility that this culture may not yield a representative result (i. e. it may be falsely negative or contaminated by skin flora).
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