Distal clavicle excision

Overview

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.