What is an Acromioclavicular Joint Excision?
An acromioclavicular (AC) joint excision is a procedure that removes a piece of the collarbone along with a piece of the acromion bone where they join together at the shoulder. The aim of the operation is to reduce the pain associated with the AC joint by removing the joint entirely.
It is generally performed arthroscopically – that is, small incisions are made around the shoulder to allow access for a camera and specialised surgical instruments. This is otherwise known as keyhole, or minimally invasive, surgery.
Who is this operation for?
Acromioclavicular joint excision is performed for people suffering from arthritis in the AC joint that has not responded to conservative (or non-surgical) treatment, like pain killers and physiotherapy.
It can also be used to treat people with bony spurs growing around the AC joint.
What are the benefits of the operation?
The main benefit of this operation is that it aims to reduce the pain and disability caused by arthritis in the AC joint.
Risks of not having the surgery
These include:
- Continued pain
- Continued disability
- Worsening arthritis
Complications
The risks and complications of a Acromioclavicular Joint Excision include:
- Anaesthetic problems
- Shoulder stiffness
- Infection – With any surgical procedure, infection is a risk. However, with the small incisions made with shoulder arthroscopy, infections are very rare.
- Damage to nerves or blood vessels – these are very uncommon complication
- Damage to bone – rarely too much bone is removed from the shoulder
- Muscle damage – the deltoid muscle, which overlies the shoulder, may be damaged
For more information on the potential complications of any surgery, see Complications of Surgery.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
In some cases, a specialised assessment for anaesthesia is required.
Tests
Tests that may be ordered for you include:
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
About the Operation
This is generally performed as a day procedure, so you come into hospital in the morning and go home the same day.
Acromioclavicular joint excision is performed under a general anaesthetic, so you won’t be awake during the procedure. Local anaesthetic is sometimes used in addition to this to reduce pain.
Generally only 2 incisions are required for this procedure both of which are no more than a few centimetres long.
The surgeon uses one of the incisions to insert the camera (arthroscope) into the shoulder, and assess all of the structures inside the joint. A burr is then used to remove a small amount of bone from the end of the collarbone. In order to do this, some ligaments around the AC joint may need to be removed.
Once the operation is finished, the incisions are stitched closed.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.
Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse will regularly check on your recovery.
What about pain?
At this stage, anaesthetic from the operation will still be having an effect. Your ward doctors and nurses can also prescribe additional pain-relief as needed (see Post-Operative Analgesia), however arthroscopy is generally only minimally painful.
Recovery and Rehabilitation
You will be encouraged to start using the affected shoulder from day 1 after the operation. These will involve passive and active assisted exercises that will have you moving your shoulder in different planes. The aim is for you to have full range of motion in your shoulder by 6 weeks.
After this, you will be encouraged to do shoulder strengthening exercises, leading up to repetitive overhead exercises 3 months after the operation.