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Paul Coplin 07-20-2009 10:19 AM

Distal clavical excision?
I've been battling a shoulder problem since last year. I;ve had pain in the front/top of my left shoulder, and after a round of Ibubrofen (1 month), one cortisone injection, and 7 months of trying to take it easy and PT exercises, it's still problematic. I'm VERY close to getting hired as a career firefighter, and as it is I'm afraid my shoulder won't let me last through an academy.

The MRI only showed inflammation of the AC joint. Because of my profession the doctor says the ultimate cure will be surgery. So I have the procedure scheduled for this week, an open distal clavicle excision (removing some of the clavicle), along with some exploratory diagnostic arthroscopy to inspect everything (supraspinatus, bursa, and rotator cuff).

Question is, has anyone had this done? What was your healing time?

The doc says I should be at 95% in three months, but there could be pain for several after that. He also said that after that three months, there won't be much I can do to reinjure it, and could work through the pain. Any experience with this? Thanks!

Everett Steinbarger 07-20-2009 10:29 AM

Re: Distal clavical excision?
Hello Paul,

I have a few questions for you:

1. Does pushing on the AC Joint recreate the pain that you complain of?
2. Have you had a second opinion?
3. Have you ever injured the AC Joint in the past?

Although AC Arthrosis is not unheard of in 29 y/o males, it certainly isn't common.

Recovery from an open distal clavicle resection takes right around 3 months. I'd say I agree with your surgeon there.

Paul Coplin 07-20-2009 10:41 AM

Re: Distal clavical excision?
Hi Everett.

I really think I overdid it last year: lots of thrusters and overhead presses, and lots of pushups, every time I worked out. Can arthrosis be causes by overuse?

1. Does pushing on the AC Joint recreate the pain that you complain of?
No, only cross-body, overhead, and pushup position irritate it.
2. Have you had a second opinion?
I have. Well, the first was a sports injury specialist, and this second guy is an orthopedic surgeon.
3. Have you ever injured the AC Joint in the past?
This is my first injury on this shoulder. I had a slight rotator cuff (I think) problem on my dominant arm last year, but I was able to rest and strengthen it on my own.

Odd thing is, I just got done with the round of NSAIDS a couple weeks ago, and right after I had to fix something on my Jeep (on back and working overhead) and really ticked it off. That's when I scheduled the surgury. Now though, I;ve been doing some normal activities and it's not as bothered, and even did 8 knee pushups yesterday, and 2 regular pushups today. I'm aware of the shoulder, but there's no pain.

Bryan Veis 07-20-2009 10:42 AM

Re: Distal clavical excision?
I had that surgery. (FYI, I seem to be a poster child for virtually every form of orthopedic surgery -- not that I wanted to be.)

It's been quite a while, but as I recall it was one of the easier recoveries (as opposed to the hip, knee, and foot). A couple weeks in a sling, staples removed on schedule, a little physical therapy, and I was back at it full tilt in about two months. Your mileage may, of course, vary.

It was very successful at alleviating my shoulder pain (which was caused by arthritis and bone spurs). The surgery opened up the joint enough so everything could move with out dragging over some stalactite hanging down from the clavicle.

I will warn you that it takes a little getting used to the visuals -- your symmetry will be gone, because they take off the "bump" at the end of the clavicle. But you will have a cool scar on the top of your shoulder . . . :)

Paul Coplin 07-20-2009 10:45 AM

Re: Distal clavical excision?
Bryan and Everett,

Do you think I could start a fire academy within 3 months of the surgery? After a year and a half of testing, I made it to #27 in a large department, and feel I have a good chance, if not for my shoulder.

Bryan Veis 07-20-2009 10:54 AM

Re: Distal clavical excision?

Originally Posted by Paul Coplin (Post 628108)
Bryan and Everett,

Do you think I could start a fire academy within 3 months of the surgery? After a year and a half of testing, I made it to #27 in a large department, and feel I have a good chance, if not for my shoulder.

I don't know what kind of demands the fire academy will place on you. I do know that I was able to pick up some fairly heavy boxes within a couple weeks. The doctor never found out about that, though, and my co-workers thought I was crazy.

Your surgeon would have a better idea than I, although he would probably be pretty conservative. There is a ligament that holds the distal end of the clavicle in place. If your surgeon does what mine did, the bone is cut outside of the ligament -- in other words, what gets cut off is, for lack of a better word, nonfunctional. It is just in the way. The surgery did not affect the stability of the clavicle. The healing in my case was simply the healing of the incision that was used to take the bone out -- in other words, all I had was basically a deep cut. I had no rotator cuff issues that required additional surgical activity. If that's all that you have, then I would give a layman's guess that you could do the fire academy in three months. If you have other problems in your shoulder, things might be very different, though.

Everett Steinbarger 07-21-2009 05:34 AM

Re: Distal clavical excision?
If all they do is the Distal Clavicle Resection (DCR), then yea, 3 months is enough time to start pushing yourself. You may have a little bit of pain, but it's just pain, not you doing further damage.

However, you are also having a Diagnostic Arthroscopy before the DCR. Your surgeon is doing this because he knows that there maybe something going on inside your shoulder that he is not appreciating on exam. You are very young to be having AC joint problems, and it would not surprise me if your labrum is involved.

If the labrum or capsule is repaired, you are looking at a longer more drawn out recovery.

The way you answered my questions hints at this as well.
1. Directly pushing on the AC joint does not reproduce the pain.
2. Crossbody, overhead, and push-up position bother it.

Personally I have dealt with AC jt issues as well as labrum issues.

When my labrum was torn (posterior tear) my bench press dropped off rapidly and was incredibly weak, as were flyes, and push-ups. The pain was prohibitive.

When my AC joint gets inflamed, I can still push BP, and any other exercise as hard as I want, it just hurts like a hot poker in the top of my shldr. The strength and the ability remain intact, I just eat more Aleve.

Hope this helps,

Arturo Garcia 07-21-2009 05:20 PM

Re: Distal clavical excision?
Here's my experience with AC joint arthrosis:

I was diagnosed with it in my right shoulder in 2007 or so. I turned 24 that year. In 2008 I had surgery on it. Four weeks later I did push-ups. 7 weeks later I was doing metcons. The doc said he removed maybe 4-5mm from both the clavicle and the acromion. The movement that caused the worst pain, for me, was popping my trapezius up, as in trying to "show off your traps", for example. The MRI confirmed the arthrosis more than the conventional movement tests of crossing your arm over your body, etc. Also no pain at all with the doc pushing down the joint.

My fun, and proper workouts, lasted 4 months. In late November 2008 I injured my left shoulder. MRI in Feb. showed small signs of the same thing in this left side. Doc said it wasn't nearly as bad... tried to just recover, ya know. Even went through 3 weeks of NOTHING with that arm (this was hard!!). MRI in June.. it got worse. Open surgery again, had it the 7th day of this month, 2 weeks ago today. I think I am recovering faster than with my right shoulder one.

Funny thing is, once again, according to the movements tests, that joint was fine. It was the MRI that confirmed it, AND, again, trying to pop the trap up (this time the left one) was painful. I have yet to find any text on this, but I suspect in upcoming years someone will do a study on this.

What I personally think? Well, For many years, about 7-8, I played an old computer game at a very high level. It was the ONLY game I played since the year 2000 or so. I retired in 2007 though. I played this game in a HORRIBLE possition. I inclined my chair back, and had both arms almost straight, at shoulder level, parallel to the floor, sortof. Maybe some days I wouldn't play, but maybe some others I'd play 2 or 3 hours. So maybe it takes it's toll. This is what I think, just me, I could be wrong. The bad posture combined with exercising = bad joint.

The doctor mentioned a guy who played this instrument, I don't know the name in english, but you touch it with your hands, like drums but with your hands... and he had both AC joints in pain. When he saw how he played it, he sat on a chair and his arms were up, at shoulder level, out in front... he told him to use a higher chair so his arms would be lower, and that "cured" him. I think this might add some weight to my own theory?

I feel I've only properly trained in 4 months out of the last 2+ years, it is a HORRIBLE feeling. Hopefully soon I'll be able to do everything nicely again :) Need to move on, past this newbie strength level!!! :D

Paul Coplin 07-23-2009 06:04 PM

Re: Distal clavical excision?
Thanks for the info, guys.

I'm now 7 hours post-op. Nerve block has not worn off, so I can't feel my arm from the trap to my thumb (tingly like its half asleep). Standard distal clavicle resection by orthoscopy, and some small cleanup. Yay! I was afraid it was going to be something more. Hopefully this takes no more than 3 months to get back into 100% ROM and 90-95% strentgh, since they arent removing anything fuctional. Sling for three days, then I get to start PTing it with Codman's exercises. Woot!

Arturo Garcia 07-24-2009 08:13 AM

Re: Distal clavical excision?
Best of luck my friend. I'm 2 weeks and 3 days since my one. Today will be my first day of doing rehab twice a day (already did the morning session with a yellow theraband and a 1# weight).

Like I said, I think 3 months is way too long for 100% ROM. Maybe for 100% strength it could be more accurate, but at least in my case, ROM came very quickly in the right one last year, and is coming along very fast in this left one just 17 days post op. I can move it pretty much ANYWHERE, except just one movement: crossing my arm across my body. I still feel discomfort though, but each day a little bit less. And I had open surgery which supossedly takes much longer to heal. You'll be back in no time. :D

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