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.
Conditions This Treats
Physicians Who Perform Distal Clavicle Excision
Providers Who Surgically Assist with Distal Clavicle Excision
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes persistent pain at the top of the shoulder with bench press, overhead work, and cross-body motion. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before distal clavicle excision include:
- bleeding and infection
- anesthesia risk
- residual pain if the AC joint was not the true pain generator
- over-resection producing AC instability
- under-resection with continued impingement
- stiffness
The indication to proceed is symptomatic AC joint arthritis that has not responded to injections and activity modification. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: