Distal Clavicle Resection Technique

DCR CPT

• 29824 = arthroscopic distal claviculectomy

DCR Indications

• Failure of non-operative management for AC Arthritis
• Distal Clavicle Osteolysis

DCR Contraindications

• Acromioclavicular instability: If there is AC instability CA ligament reconstruction +/-DCR is indicated
• Active infection

DCR Alternatives

• Non-operative treatment: NSAIDS, physical therapy, activity modifications, ACJ injections
• Open Distal clavicle resection

DCR Pre-op Planning / Special Considerations

• Ensure both 30° and 70° arthroscopes are available.
• Direct approach: Sharron, Schepsis 2007

DCR Technique

• See Shoulder Arthroscopy Technique
• Ensure that AC joint is not unstable secondary to ACJ separation.  If so concomitant coracoclavicular ligament reconstruction is indicated (Jerosch J, Unfallchirurg 1998;101:691-96).
• Ensure anterior portal is well aligned with ACJ.
• Perform subacromial decompression and remove medial fibrofatty tissue around the distal clavicle and scapular spine.
• Perform distal clavicle resection through anterior portal using a power burr while viewing from posterior portal usning a 30° scope.
• Preserve superior ACJ capsule and ligaments. (Levine WN, Arthroscopy 2006;22:516).
• Evaluate superior cortex posteriorly with a 70° scope, ensure resection is complete.
• Perform cross-body adduction test confirming no abutment occurs.
• Resect between 5 and 10mm of distal clavicle or make 5-10mm space by resection of some acromion. (Branch TP Am J Sports Med 1996;24:293-7) (Eskola A, JBJS 1996;78A:584-7).
• Use rasp or burr of known size to quantitate ACJ space created.

DCR Complications

• Instability(excessive resection)
• Continued symptoms (inadequate resection)
• Ectopic calcification
• Reactive bursitis
• Clavicle/acromion fracture
• Infection
• Adhesive capsulitis

DCR Follow-up care

Post-op: sling as needed with pendulum ROM exercises.
See Shoulder Scope Rehab protocol.
1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start at 3 weeks. Avoid cross-body adduction for 6 weeks.
6 weeks: progressive sport specific activity.
3 months: Return to sport / full activities.
In in association with SAD, or RTC repair use those rehab protocols.
Outcome measures: ASES score, pain scales.

DCR Outcomes

• 71% excellent, 16.5% good, 12.5% failure (Levine WN Arthroscopy 1998;14:52-6).
• 100% good to excellent results for DCR with SAD at an average follow-up of 6 years. 25% asymptomatic calcific density distal to the resected clavicle. (Kay SP, Arthroscopy 2003;19:805).

DCR Review References

• Burkhart SS, A Cowboy's Guide to Advanced Shoulder Arthroscopy, 2006
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Arthrotek Shoulder

Depuy/Mitek Shoulder

Linvatec Shoulder

Smith&Nephew Shoulder