Acromioclavicular Joint

AC Joint Surgery in Indianapolis, IN and Mooresville, IN

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AC Joint Pain

Distal Clavicle Excision
AC Separation Injury
CC Ligament Reconstruction

Acromioclavicular (AC) Joint Pain

The acromioclavicular joint (AC Joint) lies between the end of the collar bone (clavicle) and the acromion (part of the shoulder blade). In women, this is near where a bra strap rests. The AC joint is stressed with overhead and cross arm movement. It lies immediately above the rotator cuff.

Pain in this area can be caused by:

Osteoarthritis of the acromioclavicular joint: Oftentimes this can be seen on x-ray and/or MRI as a bone spur and can often be felt on exam. Initial treatment includes activity modification, anti-inflammatories, physical therapy, and ultrasound-guided corticosteroid injection. If non-operative treatment fails, surgery (either with an open or arthroscopic removal of the arthritis/bone spurs) may be performed. This surgery may also be performed at the same time as a rotator cuff repair to remove the bone spur that can pinch or “impinge” on the rotator cuff, which lies immediately beneath the AC joint.

Distal Clavicle Osteolysis: This is fairly rare condition that occurs most often in male patients in their 20s. Patients commonly are weightlifters, overhead laborers, and/or military personnel. Most complain of pain with repetitive movements like push-ups or bench pressing. X-rays will show the end of the clavicle (collar bone) being “resorbed” or losing its normal appearance. Conservative treatment includes activity modification (reducing the amount of heavy lifting), anti-inflammatories, and possible corticosteroid injection. If non-operative treatment fails, surgery with an open incision and removal of the end of the clavicle (collar bone) may be performed.

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Distal Clavicle Excision

If non-operative treatments fail to resolve the pain/symptoms coming from the acromioclavicular (AC) joint, surgical treatment may be offered. Excision (removal) of the distal clavicle (end part of the collar bone) can be performed either minimally-invasively with a camera (arthroscopic distal clavicle excision) or with an open incision. The root cause of the pain sometimes dictates which type of procedure would be performed. Only the very end part of the damaged or arthritic clavicle is removed (up to 1cm or about ½”).

Arthroscopic distal clavicle excision: In certain circumstances, the bone spur at the end of the clavicle (collar bone) can be removed through a minimally-invasive technique that does not require any large open incisions. This allows the body to heal faster. This procedure is often done at the same time as a rotator cuff repair in order to prevent a possible bone spur from pinching on the newly-repaired rotator cuff.

Open distal clavicle excision: Sometimes the distal clavicle must be removed in its entirety with an open incision. This procedure is usually reserved for patients who have a very large bone spur. Open removal can also be helpful if there is a cyst that has formed due to the arthritis. This open technique is also my preferred method for distal clavicle bone loss (osteolysis) that needs surgery. The incision may be either transverse (horizontal) or longitudinal (vertical) depending on the specific surgical plan. This is an outpatient procedure under general anesthesia. A pre-operative nerve block is given to help with pain after surgery.

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Acromioclavicular (AC) Joint Injury

An acromioclavicular (AC) joint separation, more commonly referred to as a “shoulder separation”, is when the clavicle (collar bone) separates from the scapula (shoulder blade). This can cause injury to the surrounding muscles, tendons and ligaments – most importantly the acromioclavicular (AC) and the coracoclavicular (CC) ligaments. The separation happens when the shoulder receives a direct and forceful blow from the side. It is an injury common among contact athletes, such as football, or cyclists that fall over the handlebars. It can also occur after a fall directly on to the shoulder.

Typically, an AC separation does not require surgery. Although there is great discomfort with an AC separation, most separations will heal on their own within 6-12 weeks. X-ray’s and a physical exam determine the severity of the injury. There are six categories of shoulder separation:

  • Grade I – slight displacement of the joint. The acromioclavicular ligament may be stretched or partially torn. This is the most common type of injury to the AC joint.
  • Grade II – partial dislocation of the joint in which there may be some displacement that may not be obvious during a physical examination. The AC ligament is completely torn, while the CC ligaments remain intact.
  • Grade III – complete separation of the joint. The AC and CC ligaments are torn. Usually, the displacement is obvious on clinical exam. Without ligament support, the shoulder droops under the weight of the arm and the clavicle is pulled up, causing a bump on the shoulder. Depending on the activity level and pain level, these may require surgical intervention.
  • Grades IV through VI – significant displacement of the joint. These are rare injuries, often the result of a car accident. Surgery is generally required.
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Coracoclavicular (CC) Ligament Reconstruction

What Happens During Shoulder Ligament Reconstruction?
Shoulder ligament reconstruction surgery involves the repair of torn or stretched ligaments so that they are better able to hold the shoulder and collarbone in place. The surgery is performed as an open surgical procedure which involves one incision over the shoulder. This is an outpatient procedure done under general anesthesia. Most patients receive a pre-operative nerve block to help with pain after surgery.

During the surgery, overstretched capsules and ligaments are tightened. A tissue graft, also referred to as an “allograft” or “cadaver tendon,” may be used to reconstruct the shoulder ligaments. This surgery creates a better environment for scar tissue to form and prevent future displacement (shifting) of the bones. The graft is wrapped around the fixed bones and secured with stitches and sometimes small buttons.
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Helpful, kind and made it as easy as possible!

“Dr. Calloway did my surgery. He's personable, up front about what your problem is and how to solve it, and open to any questions with a great bedside manner. The surgery went perfectly to the point where I was basically a little weirded out about how well it went. I had a similar surgery on my left shoulder as I did in my right shoulder, a few differences, and this particular shoulder surgery with Dr. Calloway went smooth as butter. His office staff is very nice and personable as well. No one there makes you feel like a dollar sign. When the surgery time came Dr. Calloway came to my room and pre-op to explain what was going to happen and try to call my nerves, as I have an extreme fear of going under anesthesia. He and the surgery staff were helpful and kind and made a difficult experience is easiest possible.”

Excellent Surgeon!

“Excellent surgeon! He's friendly, personable, knowledgeable and does a great job of explaining what he's going to do and what he did do after surgery.”

I have no pain, no popping, my mobility is great!

“Dr. Calloway was great to work with. After dislocating my shoulder multiple times he suggested latarjet procedure. I am now 9 months post surgery and my shoulder feels great, my incision healed very well. I have no pain, no popping, my mobility is great and my shoulder feels secure again witch I am very thankful as I do tree work and need to use my shoulders a lot. Dr. Calloway patiently answered every question I had thoroughly and I believe he set me up for the best recovery possible.”

The surgery results were great!

“I had no problems getting scheduled for appointments or for surgery. He was very friendly and courteous and gave realistic expectations about my rotator cuff surgery. He took the time to explain exactly what procedures were to be used. He answered all my questions. The surgery results were great. He was very much engaged in getting me back on the golf course with his recommendations for physical therapy and encouragement. I would definitely recommend him to others and if I need surgery on my other shoulder he will be my first choice.”

This is the first I've been painfree!

“I was referred to Dr. Calloway as a last resort. He was honest up front and told me he couldn't guarantee that he could be any help. I underwent arthroscopic surgery to have scar tissue cleaned up and he performed a tendon release on my hip. One week after surgery I am having no pain and much more mobility. This is the first I've been painfree in more than 6 years.”