The Mumford procedure, also known as distal clavical resection, is a surgical procedure that aims to relieve shoulder pain by removing a small part of the clavicle, or collar bone. Patients suffering from painful inflammation, swelling, or osteoarthritis in the acromioclavicular (AC) joint — where the end of the clavicle meets the shoulder — may elect to have this procedure, especially if alternative solutions like physical therapy and cortisone injections are unsuccessful. The surgery can be performed using an open or arthroscopic procedure, and typically requires eight to ten weeks recovery time.
Reasons to Have this Surgery
Surgeons usually perform this procedure when bone spurs develop on the collar bone, narrowing the AC joint and preventing it from moving smoothly. These spurs can be caused by arthritis or overuse. A condition called distal clavicular osteolysis or "weightlifter's shoulder" can develop in people who put a great deal of stress on this joint; in this condition, the end of the clavicle begins to break down. Removing the damaged end of the collar bone can help relieve pain and restore movement for many of these patients.
The Mumford procedure is a relatively common and simple surgery, and has a high success rate. Clinical studies show that, depending on the underlying problem and the type of surgery used, at least 75% - 90% of patients report good to excellent outcomes.
Before the Surgery
Before the Mumford procedure is recommended, a health care provider will evaluate the patient, feeling for swelling or tenderness in the AC joint and checking the patient's range of motion. A series of tests are performed to see if certain types of movement in the arm and shoulder will cause pain for the patient. This is followed by x-rays and magnetic resonance imaging (MRI) so that the health care provider can look for clear signs of bone spurs or other problems in the joint, and to help rule out alternate causes of pain.
Non-surgical treatment methods are nearly always recommended before a patient undergoes surgery to fix a problem with the AC joint. Such treatments can include icing and resting the shoulder, anti-inflammatory medications, corticosteroid injections, and physical therapy. Most health care providers recommend trying these methods for at least six months before considering surgical options.
Open Distal Clavicle Resection
During an open Mumford procedure using a direct approach, the patient may be given a sedative, along with general anesthesia or a regional interscalene block, which numbs the nerves in the shoulder and arm for up to 24 hours after the surgery. An incision is made on top of the AC joint, and the fibrous tissue, or fascia, over the joint is cut; it may also be necessary to release the shoulder muscles from the bone. A surgical saw is used to cut off about 0.4 to 0.8 inches (1 to 2 centimeters) or less of bone off the end of the clavicle. Pieces of the bone are removed and the tissue and skin are sutured back together.
In the indirect approach, the surgeon performs the procedure from below the joint rather than above. Many of the same steps are performed in this approach, although the bursa — a small fluid-filled sac that cushions the joint — is typically removed. The indirect approach is often preferred when other surgical procedures, such as a rotator cuff repair, are also being performed.
Arthroscopic Distal Clavicle Resection
Although the original Mumford procedure was an open surgery, advances have made arthroscopic techniques increasingly popular. As with open surgery, arthroscopic procedures can be performed using both direct and indirect approaches. In this type of surgery, several small incisions are made in the shoulder, and a camera and the surgical instruments are inserted into the joint. Unlike with the open procedure, it is typically not necessary to release the muscles to perform this type of surgery. The covering of the joint, known as the joint capsule, is removed and a surgical burr is used to shave off a portion of the clavicle.
Recovery
Both the open surgery and the arthroscopic surgery can be done on an outpatient basis, although in some cases, the patient may be required to stay overnight. The surgery itself typically takes one to two hours, the patient may require another two hours for the anesthesia to wear off. How long it takes for a patient to recover from the surgery itself will depend on which type of procedure was used and the body's own healing speed, but people who have arthroscopic surgeries usually recover faster. The incision in the skin and fascia and the release of the muscles in the open surgery will take longer to heal than the smaller incisions made during the arthroscopic procedure.
The patient will need to rest the shoulder and manage any pain and swelling with ice and medication for the first few days after the Mumford procedure. For the first day or two, the arm is typically immobilized in a sling, and any movement should be kept to a minimum. The bandages can often be removed after about two days with an arthroscopic procedure and a week after open surgery.
After a few days, light or passive arm movement may be recommended, and the patient can stop wearing the sling if doing so does not cause pain. After the first week, the patient may begin light physical therapy and range of motion exercises; even while wearing a sling, moving the fingers and hand can help with circulation. It often takes about three weeks for the patient to regain normal use of the shoulder and arm. Sports and other more strenuous physical activities should usually not be performed for eight to ten weeks after the surgery. The patient is advised to proceed with therapy slowly and report any pain to his or her physician.
Possible Complications
Complications from this surgery are generally minor and rarely occur, regardless of the procedure used. The most common complication is joint tenderness, along with stiffness and some minor loss of elevation. Some patients experience weakness in the shoulder and arm, particularly after the open procedure. The ligaments around the joint can be damaged during surgery, leading to shoulder instability. Infection in the joint is also possible.
In some cases, the surgeon may not remove enough of the bone during the procedure, so the patient may still experience long-term pain. It is also possible that problems with the AC joint were not the only causes of pain in the shoulder, so the surgery may not solve the underlying condition.
