29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)

Name of the Procedure:

Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Also known as: Mumford Procedure

Summary

The Mumford procedure, a type of shoulder arthroscopy, involves surgically removing the distal (end) portion of the clavicle (collarbone) near the shoulder joint. This minimally invasive technique is performed through a small incision using specialized instruments and a camera to guide the surgeon.

Purpose

The procedure addresses shoulder pain and dysfunction often caused by arthritis of the acromioclavicular (AC) joint or other degenerative joint diseases. The primary goal is to alleviate pain, improve shoulder function, and enhance the patient's quality of life by removing the damaged end of the clavicle.

Indications

• Persistent shoulder pain, especially around the AC joint
• Osteoarthritis or degenerative changes in the AC joint
• Shoulder impingement or limited range of motion
• Failure of conservative treatment methods like medications, physical therapy, or injections

Preparation

• Follow fasting instructions as provided by your healthcare team, typically no eating or drinking after midnight before the procedure.
• Adjust or temporarily discontinue certain medications as directed, especially blood thinners.
• Undergo necessary diagnostic tests such as X-rays, MRI, or CT scans to assess the shoulder condition.
• Arrange for transportation home post-procedure, as anesthesia will impair your ability to drive.

Procedure Description

1. Anesthesia: Administered to ensure comfort, usually general anesthesia or regional nerve block.
2. Incision: Small incisions (portals) are made around the shoulder.
3. Arthroscopy: A small camera (arthroscope) is inserted to visualize the shoulder joint.
4. Surgical Instruments: Specialized tools are used to remove the damaged distal end of the clavicle.
5. Closure: The incisions are closed with sutures or sterile strips, and a bandage is applied.

Duration

The procedure typically lasts about 1 to 2 hours, depending on the complexity.

Setting

Performed in a hospital or outpatient surgical center.

Personnel

• Orthopedic Surgeon: Performs the procedure.
• Anesthesiologist/Nurse Anesthetist: Manages anesthesia.
• Surgical Nurse: Assists during the procedure.

Risks and Complications

• Infection
• Bleeding
• Nerve injury
• Shoulder stiffness or limited range of motion
• Persistent pain
• Adverse reactions to anesthesia

Benefits

• Relief from chronic shoulder pain
• Improved shoulder function and mobility
• Enhanced quality of life, often noticeable within a few weeks post-surgery

Recovery

• Initial Recovery: Rest and application of ice packs to reduce swelling.
• Pain Management: Prescribed pain medications as needed.
• Physical Therapy: Begin guided rehabilitation exercises to restore strength and mobility.
• Restrictions: Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up: Regular appointments with the surgeon to monitor healing.

Expected recovery time varies but typically spans a few months, with gradual improvement in pain and function.

Alternatives

• Conservative Treatments: Physical therapy, medications, corticosteroid injections.
• Other Surgical Options: Open distal claviculectomy or shoulder replacement in severe cases.

Each alternative has its own risks and benefits, and suitability depends on the patient's specific condition.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there may be discomfort, swelling, and the need for pain management. Physical therapy will play a crucial role in recovery, and it's vital to follow all postoperative care instructions to ensure optimal outcomes.