Open excision of acromioclavicular joint (Mumford procedure) surgical technique
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This is a useful technique to be able to offer to patients with a acromioclavicular joint pain secondary to degenerative change. Isolated acromioclavicular joint pain is quite common and can vary in severity, from being either a minor inconvenience to interfering significantly with work, sport and leisure activities and in particular sleep.
The clavicle is one of the last bones to fully ossify in the human skeleton and almost as soon as it has done so there is propensity for it to degenerate at either the medial sternoclavicular joint or more commonly at the lateral acromioclavicular joint. The onset of pain in the acromioclavicular joint can be insidious or maybe as a result of minor trauma such as a grade 1 or a grade 2 sprain, which comes about as a fall directly on to the point of the shoulder or a direct blow to the acromioclavicular joint.
It has been documented that approximately 30% of the population have an intra-articular disc of soft tissue similar to a knee meniscal cartilage within the acromioclavicular joint. If this were to be damaged, then that can also be a cause of persistent pain and disability.
Once a diagnosis of acromioclavicular joint pain has been established then simple conservative measures should be recommended in the first instance. If non-operative measures have been exhausted and the patient has persistent pain, then consideration should be given to excision arthroplasty of the acromioclavicular joint with removal of the joint contents and resection of the distal clavicle articular facet. This is also known as the Mumford procedure after an early description published in 1941. The cavity then fills with scar tissue and generally the patient’s symptoms are greatly improved quite quickly. The open technique described here is relatively quick, straightforward and successful.
Author: Mr Mark Crowther FRCS (Tr & Orth)
Institution: The Avon Orthopaedic centre, Southmead Hospital, Bristol, UK.
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Question 1 of 14
Which one of the following is the recommended position for the patient undergoing the operation ?CorrectIncorrect
Question 2 of 14
The main indication for open excision of the acromioclavicular joint is which one of the following?CorrectIncorrect
Question 3 of 14
Which one of the following conservative measures is least likely to be of benefit in the early management of acromioclavicular joint pain?CorrectIncorrect
Question 4 of 14
Concerning instillation of local anaesthetic with adrenaline, which one of the following is incorrect?CorrectIncorrect
Question 5 of 14
Which one statement correctly describes the surgical incision?CorrectIncorrect
Question 6 of 14
Which one of the following describes where has the white needle been placed?CorrectIncorrect
Question 7 of 14
Which one statement accurately describes the type of incision of the superior ACJ capsule and lateral clavicle periosteum?CorrectIncorrect
Question 8 of 14
Which one of the following is the correct way to expose the acromioclavicular joint?CorrectIncorrect
Question 9 of 14
Which one of the following is the correct sequence of surgical step?CorrectIncorrect
Question 10 of 14
The importance of ensuring less than 1cm excision of distal clavicle is described by which one of the following?CorrectIncorrect
Question 11 of 14
Repair of the superior capsule ligament and lateral clavicle periosteal flaps is important. Which one of the following suturing techniques is recommended?CorrectIncorrect
Question 12 of 14
Concerning postoperative rehabilitation, which one of the following is true?CorrectIncorrect
Question 13 of 14
Which one of the following statements about the published literature is correct?CorrectIncorrect
Question 14 of 14
The comprehensive review in the British journal ‘Shoulder & Elbow’ in 2018 concluded which one of the following?CorrectIncorrect