I commonly see patients with chronic shoulder pain who have undergone a shoulder surgery bone spur removal to “open up” the shoulder. Known as distal clavicular resection, it’s one of the most commonly performed shoulder surgeries with rotator cuff repair. New research now shows that the surgery doesn’t help and leads to more shoulder instability which frequently causes more pain and arthritis.
The rotator cuff is made up of muscles that help to move and actively stabilize the shoulder. It can become torn through old age or trauma. Rotator cuff surgery is the most common shoulder surgery in the United States with about 80,000 procedures a year. Most patients will also end up with a distal clavicular resection surgery as well, which is when the end of the collar bone is chopped off. The concept behind distal clavicular resection is that it “opens up” space for the rotator cuff. This is based on the idea that constant compression of the rotator cuff muscles and/or tendons is what may have caused the muscle to tear.
So is this additional procedure that’s widely added to a rotator cuff surgery to prevent future compression of the torn muscle needed? A new study looked at 78 patients and randomized them to rotator cuff repair with or without distal clavicular resection. The researchers looked at pain and function metrics and also took specialized x-rays to determine if the shoulder was stable (which is good) or unstable (which is bad). What were the results? Whacking off the end of the clavicle did not help pain nor function anymore than not cutting out this piece. However, in the distal clavicular resection (DCR) group, some patients developed instability of the shoulder. Regrettably, this particular study design also likely vastly underestimated the number of unstable shoulders in the DCR group, as the x-ray test used to find unstable shoulders is far less sensitive than other tests that could have been used. As a side note, about 1/3 of both groups failed to heal their rotator cuff tears after surgery, which is consistent with other studies showing high rates of failure for rotator cuff repair.
The upshot? Cutting off the end of the collar bone with a rotator cuff surgery is a dumb idea. I’ve seen countless patients walk into my office with grossly unstable shoulders after this surgery who are still in pain, despite the big procedure. If you or a loved one is considering shoulder surgery, first see if you’re a candidate for newer biologic injection options before considering shoulder surgery. Second, if you can only be treated with surgery, then become an informed patient and skip the chop job on the collar bone!