How much bone is actually removed?

Around 6 to 8 millimetres of the outer end of the collarbone. The aim is to remove just enough bone to eliminate the bone-on-bone contact without compromising the coracoclavicular ligaments that hold the clavicle down to the shoulder blade. Removing too much bone risks AC joint instability, while removing too little leaves residual contact and ongoing pain. The arthroscopic approach allows precise resection under direct vision.

Will my shoulder look different after surgery?

Most patients see no visible change. The resected bone is recessed beneath skin and muscle, and the cosmetic profile of the shoulder is preserved. A small minority of patients notice a slightly less prominent AC joint, which is often welcome since the pre-operative arthritis frequently produces a visible bony bump.

How much does distal clavicle excision cost? What does Medicare cover?

Distal clavicle excision involves separate fees for the surgeon, anaesthetist, hospital and arthroscopic implants. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

What's the success rate?

Published outcomes consistently show high satisfaction rates when the diagnosis is correct and the pre-operative diagnostic injection produced reproducible relief. Patient selection is the single biggest determinant of outcome. The procedure is less reliable when the AC joint is one of several pain generators and when the pre-operative injection produced equivocal results; in those cases additional workup is undertaken before surgery is offered.

Will I need physiotherapy?

Yes — short-course physiotherapy is integrated into the post-operative pathway, focused on regaining range of motion in the first six weeks and rebuilding scapular control and cuff strength from six weeks. The total course is typically shorter than for a rotator cuff repair because the rehabilitation does not need to protect a soft-tissue repair. Most patients are independent of formal therapy by three months.

Shoulder surgery

Distal Clavicle Excision (Mumford)
in Rockhampton

Arthroscopic distal clavicle excision — the Mumford procedure — is performed at Mater Private Hospital Rockhampton by Dr Kieran Hirpara, a dual fellowship-trained orthopaedic surgeon (orthoplastic hand surgery, Manchester; shoulder & elbow surgery, Brisbane). The practice manages acromioclavicular joint pain for patients across Central Queensland.

Call 07 4863 6556 Have a referral?

Initial consult $275 · Medicare rebate ~$86 · full fees

Recovery at a glance

Light duties: 2-6 weeks
Full duties: 3-6 months
Complete recovery: 12 months

About the condition

What is going on

The acromioclavicular (AC) joint sits at the top of the shoulder, where the outer end of the collarbone (clavicle) meets the shoulder blade (acromion). The joint takes load with every overhead reach, push and pull, and is a common site for primary osteoarthritis as well as for post-traumatic arthritis after an AC separation. Patients describe a localised ache on top of the shoulder, worse with overhead reach, cross-body adduction (bringing the arm across the chest), and sleeping on the affected side. The pain is often pinpoint and reproducible by palpation directly over the joint. X-ray shows narrowing of the joint, osteophytes and sometimes cystic change; MRI confirms the diagnosis and excludes coexisting rotator cuff pathology.

When surgery is recommended

The threshold for operating

Most AC joint arthritis settles with a structured non-operative programme — activity modification to avoid the provocative overhead and cross-body positions, anti-inflammatory medications, physiotherapy focused on scapular control, and one or two image-guided corticosteroid injections into the joint. Surgery is offered when the pain is reproducible, structurally explained on imaging, responds at least transiently to a diagnostic injection, and persists despite a thorough non-operative trial. The procedure is also offered for chronic post-traumatic AC pain following an old separation that did not settle, and as a concomitant procedure during rotator cuff repair when the AC joint is independently symptomatic.

The procedure

What the operation involves

Arthroscopic distal clavicle excision is performed through two or three small portals around the shoulder. A small portion (typically 6 to 8 millimetres) of the outer end of the clavicle is resected, removing the bone-on-bone contact while preserving the stabilising coracoclavicular ligaments. The operation usually takes 30 to 60 minutes under regional and general anaesthesia; patients leave hospital the same day. The arthroscopic approach allows simultaneous assessment of the rotator cuff and glenohumeral joint, which is useful given that AC joint arthritis and cuff pathology often coexist. Full clinical detail is on the education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the distal clavicle excision education page or the shoulder surgery overview.

Recovery

What most patients experience

A sling is worn for the first one to two weeks for comfort, then movement is encouraged with pendulum and gentle range-of-motion exercises. Light desk-based work and driving usually resume between two and six weeks, with most patients returning to general daily activity within a month. Strengthening starts at around six weeks under physiotherapy guidance; manual work and contact sport are typically held until three to six months. Final outcome — full strength and resolution of any residual stiffness — continues to improve for up to a year. The procedure is reliably effective when the diagnosis is correct and the joint pain has been reproducibly relieved by a pre-operative injection. The practice's full phase-by-phase rehabilitation plan is on the distal clavicle excision rehabilitation protocol page.

At the practice

How this case is handled

In-person review at two weeks for wound check, six weeks to confirm range of motion and pain resolution, then a final review at three months to clear return to full activity. Co-located shoulder physiotherapy is integrated into the post-operative pathway, with patients from outside Rockhampton transitioning to therapy closer to home after the early sessions. When the AC joint is identified as one of several pain generators on pre-operative workup, the operation is staged carefully so the response to each component can be assessed.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

Medicare item numbers

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 48952 Arthroscopic distal clavicle excision (standalone): Used when distal clavicle excision is the only shoulder procedure performed — arthroscopic surgery of the AC joint
Item 48903 Subacromial decompression with distal clavicle excision: Used when the distal clavicle excision is bundled with a subacromial decompression in the same operation
Item 48960 Rotator cuff repair (includes AC joint resection): When the AC joint is resected during a cuff repair, the resection is included in the cuff-repair item and not separately billed

Distal clavicle excision at the practice is performed by Dr Kieran Hirpara, fellowship-trained shoulder surgeon at Mater Private Hospital Rockhampton. Sub-specialty fellowships in shoulder arthroplasty and arthroscopy at the Brisbane Hand & Upper Limb Clinic and at St Andrew's / Prince Charles Hospitals.

Patients travel from

Across Central Queensland

Patients are seen for distal clavicle excision from Rockhampton and the wider region. Drive time and scheduling notes are on each catchment page:

Frequently asked

Patient questions we hear most

How much bone is actually removed?

Around 6 to 8 millimetres of the outer end of the collarbone. The aim is to remove just enough bone to eliminate the bone-on-bone contact without compromising the coracoclavicular ligaments that hold the clavicle down to the shoulder blade. Removing too much bone risks AC joint instability, while removing too little leaves residual contact and ongoing pain. The arthroscopic approach allows precise resection under direct vision.
Will my shoulder look different after surgery?

Most patients see no visible change. The resected bone is recessed beneath skin and muscle, and the cosmetic profile of the shoulder is preserved. A small minority of patients notice a slightly less prominent AC joint, which is often welcome since the pre-operative arthritis frequently produces a visible bony bump.
How much does distal clavicle excision cost? What does Medicare cover?

Distal clavicle excision involves separate fees for the surgeon, anaesthetist, hospital and arthroscopic implants. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.
What's the success rate?

Published outcomes consistently show high satisfaction rates when the diagnosis is correct and the pre-operative diagnostic injection produced reproducible relief. Patient selection is the single biggest determinant of outcome. The procedure is less reliable when the AC joint is one of several pain generators and when the pre-operative injection produced equivocal results; in those cases additional workup is undertaken before surgery is offered.
Will I need physiotherapy?

Yes — short-course physiotherapy is integrated into the post-operative pathway, focused on regaining range of motion in the first six weeks and rebuilding scapular control and cuff strength from six weeks. The total course is typically shorter than for a rotator cuff repair because the rehabilitation does not need to protect a soft-tissue repair. Most patients are independent of formal therapy by three months.