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Education · shoulder

Distal Clavicle Excision (Mumford Procedure) Info Evidence Consent

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

Why this operation has been suggested

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At your appointment we take a history, examine your shoulder, and arrange imaging if it is needed to work out what is causing your pain.

This operation removes a small piece of bone from the outer end of your collarbone, at the joint where the collarbone meets the top of the shoulder blade. We usually suggest it when that joint is worn or damaged and causing pain that has not settled with non-operative care such as activity change and physiotherapy. It suits people whose shoulder is stable and whose ligaments that hold the collarbone in place are intact. The operation aims to relieve pain and improve how your shoulder moves and works.

Before the operation

Before your surgery, we will confirm that imaging such as an X-ray, MRI or ultrasound shows what is causing your pain and helps plan the operation. On the day of your operation, you will need to stop eating and drinking seven hours before your operation time. We ask for seven hours rather than six so that we can bring you forward if the theatre list runs early. Your surgeon will tell you which of your regular medicines to stop and which to keep taking, so bring a written list of everything you take, including any blood thinners. Arrange for someone to drive you home afterwards, as you will not be able to drive yourself. Wear loose, comfortable clothing that is easy to put on and take off. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.

On the day

You arrive at the hospital's surgical admissions unit, where you are checked in and prepared for theatre. You will meet the anaesthetist before the operation and talk through the plan. This operation is done under general anaesthetic combined with a regional nerve block. The anaesthetist will meet you before the operation and talk you through both parts.

You are then taken into the operating theatre, where the operation is performed. Afterwards you wake up in the recovery area, where nurses watch over you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and how your recovery is going.

What the operation involves

This is a keyhole operation. Your surgeon makes a few small cuts around your shoulder, including one at the back, and slides a small camera inside so they can see the joint on a screen. Working through these small cuts, they remove about 5 mm of bone from the outer end of your collarbone, just enough so the rough, worn surfaces can no longer grind against each other. They take care to remove a controlled amount, because taking away too much can weaken the collarbone and unsettle the joint.

The ligaments that hold your collarbone in place are left alone. Your surgeon also checks and protects the soft tissues on top of the joint while they work.

When the bone has been removed, the small cuts are closed with stitches and covered with a dressing.

After the operation

Most patients stay one night in hospital after this operation, though some are able to go home the same day. You wake up in the recovery area, then move to the ward, where nurses keep an eye on you and give you pain relief as you need it. Your arm rests in a simple sling for comfort; it comes off for washing and for your exercises. Someone should stay with you for the first 24 hours after you get home. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you. You can move around the house from day one, but take it gently. You will not drive for at least six weeks; once your surgeon clears you, typically at the six-week review, see Driving after upper-limb surgery.

Recovery

For the first few days your shoulder will be sore and swollen, and the nerve block from theatre will wear off gradually. Pain relief, rest and ice help settle this. The discomfort usually eases over the first couple of weeks as the swelling goes down.

Your arm rests in a simple sling for comfort. It comes off for washing and for your exercises. Your physiotherapist will guide you through gentle movements at first, then build up to strength and normal use as your shoulder allows. You can move around the house from day one, but take it gently. Sleeping upright or propped on pillows is often more comfortable in the early days, and many people find it easier to sleep in a chair or recliner at first.

Everyday tasks take a little planning. You will not be able to lift anything heavy with the operated arm at first, and you will need help with things like dressing and hair washing until your shoulder moves more freely. Once the swelling settles and movement returns, daily activities get easier week by week. Driving comes later: you will not drive for at least six weeks, and once your surgeon clears you, typically at the six-week review, see Driving after upper-limb surgery. Returning to work depends on what your job involves, and your surgeon will talk this through with you.

Recovery varies from person to person. Your timeline may differ, and your surgeon and physiotherapist will guide you along the way.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

The most common problem is pain that does not settle. This can happen if slightly too much or too little bone was removed. You might notice a deep ache at the top of your shoulder that keeps going after the first few weeks, or a catching feeling when you reach across your body. If the pain is not easing as expected, bring it up at your review appointment.

Sometimes the bone grows back at the end of the collarbone. If that happens, the rough surfaces can grind against each other again and the pain can return. You would notice the same sort of ache that brought you to surgery in the first place. Let us know at your follow-up if this sounds familiar.

Removing too much bone, or disturbing the ligaments that hold the collarbone in place, can leave the joint unstable. You might feel the collarbone shifting, clicking or moving under the skin, or a sense that the shoulder is not secure. This matters more if you have had a previous injury where the collarbone separated from the shoulder blade. Tell your surgeon about any past injury like that before your operation, as it can change the plan.

Less often, other problems can occur. These include infection, stiffness, a fracture, the joint fusing on its own, and a lasting pain condition called complex regional pain syndrome. Signs of infection include redness that spreads out from the wounds, increasing swelling, or a fever. If you notice these, call the clinic straight away. The joint can also slip out of place after keyhole surgery, which would cause sudden pain and a visible change in the shape of your shoulder. Seek urgent care if that happens.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call the clinic straight away if you have a fever, if redness or discharge from your wounds is getting worse, or if your pain is suddenly much worse than expected. Go to emergency if your calf becomes swollen or painful, if you become short of breath, or if you cannot feel or move your arm. These signs need checking without delay. If something feels wrong and you are not sure, call us. We would rather hear about it early.

Where to read more about the condition

This page is about the operation itself. The two conditions it treats have their own pages, each covering what the evidence shows about when surgery helps and when it does not: wear at the joint is covered on the AC Joint Osteoarthritis page, and the weightlifter's form, where the end of the collarbone breaks down, on the Distal Clavicle Osteolysis page.

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [9].
  • A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1].
  • Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year with no significant difference in outcome measures between groups, except for VAS pain score improvement [10].
  • Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence [2].
  • Among patients undergoing distal clavicle excision for acromioclavicular joint pathology, those having an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure [3].
  • Simple excision of the outer end of the clavicle has yielded satisfactory results in patients with complete dislocation and subluxation of the acromioclavicular joint, with no residual upward displacement disturbing the patients [4].
  • Excision of the outer end of the clavicle is preferred for old dislocations, while open reduction and internal fixation are not recommended due to complications and poor functional results [16].
  • Incomplete excision and regrowth of the distal clavicle are the most common causes of revision [6].
  • Although distal clavicle excision with 2.5 mm of bone was successful in many specimens, a 5 mm resection guaranteed no bone-to-bone abutment [11].
  • The use of intraoperative ultrasound and cannulated dilators allows surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner [7].
  • Regardless of the technique chosen for distal clavicle resection, portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures [8].

Anatomy & Pathophysiology

Bony Anatomy

  • The clavicle is the first bone to ossify, occurring in the fifth week of gestation [35].
  • The clavicle is the only long bone to ossify by intramembranous ossification [35].
  • The medial (sternal) epiphysis of the clavicle is the last ossification center to fuse, occurring at age 20 to 25 years [35].
  • The primary blood supply to the clavicle is periosteal, and no nutrient artery is present [35].
  • The scapula has only one true diarthrodial articulation, the acromioclavicular (AC) joint [35].
  • The scapula is attached to the axial skeleton by the acromioclavicular (AC) and sternoclavicular (SC) joints [34].
  • The scapula is separated from the chest wall by thin gliding fibro-fatty tissue, allowing smooth excursion over the chest wall [34].
  • The scapular spine is an osseous ridge that separates the supraspinatus and infraspinatus fossae [35].
  • The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [35].
  • Failure of fusion of the acromial ossification centers results in os acromiale [35].
  • The subchondral bone of the glenoid is relatively flat, with articular concavity augmented by cartilage and a circumferential labrum [35].
  • The glenoid averages 5° of retroversion in relation to the axis of the scapular body [35].
  • The coracoid process serves as the origin for the coracobrachialis muscle and the short head of the biceps tendon [35].
  • The pectoralis minor muscle inserts onto the medial coracoid process [35].

Ligaments and Joint Stability

  • The AC joint is a small diarthrodial joint with an interposed fibrocartilaginous disk [35].
  • The superior and posterior AC ligaments are the primary stabilizers to anterior and posterior (horizontal) translation of the clavicle [35].
  • The coracoclavicular ligaments (conoid: medial; trapezoid: lateral) are the primary stabilizers to superior (vertical) translation of the distal clavicle [35].
  • The superior shoulder suspensory complex (SSSC) provides a stable connection between the scapula and the axial skeleton [35].
  • The SSSC is composed of the glenoid, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the AC joint, and the acromion [35].
  • The superior strut of the SSSC comprises the middle clavicle [35].
  • The inferior strut of the SSSC comprises the lateral scapular border and spine of the scapula [35].
  • The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics due to their anatomic attachments [47].
  • Kinematic changes associated with AC joint dislocation can be a potential source of pain and dysfunction in the shoulder [48].
  • Scapular and clavicular kinematics are affected in AC separation models [50].

Pathophysiology and Injury Patterns

  • A type I AC injury is an isolated sprain of the AC ligaments with no clinical deformity and normal radiographs [87].
  • A type II AC injury consists of a complete tear of the AC ligaments and a sprain of the CC ligaments [87].
  • In a type II AC injury, the radiograph shows a more vertical translation of the CC interval (<25%) compared with that of the uninjured shoulder [87].
  • The normal coracoclavicular distance measures approximately 1.1 to 1.3 cm [87].
  • Injury to the AC ligaments in type II injuries causes AP instability of the AC joint, resulting in an increase of 3.6 mm in anterior and 6.4 mm in posterior translation [87].
  • In most patients, the horizontal instability present in type II injuries remains asymptomatic, but long-term problems with AC joint pain are not uncommon [87].
  • A type III AC injury involves dislocation secondary to complete disruption of the AC and CC ligaments [87].
  • A type III AC injury creates increased vertical translation of the CC distance (25% to 100%) compared with that of the uninjured shoulder [87].
  • Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury [63].
  • Fractures of the clavicle distal to the coracoclavicular ligament have a reputation for failing to unite when treated with methods similar to other clavicle fractures, such as a figure-of-eight bandage or a Billington yoke [28].
  • Distal clavicle excision (Mumford procedure) must be reserved for patients in whom the CC ligaments are intact and there is no concomitant instability [12].
  • When horizontal or vertical instability exists, results of distal clavicle excision are compromised because the technique does not address instability and may accentuate it [12].

Classification

  • Fractures of the clavicle are divided into three groups: Group I (middle third), Group II (distal to the coracoclavicular ligament), and Group III (proximal end) [28].
  • Fractures of the clavicle distal to the coracoclavicular ligament are classified by Neer into two types [28].
  • Multiple classifications for lateral end of clavicle fractures exist, including those of Allman, Craig, and Neer [73].
  • Robinson classified clavicular injuries and defined the lateral one-fifth of the clavicle as Type 3 [73].
  • The Rockwood classification defines Type I as 0% to <10% superior displacement of the distal clavicle [83].
  • The Rockwood classification defines Type II as 10% to ≤25% superior displacement of the distal clavicle [83].
  • The Rockwood classification defines Type III as >25% to ≤100% superior displacement of the distal clavicle [83].
  • The Rockwood classification defines Type V as >100% superior displacement of the distal clavicle compared with the contralateral side [83].
  • A new classification of AC joint instability defines Group 1 as a coracoclavicular distance difference (CCD) ≤30% compared with the contralateral side [83].
  • A new classification of AC joint instability defines Group 2 as a coracoclavicular distance difference (CCD) >30% compared with the contralateral side [83].
  • Group 1 in the new AC joint instability classification includes all Rockwood type I, type II, and borderline low-grade type III patients [83].
  • Group 2 in the new AC joint instability classification represents high-grade AC joint dislocations, including all Rockwood type V patients and the majority of Rockwood type III patients [83].
  • The Rockwood Type IV AC injury includes disruption of AC ligaments, disruption of coracoclavicular ligaments, and posterior translation of the clavicle [31].

Clinical Presentation

  • Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5].
  • Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [14].
  • Methods to diagnose both superior and posterior translation of the clavicle need further debate [22].
  • Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment [23].

Investigations

Imaging and Diagnostic Assessment

  • Standardized plain films are almost always sufficient to garner the information needed for shoulder care, and the temptation to "overimage" should be resisted [19].
  • The purpose of imaging the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [19].
  • At least two X-ray views should be obtained for shoulder imaging: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction [42].
  • Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared with non-weighted views [89].

Intraoperative Imaging and Technique

  • Intraoperative use of ultrasound and cannulated dilators allows surgeons to perform distal clavicle excisions in a more efficient, reproducible, and safer manner [7].

Resection Parameters and Biomechanics

  • A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness [29].

Treatment

Indications and Contraindications

  • Distal clavicle excision must be reserved for patients in whom the coracoclavicular ligaments are intact and there is no concomitant instability [12].
  • Clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis [15].

Comparative Outcomes: Open vs. Arthroscopic

  • Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up [57].

Surgical Technique and Biomechanics

  • The slight increase in the in situ graft force only in the posterosuperior and posterior direction after distal clavicle excision suggests only a marginal protective role of the acromioclavicular articulation [81].

Historical and Alternative Procedures

  • Simple excision of the outer end of the clavicle has yielded satisfactory results in patients with complete dislocation and subluxation, with no residual upward displacement disturbing the patients [4].
  • The new operative procedure described in 1972 combines resection arthroplasty with fixation of the clavicle in an anatomical position [13].

Complications

  • Persistent pain is the most common complication of distal clavicle resection, potentially resulting from over- or under-resection [78].
  • Incomplete resection can occur due to poor visualization [78].
  • To prevent under-resection, the acromioclavicular joint should be viewed via an anterior and lateral portal [78].
  • Overexuberant resection of the clavicle or disruption of the acromioclavicular and coracoclavicular ligamentous system can result in iatrogenic instability of the acromioclavicular joint [78].
  • Posterior translation of the acromioclavicular joint is increased by 32% after a distal clavicle resection with an acromioclavicular capsular incision [78].
  • Acromioclavicular joint resection alone should be cautioned in patients with prior acromioclavicular joint instability injuries, as prior capsular or ligamentous disruption may lead to greater instability after resection [78].
  • In cases of prior instability, acromioclavicular resection combined with acromioclavicular ligament reconstruction may be needed [78].
  • Posterior translation can be reduced to 13% if the distal clavicle resection is completed with a coracoacromial ligament augmentation procedure [78].
  • Postoperative iatrogenic instability may require revision surgery or coracoclavicular ligament reconstruction [78].
  • Other complications of distal clavicle resection include infection, stiffness, fracture, spontaneous fusion, and complex regional pain syndrome [78].
  • A 5 mm resection guaranteed no bone-to-bone abutment in a cadaver model, whereas 2.5 mm resection was successful in many specimens [11].
  • Portal placement remains paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen for distal clavicle resection [8].

Contraindications and Selection Factors

  • When horizontal or vertical instability exists, results are compromised because the technique does not address instability and may accentuate it [12].

Outcomes and Efficacy

  • Arthroscopic distal clavicle resection has provided more 'good or excellent' results than the open procedure, but is comprised of low-level evidence [2].
  • Patients undergoing arthroscopic distal clavicle excision through the direct approach can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure [3].
  • In carefully selected patients with isolated acromioclavicular joint pathology, arthroscopic distal clavicle excision results in statistically and clinically significant improvements in range of motion and patient-reported outcome measures [17].
  • Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing the patients [4].

Incidence and Demographics

  • 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection [30].
  • Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision acromioclavicular joint reconstruction, distal clavicle excision, and irrigation and debridement [96].

Recovery

  • Arthroscopic distal clavicle excision through the direct approach allows for a faster return to activities compared with the open procedure [3].
  • More than 90% of patients manage to return to driving within 4 weeks following arthroscopic subacromial decompression and acromioclavicular joint excision [59].
  • More than 90% of patients manage to return to work within 6 weeks following arthroscopic subacromial decompression and acromioclavicular joint excision [59].
  • Partial claviculectomy offers rapid return to function for chronic symptomatic injuries [24].

Key Evidence

  • [L5] A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen. [1] (10.1016/j.arthro.2018.03.004)
  • [L3] Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence. [2] (10.1097/blo.0b013e31802f5450)
  • [L3] Among patients undergoing distal clavicle excision for acromioclavicular joint pathology, those having an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure. [3] (10.1016/j.arthro.2009.12.007)
  • [L3] Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes. [5] (10.1186/s12891-025-09190-x)
  • [L4] Incomplete excision and regrowth of the distal clavicle are the most common causes of revision. [6] (10.1016/j.arthro.2009.06.010)
  • [L5] The technique will allow surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner. [7] (10.1016/j.eats.2024.103331)
  • [Case_report] Regardless of the technique chosen for distal clavicle resection, portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures. [8] (10.1016/j.jse.2010.08.032)
  • [L5] In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. [9] (10.5435/00124635-199905000-00004)
  • [L1] Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year with no significant difference in outcome measures between groups, except for VAS pain score improvement. [10] (10.1016/j.jse.2006.10.006)
  • [Abstract] Although distal clavicle excision with 2.5 mm of bone was successful in many specimens, a 5 mm resection guaranteed no bone-to-bone abutment. [11] (10.1016/j.jse.2007.02.105)
  • [L5] [12] (10.5435/00124635-200904000-00002)
  • [L4] The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position. [13] (10.2106/00004623-197254060-00005)
  • [L4] Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. [14] (10.1016/j.xrrt.2021.05.003)
  • [L3] Late loss of reduction was common, and clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis. [15] (10.2106/00004623-198769070-00013)
  • [L4] Excision of the outer end of the clavicle is preferred for old dislocations, while open reduction and internal fixation are not recommended due to complications and poor functional results. [16] (10.2106/00004623-196345080-00024)
  • [L4] In carefully selected patients with isolated ACJ pathology, arthroscopic distal clavicle excision results in statistically and clinically significant improvements in range of motion and patient-reported outcome measures. [17] (10.1016/j.jseint.2023.07.014)
  • [L4] Methods to diagnose both superior and posterior translation of the clavicle need further debate. [22] (10.1016/j.jseint.2019.11.006)
  • [L5] Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment. [23] (10.5435/jaaos-d-24-00360)
  • [L4] [28] (10.2106/00004623-196749040-00024)
  • [L5] A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. [29] (10.1016/j.arthro.2007.07.004)
  • [L3] This records review found that 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection. [30] (10.1177/2325967119844295)
  • [L4] [31] (10.1016/j.arthro.2016.06.013)
  • [L5] The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments. [47] (10.1016/j.arthro.2009.12.031)
  • [L5] The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation. [48] (10.1177/0363546512458571)
  • [L5] Scapular and clavicular kinematics were affected in AC separation models. [50] (10.1016/j.jse.2013.01.004)
  • [L2] Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up. [57] (10.1177/0363546506294855)
  • [L3] The results obtained in the present study suggest that more than 90% of the patients manage to return to driving within 4 weeks and to work within 6 weeks following arthroscopic subacromial decompression and acromio-clavicular joint excision. [59] (10.1111/j.1758-5740.2010.00048.x)
  • [L4] Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury. [63] (10.1177/0363546508319047)
  • [L4] [73] (10.1177/1758573214536535)
  • [L5] [78] (10.1177/0363546513485359)
  • [L5] The slight increase in the in situ graft force only in the posterosuperior and posterior direction after distal clavicle excision suggests only a marginal protective role of the acromioclavicular articulation. [81] (10.1177/0363546510374447)
  • [L1] [83] (10.1016/j.jse.2020.10.026)
  • [L5] [87] (10.1016/j.jse.2010.10.030)
  • [L4] Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views. [89] (10.1016/j.jseint.2023.06.011)
  • [L4] Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. [96] (10.1007/s00167-016-4206-y)

References

[1] Editorial Commentary: The “Mumford” & Sons: For Distal Clavicle Excisions, What Are Our Young Surgeons Doing, and How Well Are They Doing It?. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.03.004

[2] Surgical Treatment of Symptomatic Acromioclavicular Joint Problems. Clinical Orthopaedics and Related Research. 2007. DOI: 10.1097/blo.0b013e31802f5450

[3] Open Versus Arthroscopic Distal Clavicle Resection. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.12.007

[4] Complete Dislocation and Subluxation of the Acromioclavicular Joint: End Result in Seventy-three Cases.. The Journal of Bone and Joint Surgery. American Volume. 1961.

[5] Predicting reduction loss risk after acromioclavicular joint dislocation treated with the endobutton device. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09190-x

[6] Open Versus Arthroscopic Acromioclavicular Joint Resection: A Retrospective Comparison Study. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.06.010

[7] Intraoperative Use of Ultrasound and Cannulated Dilators to Safely Identify and Access the Acromioclavicular Joint for Distal Clavicle Excision: A Technique Guide. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103331

[8] Acromioclavicular dislocation after arthroscopic distal clavicle resection: a case report. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.08.032

[9] Painful Conditions of the Acromioclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199905000-00004

[10] Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.006

[11] Arthroscopic Distal Clavicle Resection: A Biomechanical Analysis In A Cadaver Model. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.105

[12] Acromioclavicular Joint Injuries: Diagnosis and Management. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200904000-00002

[13] Treatment of Acromioclavicular Injuries, Especially Complete Acromioclavicular Separation. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254060-00005

[14] The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2021.05.003

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