Mumford Procedure – Distal Clavicle Resection
Mumford procedure or its medical jargon, distal clavicle resection, is a surgical procedure performed on the clavicle, commonly known as the collar bone. Mumford procedure is done to attenuate and relieve shoulder pain associated with collar bone end abrasion. The procedure involves the removal of a tiny part of the collar bone. This removal of the bone will help people who are suffering from a number of shoulder pain inducing ailments such as painful inflammation, swelling, or osteoarthritis in the acromioclavicular (AC) joint. Surgery may be opted for when other alternative medical procedures such as physical therapy and cortisone injections failed to alleviate pain in the said area.
Mumford procedure is usually performed when pain is caused by bone spurs developing on the clavicle. This in turn narrows the AC joint, preventing it to move without friction caused by overuse or arthritis. ‘Weightlifter’s shoulder’ or clavicular osteolysis can affect people who inflict immense pressure on the AC joint, making the end of the clavicle bone wear down. When the damaged end of the clavicle is removed, it frees many of the patients from pain and the restoration of proper shoulder movement is fortified.
Mumford surgery isn’t complicated. It is a relatively simple and common medical procedure with a high success rate. 75% to 90% of patients who underwent Surgery spoke of gratification as their pain significantly reduced – clinical studies support that report.
The procedure can be performed in two ways – open or arthroscopic procedure.
Open Mumford Procedure involves patient sedation. Anesthesia is given, numbing the shoulder and arm. After an incision is made on top of the AC joint, and the area that needs to be removed reached, beneath the fibrous tissue, the surgeon proceeds to cut off 1 or 2 centimeters or less of bone at the end of the clavicle using a surgical saw. The sawed pieces of the bone are carefully removed. Then the surgical wound is sutured and dressed.
Advances made in the medical field, particularly in arthroscopic techniques made Mumford procedure, which was originally an open surgery, much simpler. Nowadays, arthroscopic distal clavicle resection is widely used – after several incisions are made in the shoulder, a camera and the necessary surgery tools are introduced into the joint. Next, the joint capsule is detached from its position and a surgical burr then shaves off the part of the clavicle that is intended to be removed.
Typically, after undergoing Surgery, the patient will take 8 to 10 weeks to fully recover and resume daily life’s activities. Though, the recovery speed depends on the type of surgery performed– open or arthroscopic and the patient’s individual healing capability. Since arthroscopic procedure is simpler, patients recover faster because the incisions are a lot smaller than the incision in the skin and fascia open Mumford procedure entails.
The arm is prohibited from much movement in the first few days after the procedure; it would be put in a sling for maximized resting position. Rest is must for the shoulder and pain management and swelling atonement can be done by medication and ice. With arthroscopic procedure, the bandage can be removed after 2 days whilst open Mumford open procedure takes a week. Gradually, movement may be increased until the shoulder completely heals and becomes normal. It is advisable for the patient to keep track of the recovery and any pain and consult the doctor for further clarification and betterment.
The Video Below by Dr William Stetson Illustrates how Arthroscopic Distal Clavicle Resection (Mumford Procedure) is performed.
Generally the rehab protocol has several considerations that need to be followed for speedy normalization.
For the first 4 weeks of post surgery, the surgical arm will be immobilized in a sling – the arm should not be raised above 70° in any plane as well. An upright shoulder girdle posture should be exercised, particularly when the arm is confined in the sling. For the first 6 weeks, the patient should avoid lifting any object weighing over 5 pounds with the affected limb and excessive reach out and rotation, both internal and external should be averted as well. Ice compress should be given 3 -5 times a day, for 15 minutes to keep inflammation and swelling under control.
The rehab is also accompanied by medical follow up with the doctor and physical therapy for the surgical arm to regain normal function.
The dressing will be changed and home program will be reviewed when postural and necessary exercises that should be done at home education is given.
Weeks 2 to 4
On day 14, the surgical wound is checked and the suture is removed. Exercise for the surgical limb that underwent the surgery is intensified – well body exercise like squats, lunges, step-ups, bridging, opposite arm rotator cuff exercises, biking is added while protection of the AC joint is looked into. In order to give secondary AC support and compression, strapping tape may be used. For shoulder and neck muscle comfort, soft tissue treatment can be applied. For the elbow, PNF stretching is started. Wrist flexion exercise is started and extension and scapular isometrics exercise is also done with manual resistance applied.
Weeks 4 to 8
A progression to more intensive strength and Range Of Motion programs is embarked on. Shoulder flexion and abduction exercises are started along with range of motion (ROM) exercises, starting in the mid range of rotator cuff external and internal rotations, both active and passive ROM, depending on patient’s ability.
Weeks 8 to 12
Extensive exercises are covered. Range Of Motions (ROM) in all planes are applied; the doing of gentle abduction, flexion, external and internal rotation exercises are undertaken. Exercises are diversified as manual mobilization of soft tissue is increased – Wand exercises, scapular and PNF exercises and ROM shoulder pulleys are introduced without any overhead lifting.
After 12 Weeks
It’s time to stretch the limits. As much as the patient can tolerate, rotator cuff program and progressive resistance exercise that include weight lifting are applied. Shoulder is subjected to full range of motions in every plane while the intensity of strength and functional training is heightened so that daily life normal exertion activities and sports can be gradually resumed. If the patient wants to return to a particular sport, the physical therapist will do it via functional testing that is associated to the particular sport.
This is just a guideline on post Mumford procedure rehab, not a sure-fire rule. All progressions depend on patients’ individualistic coping ability and healing speed that is analysed as the treatment process goes on.