Review ArticlesThe Evaluation and Management of Failed Distal Clavicle ExcisionStrauss, Eric J. MD; Barker, Joseph U. MD; McGill, Kevin BA, MPH; Verma, Nikhil N. MDAuthor Information Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL No funding or support was received for the current manuscript. Reprints: Nikhil N. Verma, MD, Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612 (e-mail: email@example.com). Sports Medicine and Arthroscopy Review: September 2010 - Volume 18 - Issue 3 - p 213-219 doi: 10.1097/JSA.0b013e3181e892da Buy Metrics Abstract Excision of the distal clavicle (DCE) is a commonly carried out surgical procedure used in the management of acromioclavicular joint pathology. Although successful outcomes after both open and arthroscopic distal clavicle excision occur in a high percentage of patients, treatment failures have been reported, creating a difficult clinical scenario for the treating orthopedic surgeon. The most common mode of failure after DCE is persistent pain and potential etiologies include under-resection, over-resection leading to joint instability, postoperative stiffness, heterotopic ossification, untreated concomitant shoulder pathology, and postoperative infection. Less common causes of failure include distal clavicle fracture, reossification or fusion across the acromioclavicular joint, suprascapular neuropathy, and psychiatric illness. Persistent symptoms and disability after distal clavicle excision require a careful assessment of these potential causes of treatment failure and the formulation of a treatment plan, which may include conservative care, revision surgery, or coracoclavicular ligament reconstruction. Although careful patient selection, preoperative planning, proper surgical technique, and appropriate rehabilitation during the index procedure can minimize the likelihood of poor outcome, this paper reviews the work-up and management of cases of failed distal clavicle excision. © 2010 Lippincott Williams & Wilkins, Inc.