Mumford Procedure

The Mumford procedures extended names are Distal Clavicle Excision, partial claviculectomy and Distal Clavicle Resection. It is open or arthroscopic surgery. When the shoulder gets rubbed continuously, pain starts occurring in a specific area known as Acromion joint because it shrinks and side by side applies a firm pressure on the tendon so a very small and extra portion of the enlarged clavicle is detached and removed. Distal Clavicle Excision is specially invented for patients who are living with osteoarthritis and when non-surgical procedures like physical therapy and cortisone booster don’t work, one can pin hope on Mumford procedure. The most appealing thing is that very few people get intraoperative complications. It is packed with the least risks and astounding results. When a patient is suffering from suspect symptomatic interfering disease, acromioplasty comes as a supportive method.

Good candidates of Distal Clavicle resection or Mumford procedure are :

1. Athletes with the age of 35 or above
2. Osteoarthritis patients
3. Old aged people
4. Acute shoulder impingement

Symptoms

What Happens Before The Mumford Procedure ?

Your doctor will perform a physical examination, lab tests and your medical history will be scanned. Give detailed information about your any medication, over the counter drug or supplements which you take on the daily basis.

• Mostly preferred doctor’s tests are MRI, X-ray and CT scan to observe the condition of acromion joint.
• The doctor advises patients to stop taking blood-thinning and anti-inflammatory medicines.
• They generally allow you to take your long-term disease medicines such as asthma, diabetes, BP and cholesterol.
• If you are an alcoholic or chain-smoker and if you are addicted to it, share that thing with the doctor as both things easily disturb after the surgery.
• You will most likely last for 7-8 hours before the surgery. This is usually done to keep you away from the major complications while you are under anesthesia.
• Apart from these, surgeons will give additional information on shoulder slings and about what to do before the Mumford procedure.

Causes

What Happens During The Mumford Procedure?

• Mumford procedure begins with sedation and general anesthesia and the body is numbed for 1 day at least.
• Several cuts are made on the top of the acromion joint to let arthroscope in the shoulder joint. 
• Then an enlarged clavicle of 1-2 cm is taken out simultaneously and air is added to thoroughly check the joint more precisely. 
• Now surgeons will take out harmed and unuseful tissues.
• Side by side surgeon will fix the rotator cuff ( connects the head of the upper arm with the shoulder joint) to improve the movement.
• Later open tissues and skin are closed together.
• The patient will be shifted to a normal ward and will be kept for 2-3 days to check the movement.

Distal Clavicle  Recovery Period

• Initially, right after the operation, your shoulder will be wrapped with many bandages and antiseptics, also, the sling will be in the inactivated form. The doctor will tell you not to move the whole hand except the fingers and thumb of that particular hand.
• On the basis of examination, the doctor will decide the stay of a patient and medicines will be prescribed to reduce the pain and to heal the wound quickly. 
• Recovery depends on your daily routine, if your work is sedentary it takes 1-2 months and if your work is effort demanding and the use of the surgical arm is done numerous times then it can take 3 months or more. If you don’t take necessary rest and doctor’s word then it can take more than the normal.
• A doctor will ask you to visit the hospital after a few days to observe the swelling and wound.
• The use of ice packs should be done multiple times in a day ( 4-5 times).

Mumford Procedure Rehab Protocols

Distal clavicle is one of such surgeries which can require a period of closely supervised rehabilitation. 

Mandatory Guidelines 

• Do not raise your arm in the first 1 month.
• For 2 months do not pick up heavy objects, over 2 -2.5 kgs.
• The use of shoulder sling should be done at least for 25-30 days.

DAY 1 THROUGH 7 – Physician or nurse will come at your home on the first day, if you are discharged then, for dressing and to make you understand what is allowed and what is not.

First doesn’t include any kind of exercises, doctors will not do any tests in this period but doctors expect that patients can start sleeping properly in the first week and a slow healing process should start.

DAY 8 THROUGH 28 – 

Frequent visits at the hospital will gradually begin from this stage and patients can do mild exercises such as squats, lunges, cloth stretching behind the back.

Rotation of 70 degrees or more also eventually tolerated. It would be better if the use of strapping tape is done in the second phase it will make the patient more flexible.

For better extension, flexion, abduction jumping pull-ups, chin up and freestanding works well with the recovery process.

DAY 29 THROUGH 56 

Doctors will do bilateral ROM testing, slightly few times internal and external movements of the rotator cuff won’t harm but intense use of ROM comes with a big “NO”.

Carry on with your 90-degree flexion and abduction.

DAY 56 THROUGH 70

New testing of the handheld dynamometer is done in this phase. Once it is done the patient can initiate dumbbell or kettlebell exercises for strengthening. But overhead lifting is still not allowed but after 10 days of this one can do normal exercises and can play all kinds of sports.

Mumford Procedure Cost

On an average, the cost is approximately $3000 – $6000  also rehab facilities, follow-ups, shoulder sling and rest of the kit may be included in some hospitals and not in others. 

FAQ

• Distal Clavicle Resection Survival Rate ?

Prognosis is good and almost 90% of people are convinced and satisfied with distal clavicle resection. It entirely treats the clavicle pain and for the long term doesn’t give a slight jerk.

• Describe In Brief About Subacromial Decompression.

Subacromial decompression is the best alternative if physical therapy doesn’t work and specifically improves the subacromial area, the common treatment is done via the ambulatory method and generally subacromial bursa is taken out. The arthroscopic method is also effective and it needs cameras and small-motorized equipment.

• How Much Time Does The Mumford Procedure Take?

It takes 80-120 minutes to complete the surgery of distal clavicle excision.

• What Complications Occur After The Distal Clavicle Resection?

1. Bleeding  
2. Joint Stiffness
3. Scarring
4. Shoulder becomes unstable
5. Joint tenderness
6. Blood vessel infection