Mumford Procedure for AC Joint Arthritis
The Mumford procedure removes a small amount of bone from the outer end of the collarbone, roughly a centimeter, so the arthritic end of the clavicle no longer grinds against the acromion. It is a small operation with a specific purpose, and it works well when the diagnosis is right.
The Mumford procedure addresses the same joint Steven Struhl, MD holds a United States patent for reconstructing. Patent 8,162,997 was granted in 2012 and later acquired by the orthopedic device manufacturer Smith and Nephew, and his outcomes for acromioclavicular reconstruction appeared in The American Journal of Sports Medicine. He is board certified in orthopedic surgery and separately in sports medicine, and has practiced in New York since 1991.
What the Procedure Does
The acromioclavicular joint sits at the top of the shoulder where the collarbone meets the shoulder blade. When that joint becomes arthritic, the two bone surfaces grind against each other and produce pain localized precisely at that spot.
Removing the outer end of the clavicle creates a gap so the surfaces no longer contact. The joint is effectively eliminated rather than repaired, and because the acromioclavicular joint contributes very little motion, patients do not miss it.
- Also Called: distal clavicle excision or distal clavicle resection.
- Amount Removed: typically around one centimeter of the outer clavicle.
- Approach: performed arthroscopically or open, depending on the case.
- Ligaments Preserved: the coracoclavicular ligaments are left intact to maintain stability.
That last point is the part that matters technically. Removing too much bone or disturbing the coracoclavicular ligaments can leave the collarbone unstable, which trades one problem for a harder one.
Who Is a Candidate
- AC Joint Arthritis: pain localized at the top of the shoulder, worse reaching across the body.
- Distal Clavicle Osteolysis: bone resorption at the clavicle end, common in weightlifters.
- Failed Conservative Care: activity modification and injection have not resolved symptoms.
- Confirmed Diagnosis: an injection into the joint temporarily relieves the pain.
The diagnostic injection is worth emphasizing. Pain at the top of the shoulder can come from the AC joint, from impingement, or from the rotator cuff, and an injection that relieves the pain confirms the joint is the source before anyone removes bone.
Recovery
- Weeks One To Two: a sling for comfort, with gentle motion begun early.
- Weeks Two To Six: progressive range of motion and light strengthening.
- Months Two To Three: return to most activity, including overhead work.
- Months Three To Four: return to heavy pressing and contact sport.
Recovery is shorter than most shoulder procedures, particularly when done arthroscopically and when no other repair is performed at the same time.
When It Is Combined With Other Surgery
The Mumford is frequently performed alongside a rotator cuff repair or a subacromial decompression, since AC joint arthritis and impingement often coexist. When it is combined, the recovery follows the larger procedure’s timeline rather than its own.
Schedule an AC Joint Evaluation in New York City
Pain at the very top of the shoulder that worsens reaching across the body is a specific complaint pointing at a specific joint, and confirming that before considering surgery is straightforward. Dr. Struhl evaluates AC joint problems at his Manhattan and White Plains offices. Contact the practice to schedule an appointment.
