Mumford Procedure, or its medical jargon, distal clavicle resection, is a surgical procedure performed on the clavicle, commonly known as the collarbone. Mumford Procedure is done to attenuate and relieve shoulder pain associated with collarbone end abrasion.
The procedure involves the removal of a tiny part of the collarbone. This removal of the bone will help people who are suffering from a number of shoulder pain issues, including ailments such as painful inflammation, swelling, or osteoarthritis in the acromioclavicular (AC) joint. Surgery may be an option when other, alternative medical procedures, such as physical therapy and cortisone injections, fail to alleviate pain in the area.
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 decreased - clinical studies support that report.
The procedure can be performed in two ways – open or arthroscopic procedure.
Open Mumford Procedure involves patient sedation. Anaesthesia 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, using a surgical saw, 1 - 2 centimetres (or less) of bone at the end of the clavicle. 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 surgical 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.
Although recovery speed depends on the type of surgery performed– open or arthroscopic - and the patient’s individual healing capability, typically the patient will need 8 to 10 weeks to fully recover and resume daily activities. 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 is 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 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 normalisation.
For the first 4 weeks post-surgery, the surgical arm is immobilised in a sling – the arm should not be raised above 70° in any plane. 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, with the affected limb, any object weighing over 5 pounds and excessive reach out and rotation, both internal and external, should be avoided as well. Ice compresses should be given 3 -5 times a day, for 15 minutes, to keep inflammation and swelling under control.
For the surgical arm to regain normal function, rehab is also accompanied by medical follow up with the doctor and physical therapy.
The dressing will be changed and home program will be reviewed; at home education, postural and other necessary exercises are 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 exercises, like squats, lunges, step-ups, bridging, opposite arm rotator cuff exercises and biking are added, while protection of the AC joint is assessed. 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 Motion (ROM) in all planes is 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.