Long-term clinical outcomes, motion, strength, and function after total claviculectomy.
BACKGROUND
Total excision of the clavicle is rarely performed. No previous study has documented long-term outcomes with objective measurements of strength, motion, and patient-centered outcomes. We present the long-term consequences of total claviculectomy on shoulder girdle function, global upper extremity function, and overall general health.


METHODS
Five total claviculectomy patients were evaluated at 2 time points (2005 and 2010, mean 4.8 and 9.4 years postoperatively) by use of the DASH, SF-36, Simple Shoulder Test, ASES, UCLA, HSS, and Constant shoulder scores. Isokinetic strength, clinical range of motion, and kinematic analysis were performed on each limb pair.


RESULTS
All clinical scores allowing side-to-side comparison were poorer for the aclaviculate side, with significance reached for 2005 ASES scores and 2010 ASES, UCLA, HSS, and Constant scores. DASH scores and SF-36 scores were not significantly inferior to age- and sex-matched population norms. Deficits in strength were present in the aclaviculate limbs, with significance reached for adduction in 2005 and for forward flexion and external rotation in 2010. Kinematic and clinical range of motion analysis revealed scapular dyskinesis and significant deficits in external rotation in the aclaviculate limb.


CONCLUSIONS
We found that the clavicle contributes to the strength, coordinated scapulohumeral rhythm, and overall range of motion of the shoulder girdle. Patients compensate for loss of the clavicle with minimal functional deficit. With time, patients gradually lose some compensatory ability as evidenced by deteriorating limb-specific, patient-centered outcome measures, diminished strength in certain planes of shoulder motion, and scapular dyskinesis at long-term follow-up. Despite objective deficits, these patients continue to have normal self-perceptions of overall health and global upper extremity function.
University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA.
James
J
Rubright
University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA.
Peter
P
Kelleher
University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA.
Christina
C
Beardsley
The Warren Alpert Medical School of Brown University, Department of Orthopaedics, Providence, RI, USA.
David
D
Paller
University of Vermont College of Medicine, Department of Surgery, Burlington, VT, USA.
Steven
S
Shackford
University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA.
Bruce
B
Beynnon
University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, Burlington, VT, USA. Electronic address: Adam.Shafritz@uvm.edu.
Adam
A
Shafritz
D000328:Adult; D001696:Biomechanical Phenomena; D002968:Clavicle / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012782:Shoulder / Q000503:physiopathology*; D016896:Treatment Outcome
Case Series; Claviculectomy; Level IV; Treatment Study; clavicle excision; clavicle function; scapular dyskinesis; shoulder kinematics