Long-term clinical outcomes, motion, strength, and function after total claviculectomy.

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Rehabilitation Medicine

Background:

• Total clavicle excision is a rare procedure with limited data on long-term functional outcomes.
• Previous studies lack objective measurements of strength, range of motion, and patient-centered results following total claviculectomy.

Purpose of the Study:

• To evaluate the long-term consequences of total claviculectomy on shoulder girdle function.
• To assess global upper extremity function and overall general health after clavicle removal.
• To document objective measurements of strength, motion, and patient-reported outcomes.

Main Methods:

• Five patients undergoing total claviculectomy were assessed at two time points (mean 4.8 and 9.4 years postoperatively).
• Evaluations included validated shoulder and upper extremity outcome scores (DASH, SF-36, Simple Shoulder Test, ASES, UCLA, HSS, Constant).
• Objective assessments comprised isokinetic strength testing, clinical range of motion, and kinematic analysis.

Main Results:

• Aclaviculate shoulders showed poorer clinical scores compared to the contralateral side, with significant differences in ASES, UCLA, HSS, and Constant scores at long-term follow-up.
• Strength deficits were observed in aclaviculate limbs, particularly in adduction, forward flexion, and external rotation over time.
• Kinematic analysis revealed scapular dyskinesis and reduced external rotation in the limb without a clavicle.

Conclusions:

• The clavicle plays a crucial role in shoulder girdle strength, coordinated movement, and range of motion.
• Patients demonstrate initial compensation for clavicle loss, but long-term follow-up reveals gradual functional decline and objective deficits.
• Despite objective impairments, patients report normal overall health and upper extremity function, indicating significant compensatory abilities.