What is the Mumford Procedure?

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The shoulder joint is a complex one and is made up of 4 joints namely: Glenohumeral joint GH joint), Acromioclavicular joint (AC joint), Sternoclavicular joint (SC joint) and Scapulothoracic jointST joint). The AC joint is formed by the union of distal end of acromion process of scapula and distal end of clavicle bone. This joint commonly gets injured by fall on the side of the sholder, hurting the joint protuberance. Dislocations of AC joint can be successfully set by the Mumford procedure.

What is the Mumford Procedure?

Mumford procedure is the surgical procedure done to treat AC joint disorders. During Mumford procedure the distal end of the clavicle bone is resected to relieve the symptoms. This procedure may be done arthroscopically or as an open surgery.

• Arthroscopic Mumford procedure: During this procedure small portals are made above and below the AC joint, through which the arthroscope and other surgical instruments are passed. The joint capsule is retracted and distal 1-2 cm of the clavical is resected using the burr. Advantages of arthroscopic Mumford procedure are rapid recovery and return to the normal activities, hospital admission not required, less post operative pain and better cosmetic outcome.
• Open Mumford Procedure: During this procedure an incision is made above the AC joint and soft tissues, muscle fascia and joint capsule are removed to reach the AC joint. A surgical saw is used to excise distal 1-2 cm of clavicle bone. Following the bone removal joint capsule, muscle fascia and other soft tissues are sutured back. The sutures are removed 1 week after the open Mumford procedure.

What are the indications of the Mumford Procedure?

AC joint injury is a very common sports injury often witnessed in heavy weight lifters and also in millitary personnals. Disorders of AC joint can be successfully treated by mumford procedure. Various indications for performing Mumford procedure are:

• Seperation of the AC joint where there may be real dislocation of the joint resulting in the protruberance of the clavicle beneath the skin or there may be sprain of the acromioclavicular ligament which may be as mild as just the simple overstretch or as severe as the partial or complete tear of the ligament.
• Arthritis of Acromioclavicular joint.
• Fracture of Acromioclavicular joint.
• Faliure of the conservative treatments ( like rest, ice, medications and physical therapy) to treat the disorders of AC joint.              

What is the rehabilitation protocol following Mumford procedure?

Rehabilitation after mumford procedure is aimed at minimising pain and swelling and gradual regain of joint range of motion, proprioception, and muscle stregth. The physical therapy starts from day 3 after mumford procedure. The patient is advised to wear arm sling for support for upto 3-4 weeks after which the patient can regain normal routine activities and sports activities can be resumed 2-3 months after mumford procedure. Various stretching, strengthening, proprioceptive exercises, mobilisation and postural training are part of the rehabilitation protocol post mumford procedure.

What is the prognosis of Mumford Procedure?

The Mumford procedure has excellent prognosis. The patient can resume the pre- operative sports activities after six weeks. There might be minimal occassional pain in the shoulder, that may happen on doing vigorous activities, which can be managed by some rest, ice and elevation of the limb.  

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