Indications for excision of the distal clavicle include symptomatic degenerative arthritis of the acromioclavicular joint, impingement syndrome, and osteolysis of the distal clavicle if nonoperative treatment has failed. Distal clavicular resection (DCR), one could argue, is by definition an impairment because of the loss of a portion of a body part, the clavicle. Yet a competently performed and uncomplicated DCR generally results in improved function, not loss of use. DCR was first mentioned in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, which stated that a resection arthroplasty of the acromioclavicular joint warrants 10% upper extremity impairment (UEI). Rating DCR using the AMA Guides, Fifth Edition, is almost the same as using the fourth edition, but evaluators can use one of two approaches: The rating physician can select a 3% rating for DCR using the fifth edition and claim to be literally following the instructions and providing a sensible rating in view of the generally good results reported in the orthopedic literature following a DCR. Alternatively, a rating physician who is aware of the historical precedent underlying the 10% UEI in Table 16-27 could cite this and the absence of an instruction in the Arthroplasty section to justify a 10% impairment rating. In the sixth edition, DCR is a key factor in classifying an acromioclavicular joint injury or disease but is disregarded in the rating of rotator cuff or glenohumeral pathology.

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