HPI: 55 year old male with AC separation in 2009 treated nonoperatively. Developed AC joint arthritis with impingement with partial rotator cuff tear. Subsequently underwent an arthroscopic SAD/DCE with rotator cuff repair by outside surgeon 8/2011. Difficulty regaining motion postoperatively despite physical therapy. Presents to our clinic 1/2012 with continued pain and stiffness.

PMH: hypertension

SH: 2 ppd tobacco use

PE: healed incisions, moderate pain with passive motion, forward elevation 120 degrees, external rotation -20 degrees, internal rotation to sacrum. Motor and sensory exam grossly intact.

XRays: heterotopic bone enveloping the subacromial space extending from the AC joint to the posterior humeral shaft.

Assessment: Heterotopic ossification after arthroscopic acromioplasty and distal clavicle excision

Questions: Have you seen this occur before?

What would your plan be?