The joint was insufflated with 20cc of normal saline with a spinal needle. Stab wound was made and a trocar and cannula was placed and the arthroscopy was commence. The gleohumeral joint was inspected. It was well stationed and there was mild chondromalacia grade I of the humeral head and rest of the glenoid. There was some fraying of the undersurface of the suprspinatus and the biceps, but it was intact. Repositioning and going to the subacromial space, a lateral incision was made and first, the aggressive debrider was used to do a bursectomy and skeletonized the undersurface of the acromion and then, the 4.5 bur was used to the acromioplasty. Ports were switched with the arthroscope through the lateral approach and the bur posteriorly and using the posterior part of the acromion as a fulcrum the anterior aspect at this point. The arthoscopy was stopped, excessive fluids were removed, instruments were removed, and ports were closed with a 3-0 nylon. A strap incision was made just medial to the AC joint about 3-4 cm long and was carried down through subcutaneous tissue. The raphe was split in line with its fibers coming down to the distal clavicle and oscillating saw was used to resect the clavicle and this was pried open with a small key elevator stabbing the distal clavicle, which was about 10-12 mm broad. The soft tissue was removed with the elevator and the Bovie. With the distal clavicle removed in to, some small shards were removed with the rongeur and gently rasped and there was a smooth cut distal clavicle.