What is Acromio-Clavicular Joint (ACJ) osteoarthritis?
Many conditions may affect the acromioclavicular joint (ACJ) including sprains, dislocations, fractures, infections, inflammation and arthritis.
Osteoarthritis of the ACJ is very common. With age, with regular use or following injury degenerative changes take place within the acromioclavicular joint. The joint becomes larger (hypertrophies) which can result in pain and it may form bony spurs that sometimes catch the underlying tendon in the shoulder causing impingement.
Who gets ACJ osteoarthritis?
This frequently occurs in individuals who spend a lot of time with their arms above shoulder level with repetitive resistance or loads. Not infrequently it is seen in scaffolders, builders, construction workers, electricians and plumbers as well as athletes regularly engaging in weight-lifting, loaded above shoulder level sports or contact sports who keep injuring their shoulder. Repetitive injuries to the ACJ or persisting instability may result in osteoarthritis of the ACJ
What symptoms occur with ACJ osteoarthritis?
Patients may complain of pain when lying on the affected side, pain when lifting their arms above shoulder level especially when trying to perform heavy work and pain when trying to move their arm across their body. They are often tender over the acromioclavicular joint and there may be a mild deformity or swelling.
How is ACJ osteoarthritis diagnosed?
Normally a careful history and physical examination will give the diagnosis. Often a plain X-ray is performed to confirm the clinical findings. Occasionally an ultrasound scan or an MRI may be requested if other pathologies are suspected.
How is ACJ osteoarthritis treated? Surgical VS Non-Surgical management
Treatment initially is conservative with physiotherapy and analgesia (painkillers). A cortisone injection will improve the symptoms significantly in a large number of patients but needs to be followed with a tailored physiotherapy programme to regain range of movement and avoid excessive loading of the joint with overhead activities.
Surgery is indicated where conservative treatment has failed and for those with advanced disease such as the presence of a bone spur. This is usually an excision of the acromioclavicular joint and usually is performed arthroscopically (often in conjunction with a subacromial decompression). The procedure is often performed arthroscopically (keyhole surgery) but may be performed through an open approach involving an incision on the top of the shoulder. Sometimes the shoulder is immobilised in a sling postoperatively for a few days for comfort.
Following surgery, a rehabilitation program with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.