ACJ Osteoarthritis

Shoulder Conditions

ACJ Osteoarthritis 

Age and injury are two causes of acromioclavicular joint (ACJ) osteoarthritis, a painful condition that could also hinder movement in your shoulder. Sports Med London offers world-class treatment in a comfortable setting. 


A Small But Important Joint 

Located at the top of the shoulder, the ACJ is formed by the meeting of the collarbones’ outer ends (lateral clavicles) and a part of the shoulder blade (the acromion). The ends of the bones are covered by cartilage, which acts as a lubricating cushion.  

A thin protective capsule surrounds the joint, and it is supported by the coracoclavicular ligaments (the conoid and trapezoid ligaments). The ACJ stabilises the shoulder during movement and when you put weight on your arms. 


Osteoarthritis In The Joint 

Osteoarthritis is one of the most common conditions that affects the ACJ. The joint becomes larger (hypertrophies) and bony spurs might form on it. The enlargement of the joint can cause pain, while the bony spurs might catch a shoulder tendon and affect your movement. 

Age, repeated use of the joint, and degenerative changes that happen after an injury are some causes of ACJ osteoarthritis. The condition is relatively common among people who often work with their arms above should level with loads or other repetitive resistance, such as athletes who weight-lift regularly, builders, construction workers, electricians, and plumbers. Persistent instability of the joint also can lead to ACJ osteoarthritis. 


Symptoms Of ACJ Osteoarthritis 

Symptoms of ACJ osteoarthritis include: 

  • Pain when lying on the affected side 
  • Pain when lifting your arms above shoulder level, especially during heavy work 
  • Pain when moving your arm across your body at shoulder level 
  • ACJ area is tender 
  • ACJ is swollen or mildly deformed 
ACJ Osteoarthritis Page


Diagnosing ACJ Osteoarthritis 

When diagnosing ACJ osteoarthritis, our specialist will ask you about the history of your complaint and perform a physical examination of the joint. You might be sent for a plain X-ray and/or an ultrasound or MRI scan if the specialist suspects you might have another condition or a more serious injury. 


Treating ACJ Osteoarthritis 

We offer non-surgical and surgical treatment for ACJ osteoarthritis at Sports Med London. 

In most cases, the initial treatment is non-surgical. Our specialists may recommend simple painkillers (analgesia) and physiotherapy, or they may recommend a cortisone injection that will be followed by a bespoke physiotherapy programme. You also would need to limit activities in which you raise your arm above shoulder height. 

If non-surgical treatment does not work, our specialist may recommend surgical treatment. Surgery may be performed via a small cut (arthroscopic or keyhole), or it may be open surgery via a larger incision. You may need to use a sling for a few days after surgery. A physiotherapy rehabilitation programme will follow your surgery. 


Technical Information:

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.