What is Acromioclavicular Joint (ACJ) Osteolysis?
Acromioclavicular Joint (ACJ) Osteolysis occurs when the bone on the lateral end of the clavicle is resorbed (erodes) faster than it is replaced or repaired.
Who gets ACJ osteolysis?
It occurs when repetitive damage exceeds the ability for the bone to heal after loading. It occurs with excessive loading such as in strength and power athletes including weightlifters, power lifters and those trades regularly performing overhead heavy activities such as builders, plumbers, painters, carpenters.
What symptoms occur with ACJ osteolysis?
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 osteolysis diagnosed?
Normally a careful history and physical examination will give the diagnosis. Frequently patients are under the age of 40 and an X-ray may show the bony erosion at the outer end of the clavicle. Occasionally an ultrasound scan or an MRI may be requested if other pathologies are suspected.
How is ACJ osteolysis treated? Surgical VS Non-Surgical management
Treatment initially is conservative with physiotherapy and analgesia (painkillers). A period of rest and avoiding overhead weightlifting usually for six weeks will help to allow the bone to heal. If this fails 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 rarely required as the majority of cases will settle by restricting and avoiding loaded overhead activities for a period of time. Where conservative measures fail surgical excision of the acromioclavicular joint can be performed either arthroscopically or 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 and a course of physiotherapy with a specialist shoulder physiotherapist is commenced under the supervision of the surgeon.