ACJ Osteolysis

Shoulder Conditions

ACJ Osteolysis 

Weightlifters and tradespeople who regularly perform heavy activities overhead, such as builders and painters, are among those at risk of developing acromioclavicular joint (ACJ) osteolysis. Sport Med London’s specialists are skilled in diagnosing and treating this painful condition. 


A Glance At The ACJ 

The ACJ is a joint many people are not aware of until a condition such as osteolysis arises. The joint is on the top of the shoulder, where the outer end of the collarbone (lateral clavicle) meets the shoulder blade at a part known as the acromion.  

The end of the collarbone and part of the acromion are covered with cartilage that acts as a cushion that protects the bone and acts as a lubricant. The joint is surrounded by a protective capsule, and it is supported by the conoid and trapezoid ligaments, which are known as the coracoclavicular ligaments. The joint’s purpose is to stabilise the shoulder when you move your arm or put weight through it. 


ACJ Osteolysis – The Basics 

ACJ osteolysis is a condition in which the bone on the end of the collarbone erodes and is reabsorbed faster than your body can repair or replace the damage. This usually happens as a result of repetitive damage caused by excessive loading. 

Those most at risk of developing ACJ osteolysis include individuals who undergo heavy loading and/or who perform heavy activities overhead on a regular basis. Power lifters, weightlifters, and other power and strength athletes, builders, carpenters, painters, and plumbers are among those who develop the condition. 


Symptoms Of Osteolysis 

Common symptoms of ACJ osteolysis include: 

  • Pain when you lift your arms above shoulder level, especially during heavy work 
  • Pain when you move your arm across your body at shoulder level 
  • Pain when you lie on the side that is affected 
  • Swelling or another mild deformity over the joint 
  • Tenderness in the area of the joint 
ACJ Osteolysis Page


Diagnosis And Treatment 

When making a diagnosis, our specialist will ask you about your recent medical history, how long you have had the problem, and the activities you perform regularly. They also will examine your shoulder physically, and they may send you for an X-ray or an MRI or ultrasound scan. 

Non-surgical treatment for ACJ osteolysis usually includes rest, simple painkillers (analgesia), and physiotherapy. You also would need to avoid overhead weightlifting for approximately six weeks. In some cases, our specialist may recommend cortisone injections and a tailored physiotherapy programme. 

Surgical treatment is seldom required. When surgery is recommended, it usually involves excising the joint via a keyhole (arthroscopic) or a larger incision on the top of the shoulder. Surgery is followed by a physiotherapy course. You may need to wear a sling for a few days after surgery. 



Technical Information:

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.