-Cyprus Orthopaedics

Acromioclavicular Joint Arthritis

Acromioclavicular joint (ACJ) arthrosis is a painful condition that affects the acromioclavicular joint, which is the small joint between the outer end of the clavicle (collar bone) and the acromion(part of the shoulder blade). The joint suffers wear and tear sometimes associated with strenuous use or occasionally after an injury. The condition usually commences with gradual onset of pain in the shoulder.
Shoulder Conditions-Cyprus Orthopaedics

Acromioclavicular Joint Arthritis

Acromioclavicular Joint Arthritis is a condition that affects the joint connecting the acromion, a part of the shoulder blade, and the clavicle, or collarbone. This joint allows for the smooth movement of the shoulder and is essential for various activities involving the arm. When this joint becomes inflamed and damaged, it leads to pain, stiffness, and limited mobility.

Causes of Acromioclavicular Joint Arthritis

Acromioclavicular Joint Arthritis can develop due to various factors. One of the primary causes is age-related degeneration, where the cartilage that cushions the joint gradually wears down over time. This natural deterioration can result in osteoarthritis, which is the most common form of arthritis affecting the acromioclavicular joint. Additionally, previous injuries, such as fractures or dislocations, can contribute to the development of arthritis in this joint. Repetitive strain on the shoulder joint, such as in athletes or individuals engaged in manual labor, can also increase the risk of Acromioclavicular Joint Arthritis.

Symptoms of Acromioclavicular Joint Arthritis

The symptoms of Acromioclavicular Joint Arthritis can vary from person to person, but they generally include pain, tenderness, and swelling in the shoulder area. Individuals with this condition may experience limited range of motion, making it difficult to perform daily activities and participate in sports or hobbies. The pain may worsen during activities that involve overhead movements or lifting heavy objects. In some cases, a clicking or grinding sensation may be felt when moving the affected shoulder. It is essential to recognize these symptoms and seek medical attention for an accurate diagnosis.

Diagnosing Acromioclavicular Joint Arthritis

To diagnose Acromioclavicular Joint Arthritis, a healthcare professional will conduct a thorough physical examination and review the patient’s medical history. They may also order imaging tests, such as X-rays or MRI scans, to assess the extent of joint damage and rule out other possible causes of shoulder pain. In some instances, an injection of local anesthetic into the joint may be performed to confirm the diagnosis. A comprehensive evaluation is crucial in determining the appropriate treatment plan for managing Acromioclavicular Joint Arthritis.

Treatment Options for Acromioclavicular Joint Arthritis

Non-surgical treatments

Non-operative interventions are essential in the treatment of AC joint arthritis. Rest and abstaining from activities that worsen the pain are effective in relieving symptoms. Engaging in physical therapy exercises can enhance the strength of the surrounding muscles, thereby improving stability and decreasing discomfort. Pain management strategies such as using heat or cold therapy, taking non-prescription pain relievers, or opting for corticosteroid injections can also offer relief. Moreover, adopting lifestyle adjustments like managing body weight and refraining from repetitive overhead motions can aid in preventing additional AC joint damage.

Surgical treatments

If non-surgical treatments prove ineffective in providing sufficient relief, surgical intervention may become necessary. Surgical options include open or arthroscopic distal clavicle resection. The open technique offers excellent visualization and is generally considered slightly less technically demanding compared to the arthroscopic approach. Drawbacks of the open procedure include the potential for injury and subsequent weakness in the reattached deltoid and trapezius muscles. These specific complications are much less common with the arthroscopic technique, as it doesn’t require removal and reattachment of these muscles. Surgical outcomes vary from satisfactory to highly impressive. Reports indicate that open resection of the distal clavicle achieves good to excellent results in 62–100% of cases, while the arthroscopic technique yields success rates of good to excellent outcomes in 83–100% of patients.

 

Rehabilitation and Physical Therapy for Acromioclavicular Joint Arthritis

Following surgical intervention or as part of the non-surgical treatment plan, rehabilitation and physical therapy play a crucial role in restoring function and enhancing recovery. A physical therapist will guide patients through exercises that focus on strengthening the shoulder muscles, improving joint stability, and gradually increasing range of motion. They may also incorporate modalities such as heat or cold therapy, ultrasound, and manual techniques to reduce pain and inflammation. Consistent participation in rehabilitation and physical therapy is vital for optimal outcomes in managing Acromioclavicular Joint Arthritis.

Preventing Acromioclavicular Joint Arthritis

While it may not be possible to prevent Acromioclavicular Joint Arthritis entirely, certain measures can help reduce the risk or delay its onset. These include:

  • Maintaining a healthy weight: Excess weight places additional stress on the joints, including the acromioclavicular joint. By maintaining a healthy weight, individuals can reduce unnecessary strain on the shoulder joint.
  • Practicing proper posture: Maintaining good posture while sitting, standing, and performing activities can help distribute the weight evenly and minimize strain on the joints.
  • Engaging in regular exercise: Regular exercise that focuses on strengthening the shoulder muscles and improving flexibility can help support the joint and reduce the risk of injury.

A diagnosis of Acromioclavicular joint arthrosis is made based on the history of a painful shoulder. Pain is usually aching in nature and experienced over the top of the shoulder when reaching overhead and across the chest. In some individuals symptoms may be associated with pain from the rotator cuff. Examination shows tenderness over the joint, pain with certain movements of the shoulder and on special acromioclavicular joint tests. An X-ray may demonstrate narrowing of the joint, erosion and formation of spurs. An ultrasound scan may be performed to examine the state of the rotator cuff. Special imaging with a Bone scan or an MRI scan is sometimes necessary.

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication. 

Physiotherapy: You may be advised to see a physiotherapist to treat associated causes of pain or stiffness. Physiotherapy may not help symptoms arising directly from the acromioclavicular joint.

Steroid injection: A steroid injection placed accurately into the acromioclavicular joint will often provide good short to medium term pain relief allowing activities to be undertaken. The injection may be repeated on 2 or 3 occasions at intervals. For further information on steroid injection in the shoulder click here.

Surgery: If symptoms persist despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment.  This consists of arthroscopic or “key-hole” surgery to remove some bone from the outer end of the clavicle and the undersurface of the acromion. Following surgery symptoms will usually settle over a period of time.

For further information on surgical treatment, please refer to the procedures section.

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