Arthritis of the acromioclavicular (AC) joint is a common cause of shoulder pain and occurs more frequently with age.
It is more common in patients engaged in repetitive overhead or lifting activities
Previous injury to the AC joint such as a low-grade AC joint separations can result in painful arthritis.
The severity of arthritis seen on X-ray does not always correlate with degree of symptoms.
Patients report pain with activitiy.
The pain is usually located at the top of the shoulder at the AC joint.
Pain with heavy lifting or when sleeping on the affected side also is reported.
Arthritis of the AC joint can produce bone spurs that can irritable the subacromial bursa and can be a cause of pain from shoulder impingement
Often patients present with shoulder impingement, rotator cuff tear and painful arthritis of the AC joint
Distal clavicle osteolysis is a similar condition that affects young patients involved with heavy lifting or repetitive activites. Pain is caused by inflammation and erosion of the AC joint with overuse and overloading. Treatment for this condition is the same as that of arthritis of the AC joint.
Radiographs (X-ray Imaging) may show osteophyte (bone spur) formation, sclerotic reaction, and bone cysts are commonly seen.
Magnetic Resonance Imaging (MRI) of the shoulder will often show fluid within the joint, bone bruising and wearing down of the cartilage. MRI is useful to assess other associated abnormalities that are commonly found in the shoulder. This includes tears of the rotator cuff tendons, bursitis of the subacromial bursa and inflammation of the long head of biceps tendon.
Non Surgical Treatment
Rest from aggravating activities, non steroidal anti-inflammatory medications (NSAIDs) are used initially; corticosteroid injections into the joint can also be used for diagnostic or therapeutic purposes.
Surgical indications include persistent pain and failure of nonsurgical treatment.
Removal of part of the clavicle at the AC joint can be performed arthroscopically or open through a small incision and is a successful procedure for relieving the symptoms (Please see video)
Pain relief is reliable (in >90% of patients).
A sling is worn for 7 days postoperative with pendulum exercises permitted.
Aftert this shoulder movement is increased with active movement as well as passive stretching.
The sling can be discarded as pain permits.
Avoid heavy lifting or strengthening exercises for 6 weeks.
After 6 weeks, full shoulder range of motion should be achieved
Rotator cuff, scapular stabilizer, and deltoid strengthening is commenced after 6 weeks
Heavy weight lifting and return to full activities as tolerated. Residual pain/soreness can persist for 3 to 4 months and can be aggravated by heavy lifting. Therefore, activity progression should be modified according to symptoms.