Providing Quality Orthopaedic Care
Filed under: Shoulder
AC joint arthritis is a common condition leading to pain in the shoulder. It is usually localised to the outer end ( lateral ) aspect of the collar bone ( clavicle ) at the site where it meets the acromion (Acromio clavicular joint). It develops after injuries, such as sprains, or repetitive minor trauma ( AFL knocks as in a “hip & shoulder bump”), but is also associated with age ( degeneration).
It is often worse with movement, but unlike a bursitis type pain which occurs in midrange motion, its often worse at the end range movement, particularly when placing arm across chest. It is also made worse with exercises like push ups and like most shoulder conditions, worse when lying flat or at night
X-ray of AC joint osteoarthritis
Reply: Diagnosis is easily made by examination, and can be confirmed with an X-ray which demonstrates irregular joint easily. In those cases that are not obvious on X-Ray, an ultrasound, MRI scan or even bone scan can demonstrate it.
Diagnosis can be confirmed, by undergoing an ultrasound guided steroid injection in the joint, which often leads to resolution of symptoms temporarily, confirming the condition.
In cases that don’t respond to the steroid injection, then surgery is a good option and can lead to a significant improvement or even resolution of symptoms in upto 95% of cases. The surgery involves an Arthroscopic ( minimally invasive ) approach to the shoulder then through the same holes (portals) the outer end of the clavicle ( outer 5-8 mm) is removed, to prevent the 2 bones ( clavicle and acromion) rubbing together. After surgery, no sling is needed and the patient is encouraged to use arm as soon as possible, but should not drive for 8 days until reviewed by Dr Nimon.
No. The clavicle function depends upon the ligaments which are inner most (medial) from the joint, and these are not affected. Excision of the outer most part of the clavicle will lead to pain for a period of time, which will resolve, but rarely leads to any shoulder dysfunction.
X-ray following AC joint excision
Further reading about shoulder conditions and shoulder surgery.