Acromioclavicular Joint Arthritis

What is it?

The acromioclavicular joint is the joint between the acromion and the clavicle on the top of the shoulder.  These joint surfaces are usually lined by smooth cartilage.  Damage to this cartilage can be progressive over time and may result from an injury to the shoulder, dislocation of the joint or possibly just from normal wear and tear.

What are the symptoms?

Often acromioclavicular joint arthritis or arthrosis is associated with impingement syndrome or possible rotator cuff tear.  As part of the patients pain and problems there is swelling of this joint with possibly bony swelling on either side of the joint and pain, which localises to this site.  It is common in weight lifters or people who perform frequent overhead activities and made worse by lifting the arm overhead.  There is often swelling and enlargement of the joint made worse by bony swelling on either side of the joint.

Clinical examination

The most common findings are pain to palpation over this site and this is often worse with deep pressure and moving the arm across the body or moving the arm up over the head.  There is frequently arthritis at this site, which is palpable on clinical examination.

What investigations are required?

Acromioclavicular joint arthritis or irritation is frequently diagnosed with a clinic examination but an xray is always required and an MRI scan may be indicated if surgery is considered to plan for surgery.

What are the treatment options?

1.  Non-operative treatment

Non-operative treatments of acromioclavicular joint arthritis are often supervised by physiotherapists.  They will rely on maintaining range of motion and reducing pain.  Frequently, an ultrasound guided steroid injection with local anaesthetic can be placed into the acromioclavicular joint.  This is partly diagnostic and partly therapeutic.  Many patients will have a dramatic improvement after this injection however this may not be sustained and will help Dr Taylor plan your surgery, if required.

2.  Operative treatment

Operative treatment for acromioclavicular joint arthritis include arthroscopic debridement which is keyhole surgery to debride and remove the degenerative damaged cartilage surfaces of the joint and frequently approximately 5mm of the clavicle bone and a small part of the surface of the acromion joint.  This is usually performed arthroscopically however, in situations where there is large bony swelling around the joint an open procedure (which consists of a 3cm incision over the superior surface of the shoulder and joint) may be required.

This is a highly successful procedure with regards to relieving pain and irritation at this site.

Possible complications

Most people are happy with the results of their surgery however complications do occur occasionally.  Complications related to this procedure are similar to all shoulder procedures which are infection, bleeding and damage to surrounding structures and there is a small chance that pain may not be completely resolved.