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Acromioclavicular Joint Arthritis

What is acromioclavicular joint arthritis?

Acromioclavicular joint arthritis (ACJ arthritis) is a degenerative condition that affects the acromioclavicular joint, where the collarbone (clavicle) meets the shoulder. The acromioclavicular joint helps to stabilize the shoulder joint and facilitates movement of the arm.

Who is affected by AC joint arthritis?

AC joint arthritis can affect people of all ages, but it is most common in middle-aged and older adults. It is also more common in people who have had a previous injury to the shoulder, for example following a direct fall onto the shoulder tip.

What are the main symptoms of AC joint arthritis?

 

The main symptoms of AC joint arthritis are pain and tenderness in the front of the shoulder. The pain tends to be worse with activity, such as overhead lifting or reaching and with overhead gym exercises such as pull-ups, shoulder press and lat-pulldown exercises. Patients also describe discomfort when the straps of a rucksack or bra press down on the joint or when lying on the affected side at night. Other symptoms of AC joint arthritis may include:

Stiffness and weakness in the shoulder

Crepitus, which describes the popping/grating sound with movements of the shoulder

Swelling, redness and localised tenderness around the acromioclavicular joint

How is AC joint arthritis diagnosed?

The diagnosis of AC joint arthritis is usually made based on the patient's medical history and physical examination. The doctor will examine the shoulder for localised swelling, tenderness, and pain with certain movements, for example when bringing the arm across the body. Imaging tests, such as X-rays, ultrasound or MRI scans, will help the doctor to confirm the diagnosis and rule out other causes of shoulder pain.

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How is AC joint arthritis treated?

 

The treatment for AC joint arthritis depends on the severity of the condition. Non-surgical treatments are often effective for relieving pain and improving function. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the pain to allow inflammation to settle
  • Ice:

    Applying ice to the shoulder for 10-15 minutes at a time, can help to reduce inflammation and pain, particularly if the joint is aggravated following exercise
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen, paracetamol or naproxen, can help to relieve mild to moderate pain.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the shoulder, to reduce stress across the painful ACJ.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain in the AC joint.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a seated or lying position. The shoulder is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions. The combined local anaesthetic and steroid is injected from the skin to the joint under ultrasound guidance.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever. If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed. The patient is also warned that following this particular injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours). This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments are not effective, surgery may be an option. Surgery for AC joint arthritis may involve:

  • Arthroscopic debridement: This minimally invasive surgery involves removing damaged cartilage and bone spurs from the AC joint and sometimes removal of a small section of bone on the end of the clavicle (collar bone)

The best treatment option for you will depend on the severity of your AC joint arthritis, your overall health, and your activity level.

If you are experiencing pain and stiffness in your shoulder, it is important to see a doctor to get a diagnosis and discuss treatment options.