ACJ Osteoarthritis

ACJ Osteoarthritis can be treated with Physiotherapy, with painkillers and anti-inflammatorys and injections into the painful joint can provide temporary relief.  When pain cannot be controlled with these measures, surgery may be required.

Resection arthroplasty is the most common surgical treatment of ACJ osteoarthritis.

An X-ray or MRI scan may be required to rule out or identify other possible problems such as ligament or tendon tears and this will aid diagnosis of degeneration in the bone.

This condition is present with superior/anterior pain, and is worse on high elevation. Examination shows tender ACJ and positive cross arm adduction. A plain radiograph may show degenerative changes and an MRI can demonstrate high signal signifying inflammation.

If conservative management with NSAIDs and physio fails, steroid injection can be tried next.

Surgery

If osteoarthritis is found in the ACJ, it may be necessary for a surgeon to perform a resection Arthroplasty. This is Arthoscopic surgery which includes shaving the end of the clavicle in order to create more space between the clavicle and the acromion.

In surgery, the bursa is removed along with any badly damaged ligaments. About 1cm of the clavicle is trimmed away and any diseased bone or bone spurs are removed. Scar tissue replaces the joint as the body heals, preventing the bones from rubbing against each other, but retaining flexibility in the joint.

Resection Arthroplasty is the most common surgical procedure for the treatment of ACJ osteoarthritis.

Arthroscopic ACJ resection is carried out with the shaver initially inserted from the lateral portal. Subacromial decompression is carried out and any inferior osteophytes at the distal clavicle are excised. The shaver is then inserted through an anterior portal in line with the plane of the joint. A shaver’s width is resected from the medial acromion and distal clavicle, ensuring about 1 cm gap. The superior acromio-clavicular ligament is preserved.

Another surgical procedure which may be used is an ACJ Excision, which is the removal of the AC Joint. This can be done Arthroscopically or as an open operation.

Shoulder surgery requires a long rehabilitation period. Physiotherapy may be required and full recovery may take from a few weeks to several months. A sling may be required directly after surgery, and ice, massage and other treatments may be required to ease pain.

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