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Acromioclavicular Joint Arthrosis: Causes, Symptoms & Treatment

Acromioclavicular joint arthrosis is a degenerative condition of the AC joint causing shoulder pain, swelling, and reduced range of motion.

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Things worth knowing about "Acromioclavicular joint arthrosis"

Acromioclavicular joint arthrosis is a degenerative condition of the AC joint causing shoulder pain, swelling, and reduced range of motion.

What is Acromioclavicular Joint Arthrosis?

Acromioclavicular joint arthrosis (also referred to as AC joint osteoarthritis or ACJ arthrosis) is a degenerative joint disease affecting the acromioclavicular joint -- the joint that connects the acromion (part of the shoulder blade) to the clavicle (collarbone). This joint plays a key role in shoulder and arm movement. As the condition progresses, the cartilage lining the joint breaks down, leading to pain, stiffness, and reduced shoulder function.

Causes

Several factors can contribute to the development of acromioclavicular joint arthrosis:

Age-related wear and tear: The cartilage naturally degenerates over time, increasing the risk of osteoarthritis in older adults.
Repetitive overhead activities: Occupations or sports involving repeated overhead movements place excessive stress on the AC joint.
Previous injuries: Past AC joint injuries or separations (sprains) can accelerate cartilage degeneration.
Direct trauma: Falls onto the shoulder or direct impact can damage the joint structures.
Inflammatory conditions: Rheumatoid arthritis and other inflammatory diseases can affect the AC joint.
Genetic predisposition: A family history of osteoarthritis increases individual risk.

Symptoms

Symptoms of AC joint arthrosis typically develop gradually and may include:

Pain at the top or front of the shoulder, especially when lifting the arm above shoulder height
Tenderness when pressing directly on the AC joint
Swelling or a visible bump over the AC joint
Crepitus -- a clicking, grinding, or popping sensation during shoulder movement
Restricted range of motion, particularly with overhead activities or cross-body movements
Discomfort when sleeping on the affected side

Diagnosis

Diagnosis is usually made through a combination of physical examination and imaging studies:

Physical examination: The doctor assesses tenderness over the AC joint and performs specific tests such as the cross-body adduction test or the active compression test (O'Brien test) to identify AC joint involvement.
X-ray: Reveals typical osteoarthritic changes including joint space narrowing, osteophytes (bone spurs), and bony irregularities.
Ultrasound: Can detect soft tissue changes and joint effusion.
MRI (Magnetic Resonance Imaging): Provides detailed assessment of cartilage, ligaments, and surrounding structures.
Diagnostic injection: Relief of pain following a local anesthetic injection into the AC joint confirms the diagnosis.

Treatment

Conservative Treatment

Most cases of AC joint arthrosis are initially managed without surgery:

Activity modification: Avoiding aggravating movements, particularly overhead and cross-body activities.
Physiotherapy: Targeted exercises to strengthen the shoulder muscles and improve joint stability.
Pain medication: NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen or diclofenac reduce pain and inflammation.
Corticosteroid injections: Injections into the AC joint can provide effective short-term pain relief.
Cold and heat therapy: Supportive measures to manage pain and swelling.

Surgical Treatment

If conservative treatment fails to provide sufficient relief, surgical intervention may be considered:

Arthroscopic distal clavicle resection: A minimally invasive procedure in which a small portion of the end of the clavicle is removed to relieve pressure within the joint.
Open surgery: Rarely required, but may be performed in complex cases.

The outlook following surgery is generally favorable. Most patients experience significant pain relief and a noticeable improvement in shoulder function after rehabilitation.

References

Rockwood CA, Matsen FA: The Shoulder. 5th Edition. Elsevier Saunders, Philadelphia, 2016.
Mazzocca AD et al. - Acromioclavicular Joint Injuries: Indications and Technique for Acute and Chronic. Journal of the American Academy of Orthopaedic Surgeons, 2007.
Bannister GC et al. - The management of acute acromioclavicular dislocation. Journal of Bone and Joint Surgery (British Volume), 1989.

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