• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • Online Consultation
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Acromioclavicular Osteoarthritis Causes, Symptoms and Treatment

By Dr Arun Pal Singh

In this article
    • Anatomy of Acromioclavicular Joint
    • Cause and Pathophysiology of Acromioclavicular Osteoarthritis
    • Presentation of Acromioclavicular Osteoarthritis – Symptoms and Signs
      • Provocative Tests
    • Imaging
      • Modified AP View
      • Scapular Y View
      • Zanca View
      • Axillary Lateral View
      • Magnetic resonance imaging
    • Procedures
    • Treatment of Acromioclavicular Osteoarthritis
      • Related

Acromioclavicular osteoarthritis is a common cause of shoulder pain and is a frequent finding in patients >50 years.

It is the most common disorder of the acromioclavicular joint.

acromioclavicular-osteoarthritis
Acromioclavicular osteoarthritis
Image credit: Grutter

Anatomy of Acromioclavicular Joint

The acromioclavicular joint is a diarthrodial joint between lateral end of clavicle and medial end of acromion.

The two articular ends are separated by a fibrocartilaginous disc which functions to correct bony incongruities, acts as a cushion.

A number of ligaments – capsular ligaments, extracapsular ligaments, and attachments from the surrounding musculature stabilize the joint.

Coracoclavicular and coracoacromial ligaments are external stabilizers of the acromioclavicular joint.

These ligaments extend from the coracoid to the inferior surface of the clavicle in a V-shaped configuration and resist vertical displacement under high-load.

The deltoid and trapezius muscles attach over the lateral clavicle and acromion, and their fiberst blend with those of the superior acromioclavicular ligament.

Acromioclavicular ligament is supplied by branches of the suprascapular and lateral pectoral nerves. Blood supply is through branches of the suprascapular and thoracoacromial arteries.

Cause and Pathophysiology of Acromioclavicular Osteoarthritis

Osteoarthritis in the acromioclavicular joint could be caused by

  • Primary osteoarthritis – Due to age related degenerative changes
  • Secondary osteoarthritis – Due to pre-existing cause
    • Trauma
    • Inflammatory arthritis
    • Infection

Usually, the osteoarthritis of acromioclavicular joint causes pain in the joint but it can result in subacromial impingement of the rotator cuff termed extrinsic impingement, resulting in pain, weakness and even injury to rotator cuff tendons.

Presentation of Acromioclavicular Osteoarthritis – Symptoms and Signs

Patients generally present with progressively worsening shoulder pain. Sometimes, minor trauma and strenuous activity may cause an acute exacerbation of the pain.

The pain of acromioclavicular osteoarthritis is localized over the anterior aspect of the shoulder in the region of the acromioclavicular joint. The pain may be referred to the shoulder and upper arm, or base of the neck.

Some patients may have associated headaches.

Activities involving overhead activities, weight lifting, and cross-body movements may worsen the symptom.

The patient may also complain of night pain, especially when he lies on the affected shoulder, often disturbing the sleep.

Complaints of popping, clicking, grinding, or a catching may be present with movements of the shoulder.

Examination of the shoulder reveals tenderness over the joint and exacerbation of pain by provocative measures. [discussed below]

Stability of the clavicle is checked to rule out any instability.

Provocative Tests

Cross-body Adduction

This test is performed by passively bringing the patient’s arm into 90 degrees of forward flexion and maximal adduction, thus causing compression across the joint.

Acromioclavicular Resisted Extension Test

The patient’s arm is placed in 90 degrees of forward flexion and the patient is asked to actively extend against resistance.

O’Brien Active Compression Test

Arm placed in 90 degrees of forward flexion with 10 degrees of adduction. With the arm in the maximal internal rotation, the thumb gets pointed downward and the patient resists a uniform downward force applied by the examiner.

The arm is then externally rotated to make palm face upward and the maneuver repeated. The test is considered positive if the pain is present with internal rotation but decreases or resolves with external rotation. Pain localized to the acromioclavicular region during this test is indicative of acromioclavicular joint pathology, whereas pain located deep inside the shoulder may indicate labral pathology.

Imaging

Initial imaging should include a modified AP view, scapular Y-view, and Zanca view radiographs.

Modified AP View

In this, the x-ray is done as in routine but the voltage is reduced by 50%. This provides a better view of the acromioclavicular joint.

Scapular Y View

Zanca View

This provides optimal visualization of acromioclavicular joint. In Zanca view, the x-ray beam is angled with 10 degrees of cephalic tilt thus eliminating overlap from the scapula and other tissues seen on standard AP radiographs

Axillary Lateral View

It is done if there is a history of trauma.

Xrays show a decrease in joint space and marginal sclerosis [see image]

Magnetic resonance imaging

MRI can be used to further characterize the degree of arthrosis when radiographs are equivocal.

Procedures

Joint Injection

A combination of local anesthetic and corticosteroid is injected after the joint is located by palpation. The joint is approached from the superior side. Ultrasound guidance also has been shown to further improve the accuracy of proper intraarticular needle placement.

Treatment of Acromioclavicular Osteoarthritis

Goals of treatment of acromioclavicular osteoarthritis are pain reduction and allowing full range of motion.

The first line of treatment is nonoperative management, and options include rest, activity modification, nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy.

Rest

Rest is indicated in patients with acute exacerbation of their symptoms. Immobilization in a sling, cold or hot fomentation would help.

Warm or cold compress. Patients can loosen a stiff joint by using moist heat, such as a warming pad or whirlpool, for a few minutes before activity. Icing the shoulder joint for 15 or 20 minutes after activity can decrease swelling and give some immediate pain relief. These treatments provide temporary symptom relief and do not treat the underlying causes of acromioclavicular joint osteoarthritis.

Activity Modification

Repetitive, overhead, and cross-body movements should be avoided. Weight lifting and sports like golf should also be avoided.

Activity modification aims at reducing the stress on the acromioclavicular joint and prevents worsening of the symptoms.

Physical therapy

It includes strength and range of motion exercises of the shoulder girdle, stretching, ultrasound, and other modalities like cryotherapy. These are more effective in concomitant impingement or rotator cuff arthropathy than acromioclavicular osteoarthritis.

Medications

  • Oral analgesics like acetaminophen
  • Oral non-steroidal anti-inflammatory drugs (NSAIDs like aspirin, ibuprofen etc.
  • Topical Applications like gels and sprays containing counter-irritant, like capsacin, eucalyptus, and NSAIDs
  • Lidocaine is an anesthetic agent that interrupts pain signals to the brain. Adhesive patches containing 5% lidocaine applied directly to the affected joint may reduce or pain.
  • Glucosamine and chondroitin sulfate – Equivocal results

Injections

Intra-articular steroid injections are used to reduce swelling and shoulder stiffness and pain. The degree of pain relief from injections is variable and temporary.

Surgery

Surgical treatment of acromioclavicular osteoarthritis is indicated when a patient with AC osteoarthritis has persistent symptoms despite conservative management.

The procedure performed is distal clavicle excision is the can be performed through either open or arthroscopic techniques.

The results of open and arthroscopic are almost comparable.

Other possible surgeries are arthroscopic to remove loose pieces of damaged cartilage and osteotomy to shave off osteophytes and reduce bone friction.

 

Related

Spread the Knowledge
 
     

Filed Under: Hand and Upper Limb

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

congenital anomalies of shoulder

Congenital Anomalies of Shoulder

Congenital anomalies of shoulder are a group of disorders of the shoulder that affect shoulder anatomy and function. Following congenital anomalies of shoulder are discussed in this article- Congenital dislocation of shoulder Congenital Glenoid Hypoplasia Aplasia of Scapula Torsional Deformity of Glenoid Cavity Congenital Varus Deformity of Proximal Humerus Torsional Deformity of Humeral Neck Different […]

Synovial Plica Syndrome

Synovial Plica Syndrome

Synovial plica syndrome is referred to the group of signs and symptoms due to inflammatory changes in plica, an otherwise insignificant remnant of the synovial membranes of the knee. Synovial plicae are normal structures found in many knees. Normally, they are asymptomatic and are not associated with any painful conditions. However, with an inciting event […]

Xray of Osteopoikilosis

Osteopoikilosis or Spotted Bone

Osteopoikilosis is a  benign, autosomal dominant skeletal dysplasia that manifests radiographically as multiple bone islands which are especially seen near the joints, epiphyses, metaphyses of long and short tubular bones. The condition is also known as the spotted bone. The islands are also seen in in the pelvis and scapulae. The distribution is typically bilateral […]

Open Fracture Femur With Bone Jutting Out

Open Fractures- Features, Classification and Management

Open fractures are fractures where hematoma is in communication with the external environment. An open fracture may have a wound size ranging from a pinprick to complete baring of the bone. Open fractures have been further classified according to their severity and help the treating doctor to plan the treatment and measure the prognosis. Open […]

Severe scoliosis

Neuromuscular Scoliosis Causes and Treatment

Neuromuscular scoliosis is a coronal and sagittal plane deformity of the spine in patients with abnormalities of the nervous system or muscles i.e. myoneural pathways of the body. The progression more severe in case of neuromuscular scoliosis and continues into adulthood. The long-term effects of the spinal deformity in patients with neuromuscular conditions can be […]

postoperative pain management

Postoperative Pain Management

Perioperative pain relief or postoperative pain management or postoperative analgesia deals with the treatment of pain that occurs after the surgery. Postoperative pain can be acute that occurs immediately after the surgery or chronic that occurs and continues over a period. This article mainly concentrates on acute postoperative pain and the term postoperative pain here […]

Cerebral palsy in child

Cerebral Palsy Presentation and Management

Cerebral palsy is a group of permanent movement disorders appearing in early childhood and caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. The symptoms often include poor coordination, stiff muscles, weak muscles, and tremors. There could also be problems with sensation, vision, hearing, swallowing, and […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...