AC Joint Arthritis
Pain usually at the front of the shoulder.
Pain usually at the front of the shoulder.
What is AC (Acromioclavicular) Joint arthritis?
The AC joint is the joint connecting a part of the shoulder blade (Acromion) to the collar bone (clavicle). The AC joint is small and must support very heavy loads generated from everyday activity (i.e. lifting, pulling, pushing, etc…). This results in very high contact forces across the joint.
Who is likely to develop AC joint arthritis?
Like all cases of arthritis, AC joint arthritis is more common with age and increased “wear and tear”. Arthritis can occur earlier in certain populations, however. Prior trauma (clavicle fractures, AC joint separations, etc…), inflammatory arthritis (Rheumatoid Arthritis, etc…), history of AC joint infection, and engaging in constant heavy overhead activities (weightlifters, overhead throwing athletes) all increase your chance of developing AC joint arthritis. Those engaged in over activity of pushups or overhead presses are particularly prone to getting AC Arthritis.
Symptoms:
Patients most commonly present with activity-related shoulder pain. Overhead activities, reaching across the body, pushing activities, and sleeping on the affected side usually worsen the pain. The AC joint itself is also normally tender when palpated.
Diagnostic Testing:
An x-ray is usually ordered first and is the best imaging test for assessing AC joint arthritis. An MRI may also be ordered to assess for other shoulder pathology.
Treatment Options:
Physical Therapy and avoiding activities that cause pain are the first-line treatments for AC joint arthritis. A corticosteroid injection into the AC joint may also be tried in an attempt to relieve pain, but can lead to only temporary improvement. Additionally, corticosteroid injections can paradoxically cause an eventual increase or worsening of the arthritis, especially if given repetitively. Alternatively, the use of Platelet Rich Plasma (PRP) can also be helpful in not only relieving the pain, but to potentially improve the actual healing of the degenerated joint.
Surgical Treatment:
Surgery is recommended for patients with severe symptoms that have failed non-operative management and involves removing a small portion of the clavicle that has become arthritic. This leads to a space between the two bones and therefore they no longer are in contact with each other, leading to pain relief. Like most arthritis surgery, when the surgery is necessary is solely determined by the patient based on their symptoms and/or functional loss.
Dr. Steven Lee will perform this removal of arthritic clavicle arthroscopically. The actual time of the surgery is typically less than 15 minutes to perform this part of the procedure. Arthroscopy involves making very small one inch incisions over the shoulder and introducing a small video camera into the shoulder joint and other small arthroscopic instruments to remove the arthritic clavicle. Shoulder arthroscopy is minimally invasive and can result in less soft tissue disruption, less pain, and minimal scar formation.
Dr. Steven Lee is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research. Dr. Lee has many years of experience successfully treating AC joint arthritis.
Learn more about scheduling surgery.
Recovery Expectations
After surgery, a sling is worn for comfort purposes and can be removed whenever the patient feels comfortable to do so. This can be anywhere from a few days to a few weeks. Physical Therapy will be prescribed after the first postoperative visit. Usually patients are back to normal activities including sports within 6 weeks after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.