How do I know my pain is from the AC joint?

AC joint pain is usually well localized to the top of the shoulder and is reproduced by reaching the arm across the body. X-rays support the diagnosis, and because it often coexists with rotator cuff or impingement problems, a small diagnostic injection into the joint can confirm how much of the pain comes from there.

Most AC arthritis is managed without surgery, using activity modification, anti-inflammatory measures, and injections such as PRP or corticosteroids. Surgery, a small procedure that removes the worn end of the collarbone, is reserved for pain that persists despite these measures.

What does the surgery involve?

A distal clavicle excision removes a small amount of the worn end of the collarbone so the arthritic surfaces no longer rub. It is often done arthroscopically and is frequently combined with treatment of a coexisting rotator cuff or impingement problem. Recovery is usually quick.

AC Joint Arthritis, Steven J. Lee, MD

The acromioclavicular (AC) joint sits at the top of the shoulder where the collarbone meets the shoulder blade. Like any joint, it can wear out, from age, heavy lifting, or an old separation, and become arthritic.

AC arthritis is often easy to localize, the pain sits right on top of the shoulder and is reproduced by reaching the arm across the body. It frequently coexists with rotator cuff and impingement problems, which is part of the evaluation.

Symptoms

Common complaints include:

Pinpoint pain on top of the shoulder over the AC joint
Pain reaching the arm across the body or sleeping on the shoulder
Pain with bench press, dips, or overhead lifting
Sometimes a small bump or tenderness directly over the joint

How it is diagnosed

AC arthritis is usually clear on examination, the pain is localized to the joint and reproduced by a cross-body test, supported by X-rays. Because it often coexists with rotator cuff or impingement problems, a diagnostic injection into the AC joint can confirm how much of the pain comes from there.

Dr. Lee's approach

Most AC arthritis is managed without surgery. Dr. Lee starts with activity modification, physical therapy, anti-inflammatory measures, and if not better, injections such as PRP or rarely corticosteroids.

When pain persists despite these measures, a small 15 minute arthroscopic procedure removes the worn end of the collarbone (distal clavicle excision), relieving the painful joint contact. It is often done at the same time as treatment for a coexisting rotator cuff or impingement problem.

Non-surgical treatment

Activity modification (especially avoiding provocative pressing and cross-body loading), avoiding sleeping on the shoulder and overhead presses in the gym, anti-inflammatory measures, and injections such as PRP or rarely cortisone.

Surgical treatment

For pain that persists, a distal clavicle excision removes a small amount of the worn end of the collarbone so the arthritic surfaces no longer rub. It is usually performed arthroscopically and is often combined with treatment of any coexisting shoulder problem.

Recovery timeline

Recovery after a distal clavicle excision is usually quick:

Weeks 0 to 2
Sling for comfort. Begin gentle motion early.
Weeks 2 to 6
Progressive range of motion and early strengthening.
Weeks 6 to 12
Strengthening and a graded return to lifting and overhead activity.

What patients commonly misunderstand

A couple of clarifications:

It often travels with other shoulder problems. AC arthritis frequently coexists with rotator cuff and impingement issues. A diagnostic injection can help sort out how much of the pain is coming from the AC joint.
Surgery is a big procedure. The procedure simply removes the worn end of the collarbone so the surfaces no longer grind. There is no implant, and recovery is usually quick.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Sharp pain on top of the shoulder? It is usually very manageable.

AC joint arthritis is one of the more localized and treatable causes of shoulder pain. Most cases settle with activity modification and an injection, and the few that do not respond well to a small arthroscopic procedure. The evaluation also checks for coexisting shoulder problems.

AC Joint Arthritis: pinpoint pain on top of the shoulder.