Shoulder Questions: Rotator Cuff Injury AC Joint Derangement Frozen Shoulder Shoulder Instability Shoulder Arthritis back |
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| ________________________________________________________________ What is the AC Joint in the shoulder? The top of the wing bone or scapula is the acromion. The joint formed where the acromion connects to the collar bone or clavicle is the AC joint. Usually there is a protuberance or bump in this area, which can be quite large in some people normally. This joint, like most joints in the body, has a cartilage disk or meniscus inside and the ends of the bones are covered with cartilage. The joint is held together by a capsule, and the clavicle is held in the proper position by two heavy ligaments called coracoclavicular ligaments. How is the AC Joint usually injured? The AC joint is injured most often when one falls directly on the point of the shoulder. The trauma will separate the acromion away from the clavicle, causing a sprain or a true AC joint dislocation. In a mild injury, the ligaments which support the AC joint are simply stretched (Grade I), but with more severe injury, the ligaments can partially tear (Grade II) or completely tear (Grade III). In the most severe injury, the end of the clavicle protrudes beneath the skin and is visible as a prominent bump. How is an AC Joint separation diagnosed? Most often the clinical exam will demonstrate tenderness or bruising around the top of the shoulder near the AC joint, and the suspected diagnosis can be confirmed using an x-ray, occasionally obtaining a comparison x-ray of the patient's other shoulder. Symptoms can range from tenderness over the joint to a complete separation of the AC joint, with considerable swelling and obvious deformity of the shoulder. What is the proper treatment for a sprained AC Joint? When a joint is first sprained, conservative treatment is certainly the best. Applying ice directly to the point of the shoulder is helpful to inhibit swelling and relieve pain. The arm can be supported with a sling which also relieves some of the weight from the shoulder. Gentle motion of the arm can be allowed to prevent stiffness, and exercise putty is very helpful to improve function of the elbow, wrist, and hand, but any attempts at vigorous shoulder mobilization early on will probably lead to more swelling and pain. How long does it take for a shoulder separation to heal? With a grade 1 or 2 separation, usually healing takes two to three weeks. In severe cases, the recovery period may take 4 to 6 weeks. When and why is surgery necessary for AC Joint separations? Usually surgery is reserved for those cases where there is residual pain or unacceptable deformity in the joint after several months of conservative treatment. The pain can occur with direct pressure on the joint, such as with straps from underwear or work clothing. Sometimes there will be catching, clicking, or pain with overhead activities, such as lifting, throwing or reaching. Finally, in some people with very thin skin and very little muscular and soft tissue padding above their shoulders, the prominent clavicle after the separation may be considered unattractive, since the shoulder can appear to be unbalanced. What type of surgery can repair AC Joint problems? The simplest type of surgery for AC joint injury involves resection or removal of the end of the clavicle using arthroscopic (mini-surgical) techniques (called a Mumford procedure). When the joint is severly displaced, then a more complex procedure is needed to restore the position of the clavicle. Usually this operation, called a Weaver-Dunn procedure, is done using a two-inch incision over the joint. The end of the clavicle is removed, and a ligament is transferred into the cut end of the clavicle to replace the ligaments torn during the dislocation. This surgery removes the portion of the AC joint that is painful while restoring stability to the distal clavicle. What is AC Arthritis? When the articular disk between the clavicle and acromion begins to degenerate and become painful, AC arthritis results. Fractures of the distal clavicle and AC dislocations may predispose this joint to osteoarthritis. Repetitive upper-extremity activity can cause mechanical wear of the articular cartilage. Changes of the AC joint on x-ray is fairly common, with almost 62% of the dominant arms of those who participate in occupations and sports that require extensive shoulder use showing degeneration. Fortunately, despite the frequency of degenerative changes, few people become symptomatic and require treatment. What are the symptoms of AC Arthritis? Common clinical complaints of those who have AC arthritis are diffuse, lateral shoulder pain and/or local AC-joint pain. Pain at night is common. The physical exam commonly reveals local tenderness to palpation of the involved joint. Active and passive range of motion of the shoulder may intensify symptoms. Crossed-arm adduction of the involved shoulder with additional passive adduction by the examiner also aggravates pain. X-rays of the painful shoulder demonstrate typical degenerative changes of bony sclerosis, subchondral cysts, osteophytes, and joint-space narrowing. What is the treament for AC Arthritits? The treatment for AC arthritis is three-fold. First, you can treat it symptomatically with anti-inflammatories and activity modifications. A person with purely AC arthritis in their shoulder will not further damage their shoulder by playing and working through their symptoms. The second treament option is to undergo a steroid injection directly into their AC joint. This is different than the typical shoulder injection that is given for rotator cuff tendonitis. This injection is given into the small acromioclavicular joint on the anterior/superior aspect of the shoulder. Generally, the relief is temporary, but if the symptm relief is prolonged, multiple injections may be given as this injection is not given near a tendon. The third option is surgery. If the AC joint continues to be painful, the end of the clavicle is removed through an arthroscope. What is weightlifter's shoulder? Occasionally, weightlifters can develop atraumatic osteolysis of the distal clavicle. Secondary to the significant wear and tear that a weightlifter can place upon their AC joint, resorption of the distal clavicle can occure and thereby cause pain. Treatment for this condition is the same as for AC arthritis. Conservative treatment and recovery can take 4 to 6 months and joint widening may persist. |
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| Blair A. Rhode, M.D. ________________________________ Sports Medicine Knee/Shoulder/Elbow Reconstruction Specialist *Board Certified* |
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