Acromioclavicular Joint Osteoarthritis

Abstract

A common cause of shoulder pain in adults is acromioclavicular (AC) joint osteoarthritis (OA). Osteoarthritis can be primary or secondary. Secondary OA is caused by trauma, rheumatic diseases, tumours, infections, and distal clavicle osteolysis. The prevalence of this clinical entity is higher in the third decade of life, most often in females as a result of progressive degeneration of the articular cartilage, as well as in patients with concomitant rotator cuff tears. The prevalence of radiographic degenerative changes of the AC joint is up to 82% in asymptomatic individuals. Radiographic evaluation, history and clinical examination are important factors that should be considered in the differential diagnosis of AC joint pain. If non-invasive treatment fails to provide pain relief over a six-month period, the treatment of choice is arthroscopic distal clavicle excision, which may be direct or indirect. The surgical procedure consists of resecting 8 to 10 mm of the distal clavicle in order to prevent bone-to-bone contact postoperatively. Advantage of the indirect technique is the preservation of the superior AC ligaments preventing postoperative instability and pain. Patients are supported in a sling for a few days after surgery and follow a rehabilitation programme while they can expect to return to everyday activities within 2 to 3 months and to sports within 6 months. Arthroscopic distal clavicle excision has demonstrated positive results in patients while additional studies are needed in order to evaluate the outcomes of this procedure in individuals with concomitant rotator cuff pathology.