Acromio-clavicular joint (ACJ) arthritis

Acromio-clavicular joint arthritis, also known as AC joint arthritis, is a condition characterized by progressive wear and tear or degenerative changes in the joint where the clavicle (collarbone) meets the highest part of the scapula (shoulder blade). This degeneration, whilst typically occurring in individuals over 40 years old, can also be seen in younger people. The condition is often asymptomatic. However, in some cases, the joint can become painful, swollen, and exhibit gradual reduction in joint space along with the development of bone spurs (osteophytes) within the joint. Common causes of AC joint arthritis include overuse due to repetitive activities (such as weightlifting or work-related tasks), previous injuries to the joint, and inflammatory arthritis conditions like rheumatoid arthritis. 

Symptoms of AC joint arthritis include: 

  • Pain, stiffness, and tenderness at the top of the shoulder joint, worsening with activity. 
  • Pain can sometimes extend to the neck or towards the inner end of the collarbone. 
  • Swelling and limitation in the movement of the affected arm, including difficulty in lifting the arm for simple activities like combing hair, dressing and undressing. 
  • Night pain and difficulty sleeping, particularly on the affected side. 
  • Audible grinding, snapping, or clicking sounds during shoulder movement, especially when reaching across the body at shoulder height. 

Diagnosis of AC joint arthritis involves a thorough medical history review, physical examination, and imaging studies such as X-rays. X-rays typically reveal narrowing of the joint space and the presence of bone spurs. 

If left untreated, AC joint arthritis can lead to progressive degeneration, affecting the function and mobility of the affected arm. 

Treatment options for AC joint arthritis include conservative (non-operative) and surgical approaches. Conservative treatments focus on pain management and improving joint function through rest, activity modification, physical therapy, medications (such as pain relievers and anti-inflammatories), steroid injections, and the application of ice packs. 

Surgical intervention may be recommended if conservative measures fail or if there are associated pathologies such as rotator cuff issues. Surgery typically involves removing the last 8-10 mm of the clavicle to restore joint function. This can be done through either open or arthroscopic (keyhole) techniques, with the latter being preferred for its minimally invasive nature. After surgery, patients undergo postoperative rehabilitation, including physiotherapy to regain shoulder mobility and strength. 

Risks associated with surgery include: 

  • Infection 
  • Nerve or vascular injury 
  • Frozen shoulder 
  • Persistence or recurrence of symptoms 
  • Further procedures 
  • Anaesthetic risks 
  • Blood clots 

The outcome of surgery depends on various factors, including the severity and type of arthritis, as well as the specific surgical technique employed. Generally, surgery can significantly reduce pain and restore normal shoulder function. In Mr Gulihar’s practice, more than 90-95% of patients experience significant improvement in pain and function after this procedure within 6-12 months of surgery. 

Regarding returning to work and driving, individuals with desk jobs may resume work within 1-4 weeks post-surgery, while those with physically demanding jobs may require 2-3 months. Driving can typically be resumed within 4-6 weeks, although these timelines may vary based on individual circumstances and the type of treatment received. It’s important for patients to follow their surgeon’s and physiotherapists’ advice regarding recovery and return to activities.