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Osteoarthritis of acromioclavicular joint — Clinical Guidelines

Overview

Osteoarthritis of the acromioclavicular (AC) joint involves degenerative changes leading to pain and functional impairment in the shoulder girdle, often exacerbated by trauma or repetitive stress. 5 8

Diagnosis

Clinical Presentation: Shoulder pain, particularly with overhead activities.

Radiographic Evaluation: X-rays often reveal joint space narrowing, osteophytes, and subchondral cysts. 13

Grading: Not specifically detailed in provided abstracts; typically assessed based on severity of symptoms and imaging findings.

Comorbid Lesions: Prevalence of associated glenohumeral pathologies in severe AC joint injuries (Rockwood III and V) should be considered 3 7.

Management

Nonoperative Treatment: Initial management includes physical therapy, activity modification, and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. 8

Surgical Options:

- Distal Clavicle Excision: Open or arthroscopic excision is common for refractory cases. 9 12 - Arthroscopic Techniques: Mumford procedure shows significant improvement in pain relief 12.

Complication Awareness: Monitor for complications such as retained lateral clavicular spikes requiring additional surgery 12.

Special Populations

Elderly: Higher incidence of degenerative changes noted, emphasizing the importance of conservative management initially 15.

Comorbidities: No specific guidelines provided in abstracts; individualized treatment plans are recommended considering overall health status.

Key Recommendations

Initial Management with NSAIDs and Physical Therapy for symptomatic relief (Evidence: Moderate 8).

Consider Surgical Intervention such as distal clavicle excision for persistent symptoms unresponsive to conservative treatment (Evidence: Moderate 9 12).

Evaluate for Concomitant Glenohumeral Pathologies in patients with severe AC joint injuries (Rockwood III and V) to guide comprehensive treatment plans (Evidence: Moderate 3 7).

References

1 Ruiz Ibán MA, Sarasquete J, Gil de Rozas M, Costa P, Tovío JD, Carpinteiro E et al.. Low prevalence of relevant associated articular lesions in patients with acute III-VI acromioclavicular joint injuries. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2019. link 2 Amirtharaj MJ, Wang D, McGraw MH, Camp CL, Degen RA, Dines DM et al.. Trends in the Surgical Management of Acromioclavicular Joint Arthritis Among Board-Eligible US Orthopaedic Surgeons. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2018. link 3 Jensen G, Millett PJ, Tahal DS, Al Ibadi M, Lill H, Katthagen JC. Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries. International orthopaedics 2017. link 4 Triantafyllopoulos IK, Lampropoulou-Adamidou K, Schizas NP, Karadimas EV. Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: an anatomic ligament reconstruction with synthetic implant augmentation. Journal of shoulder and elbow surgery 2017. link 5 Mcdonald S, Hopper MA. Acromioclavicular joint disease. Seminars in musculoskeletal radiology 2015. link 6 Pifer M, Ashfaq K, Maerz T, Jackson A, Baker K, Anderson K. Intra- and interdisciplinary agreement in the rating of acromioclavicular joint dislocations. The Physician and sportsmedicine 2013. link 7 Pauly S, Gerhardt C, Haas NP, Scheibel M. Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2009. link 8 Petron DJ, Hanson RW. Acromioclavicular joint disorders. Current sports medicine reports 2007. link 9 Rabalais RD, McCarty E. Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review. Clinical orthopaedics and related research 2007. link 10 Mehrberg RD, Lobel SM, Gibson WK. Disorders of the acromioclavicular joint. Physical medicine and rehabilitation clinics of North America 2004. link 11 Boehm TD, Kenn W, Matzer M, Gohlke F. Ultrasonographic appearance of os acromiale. Ultraschall in der Medizin (Stuttgart, Germany : 1980) 2003. link 12 Lesko PD. Variation of the arthroscopic Mumford procedure for resecting the distal clavicle. Journal of the Southern Orthopaedic Association 2001. link 13 Edelson JG. Patterns of degenerative change in the acromioclavicular joint. The Journal of bone and joint surgery. British volume 1996. link 14 Gartsman GM. Extra-articular uses of the arthroscope--acromioclavicular arthroplasty. Clinics in sports medicine 1993. link 15 Horváth F, Kéry L. Degenerative deformations of the acromioclavicular joint in the elderly. Archives of gerontology and geriatrics 1984. link90027-x)

Osteoarthritis of acromioclavicular joint