Acromioclavicular Arthritis
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Top Contributors - Manisha Shrestha, Lucinda hampton, Kim Jackson and Jacob Bischoff
Introduction[edit | edit source]
Osteoarthritis is the most common cause of shoulder pain originating from the acromioclavicular (AC) joint. It is a frequent finding in middle-aged people.[1] Most of the patients are asymptomatic, and they may present as an incidental finding in shoulder X-Ray or Magnetic resonance imaging (MRI). Patients may present with complaints of pain over the joint while doing overhead and cross-body activities.[2] AC joint arthritis is caused due to early degeneration of the cartilage and intraarticular disc.
Arthritis is often associated with distal clavicular osteolysis.[3] Damage to the ACJ can be synchronous with damage to the supraspinatus tendon and osteophytes from the arthritic joint may contribute to subacromial impingement exacerbating and producing further shoulder pain.[3]
Clinically Relevant Anatomy[edit | edit source]
To learn about Acromioclavicular joint.
Epidemiology[edit | edit source]
The incidence of ACJ pain is reported to be between 0.5 to 2.9/1000/year in primary care.[3]
Etiology[edit | edit source]
Type of AC joint arthritis: based on the etiology
- Primary osteoarthritis: It is articular degeneration without any apparent underlying cause. It more commonly affects the AC joint than a glenohumeral joint. It develops as a consequence of constant stress on the joints, often in people who perform repeated overhead lifting activities.
- Secondary osteoarthritis: It is due to other associated causes like post-trauma or other underlying diseases such as rheumatoid arthritis. Post-traumatic AC joint arthritis is even more prevalent due to the high incidence of injury to the joint. Arthritic symptoms have been demonstrated in Grade I and II sprains of the AC joint in 8% and 42% of patients, respectively.[1]
Diagnosis[edit | edit source]
Accurate diagnosis and localization of pathology to the AC joint is vital in determining the correct treatment protocol in order to avoid persistent shoulder pain.
History[edit | edit source]
- history of trauma: direct impact on the joint or a fall on an outstretched arm.
On examination[edit | edit source]
- AC joint may be tender to palpation.
- Pain elicited by the motion of forward flexion to 90° with horizontal adduction (cross-over test) or straight-ahead pushing (as in the bench press exercise).[1]
- The most sensitive tests for ACJ pain are acromioclavicular point tenderness and the Paxinos test.
Differential Diagnosis[edit | edit source]
- Calcific tendonitis
- Glenohumeral arthritis
- Adhesive capsulitis
- Rotator cuff impingement syndrome[1]
Management[edit | edit source]
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Docimo S, Kornitsky D, Futterman B, Elkowitz DE. Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Current Reviews in Musculoskeletal Medicine. 2008 Jun 1;1(2):154-60.
- ↑ Vaishya R, Damor V, Agarwal AK, Vijay V. Acromioclavicular arthritis: A review. Journal of arthroscopy and joint surgery. 2018 May 1;5(2):133-8.
- ↑ 3.0 3.1 3.2 Chaudhury S, Bavan L, Rupani N, Mouyis K, Kulkarni R, Rangan A, Rees J. Managing acromio-clavicular joint pain: a scoping review. Shoulder & Elbow. 2018 Jan;10(1):4-14.
