Review Article

Acromioclavicular Osteoarthritis: A Common Cause of Shoulder Pain

Authors: Travis J. Menge, MD, Robert E. Boykin, MD, Brandon D. Bushnell, MD, MBA, Ian R. Byram, MD

Abstract

Osteoarthritis of the acromioclavicular joint is a frequent cause of shoulder pain and can result in significant debilitation. It is the most common disorder of the acromioclavicular joint and may arise from a number of pathologic processes, including primary (degenerative), posttraumatic, inflammatory, and septic arthritis. Patients often present with nonspecific complaints of pain located in the neck, shoulder, and/or arm, further complicating the clinical picture. A thorough understanding of the pertinent anatomy, disease process, patient history, and physical examination is crucial to making the correct diagnosis and formulating a treatment plan. Initial nonoperative management is aimed at relieving pain and restoring function. Typical treatments include anti-inflammatory medications, physical therapy, and injections. Patients who continue to exhibit symptoms after appropriate nonsurgical treatment may be candidates for operative resection of the distal clavicle through either open or arthroscopic techniques.

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References

1. Depalma AF. Surgical anatomy of acromioclavicular and sternoclavicular joints. Surg Clin North Am 1963;43:1541-1550.
 
2. DePalma AF. The role of the discs of the sternoclavicular and acromioclavicular joints. Clin Orthop 1959;13:7-12.
 
3. Renfree KJ, Riley MK, Wheeler D, et al. Ligamentous anatomy of the distal clavicle. J Shoulder Elbow Surg 2003;12:355-359.
 
4. Fukuda K, Craig EV, An KN, et al. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 1986;68:434-440.
 
5. Stine IA, Vangsness CT Jr. Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthroscopy 2009; 25:968-974.
 
6. Beim GM, Warner JP. Clinical and radiographic evaluation of the acromioclavicular joint. Oper Tech Sports Med 1997;5:65-71.
 
7. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 2007;35:316-329.
 
7a. American Academy of Orthopaedic Surgeons. Arthritis of the shoulder. http://orthoinfo.aaos.org/topic.cfm?topic=A00222. Accessed March 19, 2014.
 
8. DePalma A, Callery G, Bennett GA. Variational anatomy and degenerative lesions of the shoulder joint. Instr Course Lect 1949;6:255-281.
 
9. Horvath F, Kery L. Degenerative deformations of the acromioclavicular joint in the elderly. Arch Gerontol Geriatr 1984;3:259-265.
 
10. Shaffer BS. Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg 1999;7:176-188.
 
11. Bergfeld JA, Andrish JT, Clancy WG. Evaluation of the acromioclavicular joint following first- and second-degree sprains. Am J Sports Med 1978;6:153-159.
 
12. Cadet E, Ahmad CS, Levine WN. The management of acromioclavicular joint osteoarthrosis: debride, resect, or leave it alone. Instr Course Lect 2006;55:75-83.
 
13. Beim GM. Acromioclavicular joint injuries. J Athl Train 2000;35:261-267.
 
14. Burbank KM, Stevenson JH, Czarnecki GR, et al. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician 2008;77:453-460.
 
15. Blankstein A, Amsallem JL, Rubinstein E, et al. Septic arthritis of the acromioclavicular joint. Arch Orthop Trauma Surg 1985;103:417-418.
 
16. Hammel JM, Kwon N. Septic arthritis of the acromioclavicular joint. J Emerg Med 2005;29:425-427.
 
17. Bossert M, Prati C, Bertolini E, et al. Septic arthritis of the acromioclavicular joint. Joint Bone Spine 2010;77:466-469.
 
18. Carey TW, Jackson K, Roure R, et al. Acromioclavicular septic arthritis: a case report of a novel pathogen. Am J Orthop (Belle Mead NJ) 2010; 39:134-136.
 
19. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia) 2012;4:e18.
 
20. Gerber C, Galantay RV, Hersche O. The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space. J Shoulder Elbow Surg 1998;7:352-355.
 
21. Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am 1982;64:1053-1058.
 
22. Scavenius M, Iversen BF. Nontraumatic clavicular osteolysis in weight lifters. Am J Sports Med 1992;20:463-467.
 
23. Iannotti JP. Developing a management algorithm for persistent shoulder pain. Am J Orthop (Belle Mead NJ) 2005;34:4.
 
24. Chronopoulos E, Kim TK, Park HB, et al. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med 2004;32:655-661.
 
25. O’Brien SJ, Pagnani MJ, Fealy S, et al. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 1998;26:610-613.
 
26. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. Analysis of 1,000 cases. Am J Roentgenol Radium Ther Nucl Med 1971; 112:493-506.
 
27. Shubin-Stein BE, Ahmad CS, Pfaff CH, et al. A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients. J Shoulder Elbow Surg 2006;15:56-59.
 
28. Stein BE, Wiater JM, Pfaff HC, et al. Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg 2001;10:204-208.
 
29. Bigliani LU, Nicholson GP, Flatow EL. Arthroscopic resection of the distal clavicle. Orthop Clin North Am 1993;24:133-141.
 
30. Scannell BP, Bushnell BD, Taft TN. Acromioclavicular Injection, in Miller MD, Hart JA, MacKnight JM, (eds).Essential Orthopaedics. Philadelphia, Saunders/Elsevier, 2010, pp 228-230.
 
31. Daley EL, Bajaj S, Bisson LJ, et al. Improving injection accuracy of the elbow, knee, and shoulder: does injection site and imaging make a difference? A systematic review. Am J Sports Med 2011;39:656-662.
 
32. Mall NA, Foley E, Chalmers PN, et al. Degenerative joint disease of the acromioclavicular joint: a review. Am J Sports Med 2013;41:2684-2692.
 
33. Jacob AK, Sallay PI. Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. Biomed Sci Instrum 1997;34:380-385.
 
34. Hossain S, Jacobs LG, Hashmi R. The long-term effectiveness of steroid injections in primary acromioclavicular joint arthritis: a five-year prospective study. J Shoulder Elbow Surg 2008;17:535-538.
 
35. Lemos MJ, Tolo ET. Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries, including instability.Clin Sports Med 2003;22:371-385.
 
36. Brown JN, Roberts SN, Hayes MG, et al. Shoulder pathology associated with symptomatic acromioclavicular joint degeneration. J Shoulder Elbow Surg 2000;93:173-176.
 
37. Mumford E. Acromioclavicular dislocation: a new operative treatment. J Bone Joint Surg Am 1941;23:799-802.
 
38. Gurd FB. The treatment of complete dislocation of the outer end of the clavicle: an hitherto undescribed operation. Ann Surg 1941;113:1094-1098.
 
39. Pensak M, Grumet RC, Slabaugh MA, et al. Open versus arthroscopic distal clavicle resection. Arthroscopy 2010;26:697-704.
 
40. Johnson LL.Arthroscopic Surgery: Principles and Practice. Vol 2, 3rd ed. St Louis, CV Mosby, 1986.
41. Elhassan B, Ozbaydar M, Diller D, et al. Open versus arthroscopic acromioclavicular joint resection: a retrospective comparison study. Arthroscopy 2009;25:1224-1232.
 
42. Freedman BA, Javernick MA, O’Brien FP, et al. Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg 2007;16:413-418.
 
43. Levine WN, Soong M, Ahmad CS, et al. Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches. Arthroscopy 2006;22:516-520.
 
44. Flatow EL, Cordasco FA, Bigliani LU. Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy 1992;8:55-64.
 
45. Strauss EJ, Barker JU, McGill K, et al. The evaluation and management of failed distal clavicle excision. Sports Med Arthrosc 2010;18:213-219.