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Acromio-Clavicular Joint (ACJ) Osteoarthritis

What?

The Acromio- clavicular Joint 'Collar bone Joint' is where your collar bone meets you shoulder blade.

 

Why?

The principal cause of AC joint arthritis is use. As you uses your arm, stress is placed on the joint, particularly over head heavy lifting. This stress produces wear and tear on the cartilage and eventually arthritis of the joint may occur. In some instances you may get arthritis from a previous injury to the AC Joint.

Who?

Generally AC joint arthritis is age related and the incidence of pain in this area increases in people over 40 years. Acromioclavicular joint (ACJ) disease is reported to be present in 31% of all patients with shoulder pain. Most of the time arthritic changes go on silently without producing any symptoms despite x rays showing arthritic changes.

How?

Arthroscopic surgery to shoulder or Knee surgery.jpg

DIAGNOSIS:

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AC joint arthritis is diagnosed clinically (by asking you about your symptoms and examining your shoulder) either by your GP, an experienced Physiotherapist or your Shoulder surgeon.  

Classically you will have pain on raising your arms sideways above 90 degrees or putting you arm across your chest to the other shoulder. You may also have pain putting your arms behind your back. 

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TREATMENT:

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Universally the first line treatment after a correct diagnosis has been made is non- operative with physiotherapy, pain killers and a cortisone (Steroid injection)  into the AC joint. This will reduce the inflammation and pain so that you can do your physiotherapy exercises.

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Surgery is only considered in patients who's symptoms fail to improve after a minimum of  3-4 months of treatment.

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The procedure to help treat persistent shoulder pain caused by AC joint arthritis  is an arthroscopic  (Key hole)  AC joint excision. In simple terms this means using a camera and a shaver to clear the inflammation and increase the space in the joint to stop the two ends of bone from rubbing. If you have bony spurs present these are also removed to prevent it from rubbing on the rotator cuff tendon.

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Me?

TREATMENT OPTIONS:

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The decision to undergo an Arthroscopic Acromio-Clavicular Joint (ACJ) excision is yours and my duty as your surgeon is to help guide you. My general guidance to patients is an AC Joint excision is considered once you have failed to improve with non- operative treatment measures which include at least one cortisone/ steroid injection, physiotherapy and pain killers.

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The outcomes of  arthroscopic AC Joint excision surgery are good and generally 90% of patients improve by 6 months, 

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ACJ excision is performed whilst you under a general anaesthetic which will be performed a Consultant anesthetist. You will also be offered a intrascalene nerve block to help with pain. In some circumstances the surgery can be performed whilst you are awake under a nerve block.

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General anaesthesia is very safe but still carries a small risk  (<1%) of Heart Attack, Stroke, Deep Vein Thrombosis, Pulmonary embolism. It is important to have all details of your medications and past medical history so you can be optimised for surgery and these risks can be assessed individually. 

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It is important that you understand the risk of surgery which are outlines below:

 

  • Infection (<1%)

  • Nerve & Vessel damage (<1%)

  • Persistent pain 5%

  • Re-tear/ Failure 

  • Stiffness/ Frozen shoulder (5%)

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Help?

How long do I wear a polysling after my operation?

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You should wean your self off the polyling after 48 hours and ideally discontinued by 7 days. Pendular exercised will be shown to you and these should start as soon as pain allows.

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Is it normal for my shoulder to be swollen & wound to leak fluid?

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You will notice that after surgery that your shoulder has a bulky padded dressing. This is designed to absorb excess fluid from the arthroscopy (Saline is pumped into your shoulder to allow visualisation) for 24 hours and then can be taken off. Your shoulder will appear swollen which is very normal and this will reduce over a few days. Leaking fluid from your key hole wounds will be blood tinged but not frank blood. 

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Can I get my dressings wet?

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For the first 7 days you must keep your dressings/ wounds dry. 

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When Can I start driving?

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It  is  illegal  to drive while wearing  a sling.  You may  start  to drive once  the sling  has  been discarded  but  not  until  you can safely  control  the vehicle.  This  is  normally  between 1- 2  weeks  after  the operation.  It  is  advisable to start  with short  journeys.

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When can I go back to work?

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This  will  depend on the  type of  work  you do  and the  extent  of  the surgery.  If  you have a non-manual job and do not need to drive you may  be  able  to return within 2 weeks.  If  you have a heavy  lifting  job or  one with sustained  overhead arm  movement  you may  require  6 or more weeks off.  

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How am I Likely to progress?

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It is important to recognise that improvement is slow and that this is not a quick fix operation. By 3 weeks after operation you will not have noticed much improvement. However, you should have recovered nearly full movement. Getting your hand up your back usually takes a little longer. By 3 months after the operation most people have noticed improvement in their symptoms. Everything continues to improve slowly and by 9 to 12 months after the operation your shoulder should be back to normal / feeling like the other shoulder. 

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Is it normal for my AC joint to 'click'  on moving my shoulder after the operation?

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It is not uncommon for the AC  joint to feel 'Clicky' after surgery. This newly created gap slowly fills in with scar tissue. The consistency of the scar tissue changes with time. For the first few months it is thin and weak, therefore, the bone ends can still move about. However, the scar tissue eventually stiffens to hold the bone ends in alignment and prevents them clashing, effectively acting as a new joint.   

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When can I resume recreational activities?

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 Timings for returning to functional activities are approximate and will differ depending upon the individual. However, the earliest that these activities may commence are:

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  • Driving:  2-3 weeks or when safe.

  • Lifting:   As able.

  • Swimming:  Breast stroke at 2 - 3 weeks, freestyle when able.

  • Return to work:

        Light work (no lifting) 10 days - 6 weeks. 

        Medium work (light lifting below shoulder level) from 6 weeks

        Heavy work (above shoulder height ) 3 - 6 months.

  • Golf: 6 weeks (but not driving range).

  • Racquet sports: Sport specific training when comfortable

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