Acromioclavicular Joint (ACJ) Pain/Arthritis

Have you been experiencing pain on the top of your shoulder?

Acromioclavicular Joint Pain Treatment

Does it hurt to put your hand up above your head or bring your arm across your chest (e.g. when putting on underarm deodorant)?
Perhaps you’ve had pain when pressing overhead in the gym, or doing press ups?
If so, you may be experiencing a problem with your acromioclavicular (AC) joint.

Have you been experiencing pain on the top of your shoulder?

The AC Joint is where the ends of two bones come together – your collar bone (aka clavicle) and the acromion (bony projection coming off your shoulder blade). You can feel it as little bump just in from the outer edge of your shoulder (think the epaulette area on a soldier’s uniform).

AC Joint pain can be really frustrating; it can interfere with your sleep, stop you being able to serve in tennis, or bench press in the gym.

What causes Acromioclavicular
Joint (ACJ) pain?

Although sometimes the source of the problem may be that you injured it during a fall, more often than not, it arrives gradually, as part of a wear and tear process, or because you’re excessively loading the joint. Sometimes if you’re lifting incorrectly, have poor muscle control around our shoulder girdle, or a stiff thoracic spine, the AC Joint has to take up the strain unfairly.

How is (ACJ) Acromioclavicular Joint pain assessed?

In clinic, I’ll ask you lots of questions about how your pain is affecting you, what kinds of activities are important to you, and questions relating to your sport and technique in the gym.

I’ll examine you, watching how you move, and looking at which movement and positions are uncomfortable or difficult.

To assess your shoulder further, I may recommend that we carry out an X-Ray or an MRI or ultrasound scan.

How is (ACJ) Acromioclavicular Joint pain treated?

Sometimes our assessment will show that there is inflammation within the joint or wear and tear arthritis.  We always want to try to treat this conservatively if possible, and so in the first instance, I may recommend an ultrasound-guided corticosteroid injection, and rehabilitation with a specialist shoulder physiotherapist or osteopath. You may need to adapt what you are doing in the gym or your sport, whilst we get your shoulder settled.

Acromioclavicular Joint (ACJ) Excision Surgery

Sometimes, despite physio and injection, pain may persist. If you have a very worn joint that repeatedly becomes inflamed and prevents you comfortably doing the activities you love, it may be time to consider surgery.  AC Joint surgery aims to remove the painful joint surfaces. Where possible I try to use a keyhole approach, however, in some cases, there is too much bone at the top of the joint to remove completely with keyhole. In those cases, I find a small incision, on the top of the shoulder gives the best outcome.  It’s a day case procedure under a light general anaesthetic, and the recovery is swift; for instance, if you’re a golfer, you could reasonably hope to be back on the driving range at 6-8 weeks.

Jogging or running is probably achievable at around six weeks, and lifting in the gym may take 8-12 weeks, loading up gradually.

Post surgery FAQ

Make sure that your hand is above the level of your elbow, so that your arm is completely relaxed in the sling.

Yes.

Lying flat can be painful, so try propping yourself up on several pillows.

You can sit on a stationary bike straight away (as long as you keep your arm in your sling). You’ll be given more detailed instructions about other activities, when you are seen in clinic.

My secretary will arrange a follow up appointment approximately 10 days after surgery. At this appointment, I’ll remove your dressings, and check that the wound is OK. If you’ve had surgery for a fracture or joint replacement, we may need take an X-ray.

For the first three to four days, don’t wait for the pain to kick in, take them regularly (even if you’re not feeling pain – we want to keep it at bay).

Yes, unless you’ve had surgery for a frozen shoulder, or shoulder impingement surgery – in which case, you can take it in and out, as comfort allows.

Avoid baths until the dressings have been removed – typically at 10 days. Your wounds will have waterproof dressings on, so it’s ok to take a shower. It’s really important to keep your arm pits clean – so have a good scrub with a flannel!

It’s important to use the keyboard with your forearms supported on the desk. Wait till you’re comfortable and don’t overdo it?

Don’t rush back to work; try to take off at least a week.

Ms Susan Alexander is recognised by all the UK’s major insurers