Acromioclavicular (AC) Joint Arthritis
AC Joint Arthritis leads to pain at the top of the shoulder. Painful AC Joint Arthritis occurs more frequently in laborers and weight-lifters, but is very common in the general population as well. It is important to understand that AC Joint Arthritis is extremely common on X-rays and MRIs. In fact, 90% of people over the age of 30 have apparent AC Joint Arthritis on X-ray and/or MRI. However, seeing some arthritis on X-ray or MRI doesn’t mean that the AC Joint Arthritis is actually causing pain; more commonly, the finding of AC Joint Arthritis on an X-ray or MRI is a ‘red herring’, and not the cause of shoulder pain. The best way to determine if AC Joint Arthritis is actually a source of shoulder pain is by an Upper Extremity or Shoulder Surgeon’s physical examination and a diagnostic injection.
As for other areas, if a steroid injection into the AC Joint relieves part or all of the shoulder pain, even temporarily, then the AC Joint is a ‘pain generator’. Activity modification should also be tried: Weight-lifters can try widening or narrowing their grip on the bar to see if helps. If non-operative treatment doesn’t work, or the steroid injection ‘wears off’, then a decision is made to either live with the pain or to treat the AC Joint surgically.
Surgery for AC Joint Arthritis involves removing a small amount, 5-7 mm, of bone from the outside of the clavicle. This creates a space where the AC joint was so that the two bones of the AC Joint, the acromion and the clavicle, don’t rub together anymore. This is called ‘Distal Clavicle Excision’ or a ‘Mumford Procedure’. A Distal Clavicle Excision can usually be accomplished arthroscopically, except in cases where a bone spur has grown so far outside the joint that an open incision is necessary to remove it.
Arthroscopic Distal Clavicle Excision is usually performed in conjunction with any other necessary arthroscopic shoulder procedures. Arthroscopic Distal Clavicle Excision requires no formal post-operative activity limitations. While the area where the bone was removed from may be sore for a few months, Distal Clavicle Excision usually provides lasting relief from the pain of AC Joint Arthritis. Distal Clavicle Excision is a commonly performed and very successful outpatient procedure that has been performed for decades and has “stood the test of time”.
After surgery, keep the arthroscopy portals (stab wounds) clean and dry for 24 hours. Before 24 hours, bathing is fine; just keep the shoulder above water and don’t get the dressings wet. After 24 hours, the wounds can get wet in the shower, just blot them dry. Don’t submerge the wounds under water until the stitches are removed, which usually occurs at the first post-operative appointment after 2 weeks. The elbow, wrist, forearm and hand can all be moved early on, to prevent stiffness. During Shoulder Arthroscopy, fluid is placed into the shoulder. This fluid will leak out over the first 2-3 days, and is not blood..