Fractures, Sprains and Strains

AC Joint Issues

Anatomy

The shoulder is a complex, ball-and-socket joint made up of three bones: the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The ball, or head, of the upper arm bone fits into a rounded socket (glenoid) in the shoulder blade. The arm bone is kept centered in the shoulder socket by a combination of muscles and tendons (rotator cuff). The rotator cuff covers the head of the upper arm bone and attaches it to the shoulder blade.

The AC (acromioclavicular) joint is formed where a portion of the scapula (acromion) and the clavicle meet and are held together by tough tissues (ligaments) that act like tethers to keep the bones in place.

Description

Although many things can happen to the AC joint, the most common conditions are fractures, arthritis and separations. Arthritis in the joint is characterized by a loss of the cartilage that allows bones to move smoothly and is essentially due to wear and tear. Like arthritis in other joints of the body, arthritis of the shoulder often produces pain and swelling, especially with activity. When the AC joint is separated, it means that the ligaments are torn and can no longer keep the clavicle and acromion properly aligned.

Symptoms

Torn or stretched ligaments can be very painful. In an AC separation, the injury to the ligaments can be mild to severe, and pain is usually in direct proportion to the severity of the separation.

Nonsurgical Treatment

AC joint issues often heal with nonsurgical treatment such as immobilization of the arm in a sling, and modification of activities to avoid aggravating the condition. Your physician may also recommend one or more of the following:

• Activity changes—Modify your daily routine to avoid activities that cause or aggravate symptoms.
• Immobilization—Placing the arm in a sling may be recommended to protect the shoulder from excess movement.
• Rest—Modify or discontinue participation in activities that aggravate the condition.
• Ice—Applying ice to the joint several times a day can decrease pain, inflammation and discomfort.
• Nonsteroidal anti-inflammatory medication (NSAIDS)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDS such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be used carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Cortisone (a type of steroid) injection—If other nonsurgical treatments do not bring relief, a cortisone injection (often used for arthritis) may be recommended to reduce inflammation and pain.
• Physical therapy—Your physician or physical therapist may prescribe specific exercises to help you improve strength and flexibility, restore movement, and provide relief from uncomfortable symptoms. Physical therapy is often a key factor in successfully recovering from a wide range of conditions and disorders.

Surgery

Bone spurs (caused by arthritis) must be surgically removed from the AC joint. In the case of severe AC separations, reconstructive surgery is required.

With any surgery there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.