|
Cascade Orthopaedics Practice Newsletter |
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems. Cascade's Website
|
Common acromio-clavicular (AC) joint problems
The acromioclavicular joint connects the clavicle or collarbone with the acromion, which is the top of the scapula (shoulder blade) covering the shoulder joint. Most people have a little bump there, about 1 inch in from the lateral point of the shoulder. This joint moves the most with reaching up overhead or reaching across the body to touch the opposite shoulder. These maneuvers are therefore the most uncomfortable when there is an injury to the AC joint.
|
|
Common Injuries:
The 2 most common injuries that occur at the AC joint include shoulder separations and AC joint inflammation.
Shoulder separations occur when someone falls onto the top of their shoulder. We see this commonly in mountain bikers who fall headfirst over their handlebars and snowboarders who fall onto the point of their shoulders. The ligaments that suspend the scapula or shoulder blade from the clavicle are torn as the scapula is driven inferiorly by the force of the fall coming down onto the top of the shoulder. Characteristically, a bump will develop at the AC joint that is tender. The size of the bump, or the amount of displacement that occurs, depends on the extent of the ligament damage. Mild strains can cause pain, but do not result in any appreciable bump or displacement. Complete ligament ruptures can result in quite a significant bump at the end of the collarbone. Patients typically complain of pain with reaching up overhead or across their bodies. It is also uncomfortable to lie on the injured side as the pressure from lying on the side compresses the AC joint and causes pain.
The vast majority of separations are treated with a "wait and see" approach. Although the bump will never go away, the pain typically resolves completely within about 6 weeks and the vast majority of people can do all normal activities without discomfort. We will recommend using a sling for comfort as needed and slowly progress to use of the shoulder as tolerated.
Some people will have persistent pain at the separated joint. This is seen most commonly in people doing heavier manual labor and in people who do a lot of overhead sports activities. If the AC joint becomes symptomatic, there are a variety of surgical procedures that can reconstruct or replace the ligaments that are torn and therefore eliminate the bump and stabilize the joint. Essentially, the same procedure is performed whether the surgery is done 2 months after injury or 2 years after injury. Therefore, there is no penalty to taking a "wait and see" approach towards the separations. If the separated AC joint is not painful, a patient who chooses surgery is just trading a bump for a scar and oftentimes a scar is more noticeable.
The other most common problem that occurs at the AC joint involves inflammation and pain in the joint. Most people develop some wear changes (arthritis) in the joint over time but, in the vast majority of people, these are asymptomatic. However, sometimes an injury to the AC joint can turn on an inflammatory process that becomes painful. These injuries usually involve some sort of lateral blow to the shoulder or a sudden straining injury to the shoulder joint, such as when someone is falling and braces themselves suddenly. The joint can also become inflamed in people who do a lot of bench press or military press weightlifting activities. Although a small bump can develop in these patients, in general, their problem is more one of pain at the AC joint rather than the development of a bump. An inflamed AC joint hurts when one lies on that side, when one reaches up overhead, or one when one reaches across the body to the other side. It can also click and be painful when lifting heavier weights. The pain, however, is always felt right at the AC joint and not around the rest of the shoulder. There is a little cartilaginous disc in the AC joint between the ends of the 2 bones and it is sometimes broken or cracked in the course of these injuries. Sometimes the bone ends themselves can be pitted or worn with little cysts in the bone. These can be seen on x-ray, and will often cause little clicks or pops that are felt with raising or rotating the arm.
Treatment:
Like most musculoskeletal strains, AC joint inflammation will sometimes resolve on their own. It is important to avoid aggravating activities and be patient. Nonsteroidal anti-inflammatory medications such as ibuprofen and Aleve are appropriate initial treatments. If pain persists, a physician can inject the AC joint with some numbing medicine (lidocaine), and see if this takes away the pain with the provocative maneuvers. If the pain is relieved with lidocaine in the AC joint, then one knows with certainty that the joint is the source of the pain. In this situation we often recommend injecting a corticosteroid into the joint in an attempt to quiet it down. This is often effective for a significant period of time. If the problem recurs, another corticosteroid injection can be done. We usually don't recommend more than 3 injections in a six-month period.
If the pain persists for more than 6-9 months despite appropriate treatment, then consideration can be given to a surgical procedure. Essentially, we resect or cut away between 8 and 10 mm of the end of the clavicle to open up the space between the bones so that they are not bumping against each other anymore. The space then fills in with scar tissue that acts as a bumper between the bone ends. This can be done either arthroscopically through little poke holes or more traditionally through a small 1 inch incision across the top of the joint. It usually takes about 4 months for complete recovery from a surgical procedure with the patient using the arm as tolerated during that time. The hope is that the AC joint inflammation will burn out on its own without needing surgery.
During the treatment of an inflamed AC joint patients are advised to do activities as tolerated and avoid specific motions or activities that make the joint sore. Because the problem is in the joint itself, there really are not any specific exercises that can be done to help the joint. Although, as people with AC joint inflammation and pain often have a deconditioned shoulder, we will often recommend some gentle rotator cuff strengthening exercises be done during the recovery period.
It is important to realize that there are many components to the shoulder. It is a complicated joint. Although rotator cuff tendinitis and bursitis are common, the AC joint is an often overlooked source of shoulder pain. By paying attention to where the pain is and what makes it better and worse, patients can often help us pinpoint the source of their problems and thus recommend the most appropriate treatment.
If you think you may have this condition and wish to be assessed, one of our surgeons would be happy to see you. Please call Cascade Orthopaedics at 253-833-7750 to make an appointment.
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice.
|
