Causes and Treatment of A/C Joint Arthritis

The ends of the bones of the acromion and the clavicle are covered with a layer of surface cartilage that helps the ends of the two bones slide smoothly on each other. This cartilage is important for maintaining the normal and full range of motion of the shoulder.

Arthritis of the A/C joint occurs as the surface cartilage starts to wear out. When it  becomes rough and the bones do not slide smoothly, the joint can become painful and swollen. Arthritis of the A/C joint is usually more painful with activity, especially ones that require a lot of overhead work. As a result of the arthritis, bone spurs develop on the ends of the acromion and clavicle and are the most reliable sign that the joint has become arthritic.

The treatment of A/C joint arthritis is designed to manage the symptoms of pain and discomfort. There is currently no way to replace the cartilage inside an A/C joint once it has worn out. So reducing the amount of aggravation and irritation of the joint is the best way to treat the arthritis at first. This is accomplished by avoiding activities that are particularly aggravating to the joint. 

Two other very useful ways to treat A/C joint arthritis are ice and medications that decrease inflammation. Placing ice over the joint after athletic activities or when the joint is sore can get rid of a lot of pain and discomfort. This can be done as often as needed. Anti-inflammatory medications, such as aspirin and ibuprofen, are also a very effective way to decrease shoulder pain and soreness. 

If, after a reasonable time, ice and anti-inflammatories still do not work, a cortisone shot may be used.

This injection combines an anesthetic agent with the strong anti-inflammatory effects of a steroid called cortisone. Sometimes a single shot can take care of the pain and swelling forever. Unfortunately, it is impossible to predict how long the effects of the medication will last. If after two or three injections the pain still exists, it is likely hat surgery will be required.

The source of the shoulder pain can be eliminated surgically by removing the tip of the clavicle. The A/C joint functions very well even if the ends of the bone do not come in direct contact with each other. This type of surgery, a distal clavicle resection, can be done either through a small incision over the tip of the clavicle or with several small incisions using an arthroscope.

The amount of pain after the operation is minimal with both techniques, and the recovery from the operation is also very similar. Nearly 95 percent of patients return to the same sports and activities they were doing before they were injured.

Causes and Treatment of A/C Joint Separations

A direct blow to the shoulder can separate the A/C joint and cause a lot of pain. This injury most commonly occurs in sports, such as like football, rugby, and ice hockey, when an athlete falls and hits the ground with the tip of the shoulder.

When the A/C joint is separated, the capsule and ligaments that surround the joint have been torn and the ends of the acromion or the clavicle are not in the proper position. In type I injuries, the capsule and ligaments of the A/C joint have been sprained but not completely torn. In type II injuries, the acromio-clavicular ligaments have been completely torn, but another ligament between the clavicle and a part of the scapula called the coracoid process (the coraco-clavicular ligament) is still intact. In type III injuries, both of these ligaments have been completely torn. 

Acromio-clavicular separations can be very painful, especially right after the injury. However, the good news is that most of these injuries can be treated without surgery.

The first goal of treatment is to make the patient comfortable by placing the arm in a sling and applying an ice pack to the shoulder. Mild pain medications are all that should be required to take away most of the shoulder pain.

Over the first week or so, the shoulder pain will start to fade.  and it is important to start moving the entire arm and shoulder as much as possible in order to prevent the joints from becoming stiff. The amount of time it takes to get back normal motion and use of the arm depends upon how severe the injury was. As a general guideline, a type I injury takes as many as 14 days to heal before the shoulder can be used without a lot of pain. A type III injury can take six and eight weeks, while a type II injury should heal somewhere in between.

More than 95 percent of A/C separations are treated in this manner. Some type III injuries may create a  bump by the tip of the clavicle that is often noticeable. For serious athletes, especially those who are throwing athletes, like baseball pitchers, or people who make their living doing very hard manual labor, surgery may be required.

Rarely, the clavicle will be so far out of place that it will feel very uncomfortable or unstable, even after the injury has completely healed. In these cases, surgery is recommended to bring the joint back into proper alignment.

Broken collarbone - broken clavicle

The collarbone, or clavicle, is an S-shaped bone that connects the shoulder to the breastplate, or sternum. Very near the skin, the clavicle can be seen and felt very easily in most people. The clavicle is designed to support the shoulder, acting like a strut that helps to align the shoulder with the rest of the chest.

This common injury occurs when a person falls onto an outstretched hand or onto the point of their shoulder. It is easy to tell when the bone in broken because a cracking sound can be heard, there is a lot of pain at the site of the fracture and the swelling and the bruising can easily be seen.

More than 85 percent of clavicle fractures occur in the middle of the bone. This type of fracture rarely ever needs surgery, except in special circumstances. The bone is allowed to heal on its own. Patients wear a sling for two weeks, apply ice and take mild pain medication to ease the pain and discomfort.

The younger you are when you break your clavicle, the less time it takes for the fracture to heal. Children will heal in 3 to 4 weeks, teenagers 6 to 8 weeks and adults 3 to 4 months. More than 95 percent of clavicle fractures will eventually heal on their own, without requiring surgery.

Nearly all clavicle fractures heal with a noticeable bump under the skin in the area where the bone was broken. While many people do not like the way the bump looks, tit rarely causes pain or discomfort. Those who commonly carry heavy backpacks may have problems with the shoulder straps irritating the skin. Other than that, it is rare to have long-lasting problems after a broken clavicle has healed.

There are certain circumstances in which fractures of the clavicle may need to be treated with surgery. One is an open fracture, where the ends of the bone have come out through the skin. Another is a special type of break that heals so slowly that surgery is often preferred. And sometimes the bones may grow back together on their own and realignment with a plate and screws is necessary.

These injuries occur approximately 10 percent of the time.