Acromioclavicular joint disorders
The acromioclavicular joint is formed by the distal clavicle and the acromion. It is held together by a thick capsule. The clavicle is attached to the coracoid process by two strong ligaments. In a fall, these ligaments may be stretched or torn (acromioclavicular joint sprain) and the injury is graded according to its severity (grade I to VI).
When is surgical treatment necessary for a sprained acromioclavicular joint?
Surgery is rarely necessary. The most common types (I and II), although very painful during the first few weeks, respond very well to conservative treatment (rest, ice, physiotherapy, early mobilization). Grade III is the intermediate stage and refers to a complete separation of the clavicle and the acromion as well as ptosis of the entire upper limb. While this seems horrible and unacceptable at first, once the aesthetic deformity is accepted, normal function is almost fully restored (many professional hockey and football players will confirm this). Surgical repair is reserved for certain grade III cases in people who practice high-level activities that require full elevation of the arm (e.g., professional tennis players) or for very rare (extreme) grade IV, V and VI cases. The decision as to whether or not to perform surgery must be made very early, for the success rate of later reconstruction surgery is much lower than that of surgery performed in the acute phase (i.e., within three or four weeks of injury).
Osteoarthritis of the acromioclavicular joint
Is osteoarthritis of the acromioclavicular joint a sign of aging? Not at all. Many people show evidence of degeneration in their thirties, especially if they are very active physically. It is common in weightlifters (with osteolysis) who do bench presses and in people over 50 years of age. Rarely painful, it can be “triggered” by a fall or a strain. In this case, the pain is quite well localized to the top of the shoulder. This is called acute synovitis and will resolve after a few weeks of treatment with standard anti-inflammatories. More refractory cases may require a cortisone injection administered by a professional who is qualified to give this type of infiltration (one of the most difficult to administer).
Surgery for osteoarthritis of the acromioclavicular joint?
Excision of a 1 cm portion of the distal clavicle is performed. In advanced osteoarthritis, the cartilage covering the distal clavicle gradually wears away until it disappears completely, allowing the exposed bone to come into direct contact with the acromion and causing pain. The purpose of resection is to create enough space to prevent bone-to-bone contact, which increases when the arm is crossed over the chest. The newly created space then fills with painless fibrous scar tissue. Bone spurs (osteophytes), which often form over the years, filling the space over the rotator cuff and causing mechanical impingement, are also excised. This procedure can be performed arthroscopically, either alone or in combination with acromioplasty.
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