American Shoulder and Elbow Surgeons
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A 31-year-old professional bodybuilder reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint. Based on the radiograph shown in Figure A, which treatment is likely to provide the most successful result?
Glenohumeral joint injection
Periscapular muscle strengthening
Arthroscopic resection of the distal clavicle
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Osteolysis of the distal clavicle is one cause of shoulder pain that can occur after acute injury or repetitive microtrauma. It is more common in weight-lifters. Open resection of the distal clavicle has been shown to be a reliable treatment for isolated painful acromioclavicular (AC) joint pathology refractory to nonoperative treatment. Arthroscopic resection of the distal clavicle has been reported to provide pain relief and allow a return to function comparable to open techniques. The arthroscopic approach offers the advantages of decreased morbidity, with fewer postoperative restrictions on motion, earlier return to normal activity, and improved cosmesis.
In a study of arthroscopic distal clavicle excision by Zawadsky et al., 22 shoulders had excellent results, 16 had good results, and 3 were failures at an average follow-up of 6 years. All 3 failures occurred in patients with a traumatic etiology.
The Auge paper reports faster return to sport in a series of 10 weightlifters treated with a more limited arthroscopic resection than is usually advocated.
Auge WK 2nd, Fischer RA.
Am J Sports Med. 1998 Mar-Apr;26(2):189-92. PMID: 9548111 (Link to Abstract)
Auge, AJSM 1998
Zawadsky M, Marra G, Wiater JM, Levine WN, Pollock RG, Flatow EL, Bigliani LU
Arthroscopy. 2000 Sep;16(6):600-5. PMID: 10976120 (Link to Abstract)
Zawadsky, ASCOPY 2000
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The AC joint (acromioclavicular joint) only moves 10-15 degrees throughout the e...