AC Arthritis

Author: David Abbasi

Topic updated on 01/20/13 10:24am

Introduction

AC joint arthritis is caused by transmission of large loads through a small contact area
- process may be caused or accelerated through AC separations
Epidemiology
- more common with age but can occur by second decade of life
- commonly associated with individuals who engage in constant heavy overhead activities
  - especially in weight-lifters and overhead throwing athletes
Associated conditions
- distal clavicle osteolysis

Anatomy

Acromioclavicular Joint Anatomy
Diarthrodial joint
- articulates scapula to clavicle
- contains a fibrocarilaginous disk
Ligaments
- AC ligaments
  - provide anterior-posterior stability
    - posterior and superior AC ligaments most important for stability
- Coracoclavicular ligaments
  - provide superior-inferior stability

Presentation

History
- activity related pain
  - with overhead activity
  - with arm adduction
Physical exam
- pain with direct palpation of AC joint
- pain with cross body adduction test

Imaging

Radiographs
- best evaluated using Zanca view (15 degree cephalic tilt)
  - can show osteophytes and joint space narrowing
  - distal clavicle osteolysis
  - imaging findings do not always correlate with patient symptoms
MRI
- increased signal and edema in AC joint

Treatment

Nonoperative
- activity modification and physical therapy
  - indications
    - indicated as a first line of treatment
  - technique
    - therpay should focus on strengthening and stretching of shoulder girdle
- AC joint injection with corticosteroids
  - can be both a diagnostic and therapeutic modality
Operative
- arthroscopic vs open distal clavicle resection (Mumford procedure)
  - indications
    - severe symptoms that have failed nonoperative treatment
  - outcomes
    - open vs. arthroscopic based on surgeon preference and comfort
      - arthroscopic resection has the advantage of allowing evaluation of the glenohumeral joint
      - open procedures require meticulous repair of deltoid-trapezial fascia

Techniques

Arthroscopic distal clavicle resection
- should resect only 0.5-1cm of distal clavicle

Complications

AC joint instability
- anterior-posterior instability
  - can be due to aggressive surgical distal clavicle resection (>1-1.5cm)
  - due to aggressive debridement sacrificing posterior and superior AC ligaments
- superior-posterior instability
  - usually iatrogenic due to aggressive surgical resection compromising coracoclavicular ligaments
Continued pain after surgery
- most commonly due to failure of posterior-superior resection of distal clavicle
Heterotopic ossification
Deltoid dehiscence
- due to inadequate deltoid-trapezial junction repair in open surgery

Please Rate Educational Value!

3.0

Average 3.0 of 3 Ratings

Qbank (0 Questions)

TAG

(SBQ07.12) Your partner performs distal clavicle excisions through an open approach while you prefer to use an arthroscopic approach. He notes that the literature shows both techniques have similar results with the exception of which of the following benefits of an arthroscopic approach? Topic

Review Topic

1. Ability to evaluate the glenohumeral joint
2. Preservation of the coracoclavicular ligaments
3. Preservation of the inferior acromioclavicular ligaments
4. Lower complication rate
5. Decreased surgical time

PREFERRED RESPONSE ▶

DISCUSSION: The diagnostic arthroscopy is felt to be helpful in confirming the diagnosis and identifying other pathology.

Berg et al. reviewed failures of open distal clavicle excision and found that 15 patients had a missed SLAP lesion. Fewer complications, lower infection rate, and decreased surgical time have not been documented in the literature.

Lemos & Tolo reviewed complications resulting from treatment of AC joint pathology. The open technique can often miss other underlying pathology, such as rotator cuff and labral pathology, that may be associated with degenerative changes of the acromioclavicular joint. Therefore, they recommend that even if an open distal clavicle excision is the treatment of choice, an arthroscopic evaluation of the glenohumeral joint be performed at the same time.

REFERENCES:

1. Berg EE, Ciullo JV: The SLAP lesion: A cause of failure after distal clavicle resection. Arthroscopy 1997;13:85-89. PMID:9043609 (Link to Abstract)

2. Lemos MJ, Tolo ET: Complications of the treatment of acromioclavicular and sternoclavicular joint injuries, including instability. Clin Sports Med 2003;22:371-385. PMID:12825537 (Link to Abstract)

Question Authors:

Patrick McCulloch MD, Ben Taylor MD, John Badylak MD,

Please Rate Educational Value!

2.0

Average 2.0 of 4 Ratings

Videos

Mumford procedure- distal clavicle resection

Sports - Surgical Techniques - AC Arthritis

Arthroscopic Mumford procedure shows distal clavicle resection

1/20/2013

80 views

See More Videos

Groups

ABOS II: AC Arthritis

General - Oral Boards Review

7/29/2011

2 responses

See More Groups

Evidence & References Show References

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012

Undefined

Berg EE, Ciullo JV: The SLAP lesion: A cause of failure after distal clavicle resection. Arthroscopy 1997;13:85-89. PMID:9043609 (Link to Abstract)
Lemos MJ, Tolo ET: Complications of the treatment of acromioclavicular and sternoclavicular joint injuries, including instability. Clin Sports Med 2003;22:371-385. PMID:12825537 (Link to Abstract)

Topic Comments

Subscribe status: On Off

Recent on Bottom | Recent on Top

Page:1