What are the symptoms?
AC joint osteoarthritis usually causes pain and tenderness at the end of directly over the AC joint over the top of the shoulder. Pain may be made worse when reaching high or across the body and can cause difficulty using the shoulder for everyday activities. Symptoms are usually insidious, without a history of discrete trauma although there may have been an injury in the past.
Will I need any further investigations?
Diagnosis of AC joint osteoarthritis is usually made on examination. X-rays can show narrowing of the joint and bone spurs around the joint, which are signs of degeneration. More specialist tests are not usually required if the diagnosis is clear.
What are the non-surgical treatment options?
Painkillers and anti-inflammatory medication may help reduce pain. Physiotherapy may help to strengthen the rotator cuff muscles and control symptoms. A steroid injection into the affected joint can help reduce inflammation and pain although the effects may only be temporary.
What does surgery involve?
Surgery (arthroscopic excision of the AC joint) may be necessary if other treatments fail. This is a keyhole procedure, performed under general anaesthetic, with or without a nerve block, usually as a day case. Small puncture wounds are made around the shoulder to allow insertion of the arthroscope (camera) and instruments. The AC joint is located and a bone shaver is used to remove a small portion of the end of the clavicle. This leaves a gap to prevent the bone ends from rubbing together.
What is the success of surgery?
Generally, this is a safe and reliable operation to resolve pain and improve shoulder function although full recovery can take several months. One in twenty patients continue to have some discomfort after surgery although significantly milder than pre-operatively.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The risks of the operation include infection, bleeding, nerve damage and incomplete relief of symptoms.
What is the recovery after surgery?
You will have a sling to wear for comfort after the surgery that is usually discarded as your pain settles. You can safely use the shoulder within your comfort zone. Physiotherapy is essential after the operation, to encourage good movement, rehabilitate the muscles back to normal function and ensure you are making good progress. You will see a therapist prior to discharge from the hospital. You will be given painkillers to take home after surgery. The use of an ice pack on the shoulder may also be helpful for the first few days after surgery. You will be seen in clinic two weeks after surgery to check the wounds and assess your progress. There are no sutures to be removed. The pain will gradually settle and you will regain the movement in the shoulder over the next few weeks although it can take several months before you fully recover from the surgery.
When can I return to normal activities?
Return to work depends on the nature of the job and your speed of recovery. You can return to desk and computer work when you feel comfortable to do so but avoid any manual work, heavy lifting or sporting activities for 4-6 weeks. You may return to driving when you feel safe to control the vehicle, which is usually about 10-14 days after surgery.