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According to large-scale epidemiological research, shoulder pain is the third most common musculoskeletal pain that doctors in primary care are trying to alleviate. In most cases, the culprit is the acromioclavicular joint, located at the top of the shoulder where the clavicle and the highest part of the scapula (acromion) meet. In between lies the fibrocartilage tissue, which acts as a shock-observer and distributes weight-bearing forces, a similar function as that of the meniscus.
The shock-observing properties of the articular joint, as well as the fact that it is consistently under a lot of pressure, even when the shoulder is in a resting position, render it vulnerable and highly prone to injuries. Most patients who visit the orthopedist believe their discomfort is linked to a shoulder injury. This is a common ‘‘misunderstanding’’ due to the contiguity of the joints. According to epidemiological data, in most cases, the patients are suffering from acromioclavicular arthritis– a study published in the journal Current Reviews in Musculoskeletal Medicine in 2008, reported the assessment of MRI scans for asymptomatic diseases in the general population that revealed a 48% to 82% link to osteoarthritis.

All types of arthritis are the result of cartilage lesions and gradual cartilage degeneration that causes friction between the articular surfaces. Subsequently, acromioclavicular arthritis can induce the narrowing of the joint space between the clavicle and the acromion. As a result, added pressure on the rotator cuff tendons can potentially lead to the development of shoulder impingement syndrome.
For individuals over the age of 50, degeneration of the cartilage tissue is age-related and a result of the natural thinning of the joint. However, individuals who participate in sports or perform heavy manual work are also largely affected. Repetitive movements (for example weight lifting or throwing) cause damage to the articular cartilage and stimulate the growth of osteophytes (bone spurs)– in these cases, the patient’s age is not a contributing factor to the development of arthritis since it is also common amongst young athletes. Furthermore, destabilizing injuries caused by joint tears can also lead to the development of this type of arthritis. 

Symptoms of acromioclavicular arthritis include intense pain at the top of the shoulder, which is aggravated during certain movements, for example when lifting the arm over the level of the shoulder, any cross-body movement, or when lifting a heavy object. Sensitivity when pressing the surface of the joint, as well as laying on the side of the injured shoulder, are common symptoms as well.
Diagnosis for acromioclavicular arthritis is possible after clinical examination and the assessment of the patient’s detailed medical history. An engorged joint is a common sign, whereas in cases of prior ligament tears, frequent clavicle dislocation can be another symptom. Using radiographic inspection, the orthopedist can examine the patient for degenerative lesions (osteophytes), and for the narrowing of the joint space. Patients with chronic joint injuries, might also be diagnosed with superior displacement of the distal clavicle. MRI scans can additionally reveal symptoms such as inflammation, fluid and soft tissue deterioration.

The primary treatment for acromioclavicular arthritis is conventional. Rest, reduced load on the acromioclavicular joint and adjusting the patient’s program are recommended by the doctor. Medication with anti-inflammatory drugs can reduce pain, and potential physiotherapy sessions for strengthening the shoulder muscles, are part of the total rehabilitation program.
If the symptoms continue to persist and affect the patient’s quality of life, and in cases of professional athletes that must promptly return to physical activities, surgical reconstruction of the acromioclavicular joint is recommended. The surgical procedure is exclusively performed arthroscopically, through small incisions and by using a camera. The surgeon makes a 5 cm incision on the distal clavicle and removes the osteophytes. The operation aims to increase the joint space and subsequently alleviate the symptoms.
Postoperatively, the joint is suspended for one week. Physiotherapy sessions begin the second week after surgery, in order for the patient to regain range of motion and strengthen the muscles, and it lasts approximately 3 weeks.

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