Arthritis of the A/C joint happens as the surface cartilage starts to wear out. When the layer of surface cartilage becomes rough and the bones do not slide smoothly on each other, the joint can become painful and swollen. Arthritis of the A/C joint is usually more painful with activity, especially ones that require a lot of overhead work. A/C joint arthritis is especially common in weight lifters because the bench press and military press put a lot of strain on the joint. As a result of the arthritis, bone spurs develop on the ends of the acromion and clavicle, and these bone spurs can be seen on an X-ray. Bone spurs are the most reliable sign that the joint has become arthritic.
How is A/C joint arthritis treated?
The treatment of A/C joint arthritis is designed to manage the symptoms of shoulder pain and discomfort that come from the A/C joint. These symptoms can be managed, but the cause of the arthritis cannot be cured. This discussion will first explain how arthritis of the A/C joint is treated without surgery, and then what kind of surgery is done if the A/C joint continues to be painful.
First things first: ice and anti-inflammatory medications
The wear and tear on the cartilage in our joints is a natural part of life. Unfortunately, in spite of an incredible amount of scientific research, there is currently not any way to replace the cartilage inside an A/C joint once it has worn out. As a result, reducing the amount of aggravation and irritation of the joint is the best way to treat arthritis at first. This can be accomplished by avoiding the activities that are particularly aggravating to the joint. In the case of A/C joint arthritis, this may involve changing the way in which you train. For instance, weight lifters will often have to switch from the bench press to butterfly curls, and will need to avoid doing the military press. Your physical therapist will be able to suggest ways in which you can modify your own training program in order to reduce the symptoms of A/C joint arthritis.
The other two very useful ways to treat A/C joint arthritis are ice and medications that decrease inflammation. Placing an ice pack over the joint, or rubbing an ice-cube over the joint after athletic activities or when the joint is sore can get rid of a lot of pain and discomfort. Ice is a wonderful way to decrease the amount of pain and inflammation from any type of injury, and it can be done as often as you like.
Anti-inflammatory medications are also a very effective way to decrease shoulder pain and soreness. Some common examples of these types of medications are aspirin, ibuprofen (which is sold as Advil® or Motrin®), Naprosyn® (Aleve®), Feldene®, Clinoril®, Daypro®, and many others. Many of these medications are available without a prescription and they are generally very safe medications to take. If you have a history of having any type of stomach problems, or frequently get an upset stomach after taking anti-inflammatories, then you should consult with your doctor before taking any of these medications.
What happens if this doesn't work?
If you have tried all of these methods for a reasonable amount of time, and yet you still have a lot of pain and soreness in the A/C joint, your doctor will probably offer you a cortisone shot in the joint. This type of an injection combines an anesthetic agent like the xylocaine that the dentist uses with the strong anti-inflammatory effects of a steroid called cortisone. This is a very safe procedure, and sometimes a single shot can take care of the pain and swelling forever. Unfortunately, it is impossible to predict how long the effects of the medication will last, and some people find that the relief that they receive doesn't last long enough. Most doctors don't like to give more than two or three injections in the same joint. There isn't anything particularly harmful about having more than two or three injections, but in general, doctors believe that this is a sign that surgery will be required to properly take away the pain.
What type of surgery can be done for A/C joint arthritis?
Surgery for A/C joint arthritis is designed to take away the source of the shoulder pain, which is caused by the roughened ends of the clavicle and the acromion rubbing on each other. This source of pain can be eliminated by surgically removing the tip of the clavicle. The A/C joint functions very well even if the ends of the bone do not come in direct contact with each other. This type of surgery, which is called a distal clavicle resection, can be done either through a small incision over the tip of the clavicle or with several small incisions using an arthroscope. There is not a lot of difference between the two types of procedures, and which one your surgeon will use will depend largely upon their personal preferences. The amount of pain after the operation is minimal with both techniques, and the recovery from the operation is also very similar. Most patients will have excellent pain relief after this operation and nearly 95% of patients will be able to return to the same sports and activities that they were doing before they were injured.
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