AC Joint Arthritis

AC JOINT ARTHRITIS

 

What is it?

The clavicle is connected to the acromial part of the scapula(shoulder blade) by a small joint, the acromioclavicular joint, often referred to as the AC joint. In some persons the joint becomes degenerative and arthritic. This can result in pain from the joint arthritis itself and if the joint forms osteophytes on the under surface these can lead to pain from impingement on the rotator cuff.

 

Investigation

History and examination of which the examination is the most important. If the source of the pain is found to be located at the AC joint then this is an indication for treatment. Radiographs can be misleading as some joints appear to be arthritic but strangely asymptomatic, others may only have minor changes but are significantly painful.

 

Treatment

If the other modalities of treatment such as rest, medications, physiotherapy and injection therapy have been unsuccessful then the treatment indicated is an arthroscopic (keyhole) procedure.

 

Anaesthesia

The operation can be done as a general anaesthetic or alternatively with a local anaesthetic. This is an injection in the neck which numbs the shoulder and arm negating the problems associated with anaesthetic gasses and allows patients to stay awake and watch their operation. If preferred patients can listen to music rather than watch or have a supplementary relaxing injection. It is important to note however that patients having an operation with Martin Holt can have a local or general anaesthetic - its your choice.

 

The operation

An arthroscopic excision of the AC joint is an operation often completed through two portals (small skin incisions approximately 1cm) one of the portals is used to insert a viewing instrument, an arthroscope, which enables the surgeon to visualise the shaving instrument inserted through the second portal. The shaver removes the inflamed tissue of the AC joint and the degenerate articular surfaces. Often there are also signs of subacromial impingement and so a decompression is combined with the AC joint excision using an additional portal. The portals are usually so small they most often dont require sutures.

 

Recovery

This is a day case operation and so provided you, the patient, have sufficient support at home following the operation you will be able to go home the same day. Dressings placed over the portals are retained for 7-10 days. Rarely absorbable sutures are used but these do not require removal as they dissolve over the course of time.

Prior to discharge a physiotherapist will explain to you your exercise program. A physiotherapy appointment can be arranged for you but you will also be supplied with instructions to show an alternative physiotherapist if you have chosen to continue with physiotherapy closer to home. It is important to not only undertake the formal physic with a therapist but also to complete a home physiotherapy regime as instructed to optimise your recovery and shoulder function.

 

Time off work

The time you have off work doing the physiotherapy can vary from2-6 weeks. It is dependent on several factors but importantly on the pathology, rate of healing and your occupation.