AC Joint Treatments

Recent article defines treatments as steroid injection or distal clavicle excision. It found little evidence of persistent benefits of AC steroid injection and found arthroscopic distal clavicular excision satisfactory in 92.5% of cases on average.

Shoulder Elbow. 2018 Jan;10(1):4-14.
doi: 10.1177/1758573217700839
Managing acromio-clavicular joint pain: a scoping review.
Chaudhury S et al

  • tests mentioned include AC joint tenderness and Paxinos test (pushing acromio and clavicular parts together to see if more pain). They find high sensitivity but low specificity . I mentioned a better test here:
    Testing For Shoulder AC Joint Pains
    the adducted O’brien’s test
  • Note that bone scan can confirm activity – something I had forgotten about using.

Studies on AC injection found:

  • pain often back by 3 weeks
  • using imaging to make it intra-articular might make it worse by damaging internal structures

Only other option mentioned was distal clavicular excision

  • open excision is less satisfactory with a “satisfactory outcomes ranging from
    50% to 100% and a mean satisfaction of 76.3%”.  –  mean follow up of 4.9 years
  • doing above with concomitant procedures such as sub-acromial decompression and rotator-cuff repairs can boost this up to 94%
  • arthroscopic technique often have concomitant and have above success rates
  • “Six studies reported poor outcomes in 23% of the 130 patients receiving open or arthroscopic DCE”

Comment – finding here do not necessarily translate into what is seen in the office. Isolated AC joint issues often respond miraculously to steroid injection but these are often fresh cases not allowed to transition into a full regional pain problems.  There are cases with obvious instability that just comes back because the wear  to structures by the instability. Dextrose prolotherapy has a role here and I have seen successes. Surgical removal of distal clavicule appears to offer an alternative but in “desperate” cases, the condition has regionalized and many structures will be affected and need surgical treatment as well…

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