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Osteoartrite da articulação acromioclavicular Folheto In-depth

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

A dor está localizada bem no topo do ombro, na pequena articulação onde a clavícula se encontra com a escápula. Ela pode se espalhar para a frente do ombro ou para o músculo que vai do pescoço até o ombro. Levantar objetos pesados tende a desencadear a dor; o mesmo acontece ao deitar-se sobre esse lado à noite.

Algumas pessoas percebem a dor principalmente após a atividade física, enquanto outras sentem-na ao acordar. Esticar o braço para o outro lado do corpo — como ao pegar o cinto de segurança ou colocar uma bolsa do outro lado da mesa — também pode ser doloroso. Levantar o braço bem acima da cabeça também causa dor exatamente nesse ponto no topo do ombro.

É importante saber o seguinte: a artrose observada em exames de imagem nem sempre corresponde ao grau de dor que a pessoa sente. Algumas pessoas apresentam sinais de artrose nessa articulação nos exames, mas não sentem absolutamente nada. Na verdade, a maioria das pessoas cuja artrose é visível nos exames, mas que não sentem dor, permanecem sem dor ao longo dos anos seguintes. Outras têm exames que mostram poucos sinais de artrose, mas sentem muita dor. O que importa são os seus sintomas, e não apenas o resultado do exame de imagem.

Se o seu ombro estiver dolorido, o cirurgião verificará se há sensibilidade exatamente nesse ponto no topo do ombro e testará a amplitude de movimento do seu braço. Às vezes, uma injeção anestésica na articulação é utilizada para confirmar se essa é a origem da dor. Se a dor desaparecer após a injeção, isso nos indica de onde ela vem.

O que está realmente acontecendo

A articulação na parte superior do ombro é onde a clavícula se encontra com a escápula. Trata-se de uma articulação pequena e móvel, não rígida. Ela se move um pouco em todas as direções à medida que a escápula oscila ao redor do tórax. Pense nela como uma pequena dobradiça que também desliza e gira, permitindo que os dois ossos se movam em sincronia enquanto o braço se move.

Entre os dois ossos há uma almofada macia, parecida com uma gaxeta. Ela amortece a articulação e garante que as superfícies ósseas deslizem suavemente. Com o tempo, essa almofada se desgasta; é aí que os problemas começam. As superfícies articulares passam a se esfregar uma contra a outra, e o osso responde formando pequenos esporões ósseos nas bordas. Isso é a artrose por desgaste.

Esse tipo de artrose geralmente aparece a partir do início da meia-idade. É mais comum em pessoas que realizam muitos movimentos repetitivos acima da cabeça ou levantam cargas pesadas. Uma separação antiga do ombro, mesmo que leve e ocorrida há anos, também pode levar ao desenvolvimento de artrose dolorosa nessa articulação posteriormente.

Quando a articulação se desgasta, a dor surge exatamente onde você sente: na parte superior do ombro. Levantar objetos, esticar o braço ao longo do corpo e deitar sobre esse lado pressionam as superfícies desgastadas, motivo pelo qual esses movimentos causam dor. Os esporões ósseos e as superfícies articulares expostas são a origem da dor mencionada anteriormente.

O ponto mais importante é este: o que o exame de imagem mostra não determina o que você sente. Muitas pessoas têm artrose nessa articulação e nunca percebem. A maioria permanece sem dor ao longo dos anos. Outras apresentam apenas sinais leves de desgaste, mas sentem dor real. São os seus sintomas, e não a imagem do exame, que devem guiar qualquer decisão terapêutica.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membros superiores no Mater Private Hospital Rockhampton, começa com as opções menos invasivas adequadas ao seu quadro clínico. Em geral, os pacientes são encaminhados à nossa clínica pelo médico de família; caso um fisioterapeuta tenha sugerido que você nos procure, ainda assim será necessário um encaminhamento do seu médico de família para ter direito ao reembolso do Medicare. Na sua primeira consulta, colhemos o histórico clínico, examinamos o ombro e solicitamos exames de imagem, se necessário. Como se trata de um problema degenerativo de longa data, geralmente iniciamos com tratamentos não cirúrgicos.

O primeiro passo é simples: evite as atividades que provocam dor e aplique gelo quando ela surgir. Os comprimidos anti-inflamatórios, que reduzem a dor e o inchaço, são frequentemente utilizados no início do tratamento. A fisioterapia visa restaurar o movimento confortável da articulação e fortalecer os músculos ao redor do ombro, de modo que eles assumam parte da carga da articulação. Dê uma chance justa a essas medidas antes de considerar outras opções.

Caso essas medidas não resolvam o problema, vêm as injeções. A injeção de cortisona coloca medicamento anti-inflamatório diretamente na articulação; ela pode ajudar a identificar a origem da dor e também aliviá-la. Em cerca de 47% dos pacientes, essa injeção ainda é considerada um sucesso um ano depois. Nem todos obtêm alívio duradouro, mas para alguns ela proporciona um bom período de conforto.

A cirurgia é considerada somente quando a dor persiste apesar de todas as medidas acima. A operação consiste na remoção de uma pequena porção de osso na extremidade externa da clavícula, impedindo que as superfícies desgastadas e espinhosas da articulação se friccionem. Conversaremos sobre isso com você somente após os tratamentos mais simples terem sido testados; a decisão é sempre tomada em conjunto.

O que esperar

Para a maioria das pessoas, essa condição evolui lentamente, e não de forma súbita. A dor tende a aparecer e desaparecer conforme as atividades realizadas: atividades mais intensas a provocam, enquanto períodos de repouso a acalmam. Algumas pessoas percebem que a dor se estabiliza com medidas simples e permanece ausente por longos períodos; outras sentem que ela persiste por meses ou anos, piorando quando exageram nas atividades.

Se você não sente dor, o prognóstico é favorável. A maioria das pessoas cuja artrose é visível em exames de imagem, mas que não apresentam sintomas, permanece sem sintomas por até sete anos. O desgaste nessa articulação, quando indolor, geralmente permanece assim.

Caso seu ombro já esteja dolorido, o tratamento não cirúrgico merece ser tentado. O repouso, a fisioterapia e os anti-inflamatórios ajudam muitas pessoas. A injeção de cortisona, como mencionado anteriormente, ainda apresenta bons resultados após um ano em cerca de metade dos pacientes que a recebem. Quando a injeção é eficaz, não parece importar se o exame de imagem mostrou muito ou pouco desgaste: ambos os grupos relatam o mesmo nível de satisfação posteriormente.

Se a dor persistir mesmo após todas essas medidas, a cirurgia para remover um pequeno fragmento ósseo da extremidade externa da clavícula elimina a dor de forma confiável e melhora a função do ombro. Esse alívio se mantém ao longo dos anos, não apenas nos primeiros meses.

Se deixada sem tratamento, a artrose dolorosa nessa articulação geralmente não danifica outras estruturas do ombro. O desgaste não tratado não impede o sucesso de outras cirurgias no ombro, nem é motivo para remover parte da clavícula em procedimentos cirúrgicos posteriores. O principal risco de não tratar a condição é simplesmente a continuidade da dor.

Um aviso honesto: a cirurgia não é uma solução infalível. Qualquer operação traz seus próprios riscos potenciais, e uma técnica cuidadosa reduz esses riscos, mas não os elimina por completo. Antes de qualquer decisão, discutiremos com você a situação real, e a escolha sempre será feita em conjunto.

Quando procurar ajuda médica

Consulte seu médico de família se a dor na parte superior do ombro persistir, especialmente ao levantar objetos, ao estender o braço para além do corpo ou ao deitar sobre esse lado. Solicite uma avaliação por um especialista caso as medidas simples não tenham aliviado os sintomas após um período razoável de tentativas, ou se a dor estiver atrapalhando seu sono ou impedindo que você trabalhe. Vale a pena procurar ajuda ainda mais cedo se a dor for aguda e estiver concentrada numa pequena área na parte superior do ombro, pois a sensibilidade nesse local é um indicador útil sobre a origem do problema. Essa condição não é uma emergência, e não requer atendimento imediato. Contudo, uma dor que não cede merece uma avaliação adequada, pois os tratamentos mencionados anteriormente são mais eficazes antes que o problema se torne crônico.

Em maior profundidade

Advanced reading: the deeper science (optional)

Esta seção vai além do que você precisa saber para tomar decisões sobre o próprio tratamento. A artrose da articulação acromioclavicular merece ser lida com atenção por um motivo desagradável: ela é extremamente comum nos exames de imagem, é frequentemente apontada como causa da dor no ombro, e as evidências de que o tratamento traz benefícios são mais fracas do que quase qualquer outra informação apresentada neste site.

As evidências não comprovam que algum tratamento funcione

Uma revisão sistemática sobre o tratamento da osteoartrite primária da articulação acromioclavicular reuniu 1.902 pacientes e chegou a uma conclusão raramente expressa de forma tão direta: os estudos apresentavam variações quanto às indicações, intervenções e qualidade metodológica, não fornecendo evidências de que nem as intervenções não cirúrgicas nem as cirúrgicas sejam eficazes [1].

Isso não equivale a dizer que nada ajuda. Significa apenas que os ensaios clínicos capazes de comprovar isso ainda não foram realizados com um padrão de qualidade suficiente para sustentar tal afirmação. A excisão distal da clavícula é uma cirurgia há muito tempo estabelecida, realizada com base na lógica mecânica de que a remoção da superfície articular desgastada elimina a dor; porém, “ser há muito tempo utilizada e mecanicamente sensata” não constitui evidência científica. É importante conhecer essa distinção na hora de tomar decisões terapêuticas.

Adicionar esse procedimento a outra cirurgia não melhora o resultado dessa cirurgia

O teste mais direto vem de pacientes nos quais outro procedimento é realizado simultaneamente. Entre 208 pacientes com ruptura do manguito rotador, a ressecção da extremidade distal da clavícula não resultou em melhores escores de desfecho clínico nem em maior amplitude de movimento [2].

Isso é relevante porque essa é exatamente a situação em que a articulação acromioclavicular é mais frequentemente ressecada: o cirurgião já está dentro do ombro, a articulação parece degenerada nos exames de imagem, e a remoção de alguns milímetros de osso é um procedimento rápido. As evidências mostram que o paciente não obtém nenhum benefício mensurável. Caso esse procedimento seja proposto como complemento à reparação do manguito rotador, é legítimo questionar sobre seus reais benefícios.

A técnica não é a questão relevante

A ressecção aberta versus artroscópica foi comparada repetidamente, e a resposta é consistente: resultados funcionais e clínicos semelhantes em ambos os métodos, em um total de 319 pacientes [3]. Uma comparação anterior envolvendo 429 pacientes também não indicou vantagem clara para nenhum dos métodos [4].

Quando duas abordagens técnicas bastante distintas produzem o mesmo resultado, a conclusão lógica é que a técnica não é o fator determinante do desfecho; o que importa é a seleção adequada dos pacientes.

Por que a seleção do diagnóstico é tão difícil aqui

A articulação acromioclavicular se degenera em quase todas as pessoas com o avançar da idade. Trata-se de uma articulação pequena, sujeita a grande carga mecânica, cujo disco articular é fino e se desgasta precocemente; portanto, a presença de sinais de degeneração dessa articulação em um exame de imagem é algo esperado após a meia-idade, e não necessariamente um diagnóstico.

Existe um correlato estrutural mensurável: nas articulações acromioclaviculares degeneradas e sintomáticas, tanto a extremidade distal da clavícula quanto o acrômio apresentam aumento de tamanho, enquanto em pessoas assintomáticas essa relação entre ambos permanece inalterada [5]. Isso é um indício útil de que a degeneração sintomática e a degeneração incidental diferem estruturalmente; porém, trata-se de uma observação feita em nível populacional, não de um teste aplicável especificamente ao seu ombro.

Na prática, é por isso que a injeção diagnóstica na articulação tem grande importância aqui. Se o anestésico local, aplicado com precisão na articulação acromioclavicular, eliminar a dor, é provável que essa seja a fonte do problema. Caso contrário, a degeneração observada no exame de imagem provavelmente é um achado incidental, e sua correção cirúrgica dificilmente trará benefícios — exatamente a situação que as evidências acima alertam para evitar.

Referências

[1] Welch M, Rankin S, How Saw Keng M, Woods D. Uma revisão sistemática do tratamento da osteoartrite primária da articulação acromioclavicular. Shoulder Elbow. 2023;16(2):129-44. https://doi.org/10.1177/17585732231157090

[2] Wang J, Ma J, Zhu S, Jia H, Ma X. A ressecção da extremidade distal da clavícula reduz a dor ou melhora a função do ombro em pacientes com ruptura do manguito rotador? Uma meta-análise. Clin Orthop Relat Res. 2018;476(12):2402-14. https://doi.org/10.1097/CORR.0000000000000424

[3] Hohmann E, Tetsworth K, Glatt V. Ressecção aberta versus artroscópica da articulação acromioclavicular: uma revisão sistemática e meta-análise. Arch Orthop Trauma Surg. 2019;139(5):685-94. https://doi.org/10.1007/s00402-019-03114-w

[4] Pensak M, Grumet RC, Slabaugh MA, Bach BR. Ressecção aberta versus artroscópica da extremidade distal da clavícula. Arthroscopy. 2010;26(5):697-704. https://doi.org/10.1016/j.arthro.2009.12.007

[5] Bulkmans K, Peeters I, De Wilde L, Van Tongel A. A relação entre o acrômio e a extremidade distal da clavícula em articulações acromioclaviculares normais e degenerativas sintomáticas. Arch Orthop Trauma Surg. 2019;140(4):465-72. https://doi.org/10.1007/s00402-019-03258-9

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of cases over a seven-year period [3].
  • Symptomatic acromioclavicular joint osteoarthritis occurred in 15.9% of patients following total anatomic shoulder replacement with follow-up of up to 12 years [8].
  • Treatment choice for acromioclavicular dislocation should not be influenced by the potential development of acromioclavicular osteoarthritis [1].
  • Untreated acromioclavicular joint osteoarthritis, whether symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [4].
  • Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair [4].
  • Further characterisation of patients in whom mild arthroscopic findings of acromioclavicular joint osteoarthritis are clinically significant and warrant resection is needed [2].
  • A distinction between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis appears unnecessary, as all patients were equally satisfied with the outcome following a preoperative acromioclavicular injection [7].
  • Limited distal clavicle excision in patients with acromioclavicular joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up [10].
  • Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic acromioclavicular osteoarthritis [14].
  • Open and arthroscopic resection arthroplasty techniques each have a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique [14].
  • Biplanar reconstruction with pectoralis minor tendon and coracoacromial ligament transfer aims to preserve the lateral portion of the clavicle whenever possible [9].
  • In biplanar reconstruction for chronic acromioclavicular joint dislocations, resection is limited exclusively to cases of acromioclavicular joint osteoarthritis or irreducible joints [9].
  • Clinicians should consider overreduction of the acromioclavicular joint because it may lead to favorable radiological results in acute high-grade dislocations [6].

Anatomy & Pathophysiology

Joint Structure and Biomechanics

  • The acromioclavicular (AC) joint is a diarthrodial joint that supports the shoulder girdle through the clavicular “strut” [29].
  • The AC joint serves as a primary link between the axial skeleton and the upper extremity [67].
  • The AC joint is movable in all planes and is not a rigid structure [67].
  • The normal AC joint is capable of translating 4 to 6 mm in the anterior, posterior, and superior planes under 70-N loads [67].
  • The AC joint accommodates rotary motion of 5° to 8° during scapulothoracic motion and 40° to 45° with shoulder abduction and elevation [67].
  • The AC and coracoclavicular (CC) ligaments are the static stabilizers of the AC joint, whereas the deltoid and trapezius muscles are the dynamic stabilizers [67].
  • The horizontal plane stability of the clavicle is provided by the AC ligaments, specifically the posterior and superior portions [15].
  • The scapula and clavicle are linked into a single segment referred to as the “claviscapula” [69].
  • The AC and CC ligaments play a role in torque transduction and horizontal and vertical stability within the scapulohumeral rhythm [69].
  • Kinematic changes resulting from AC joint dislocation can be a potential source of pain and dysfunction in the shoulder [33].
  • Scapular and clavicular kinematics are affected in AC separation models [34].

Ligamentous Anatomy and Injury Progression

  • Injury to the AC joint results in progressive disruption of the ligamentous support, beginning with the capsular ligaments and progressing to the CC ligaments [16].
  • The extent of injury to the AC and CC ligaments, as well as the amount and direction of clavicle displacement, often determines the severity of AC joint separation [41].
  • Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation [11].
  • Although various reconstruction techniques can restore different elements of joint kinematics, none completely restores the shoulder girdle to its preinjured state [31].

Pathoanatomy of Degenerative Conditions

  • AC joint osteoarthritis is more common with advanced age following degeneration of the intra-articular disk [15].
  • Arthritic deterioration of the AC joint starts in early middle age [15].
  • AC joint osteoarthritis is more common in patients engaged in repetitive overhead or lifting activities [15].
  • Previous low-grade AC joint separations can result in painful arthritis [15].
  • The radiographic severity of AC joint arthritis does not always correlate with patient symptoms [15].
  • Asymptomatic AC joint degeneration is frequent and does not always correlate with the presence of symptoms [29].
  • Distal clavicle osteolysis involves localized hyperemia of the distal clavicle, resulting in inflammation, bone resorption, microfractures, and secondary arthritis of the AC joint [15].
  • Distal clavicle osteolysis is more common in males and seen in younger patients [15].
  • Distal clavicle osteolysis is associated with heavy lifting or repetitive motions [15].

Radiographic Anatomy and Normal Values

  • The normal coracoclavicular (CC) distance on an AP radiograph should be less than 11 to 13 mm [15].
  • The normal coracoclavicular distance, measured between the superior aspect of the coracoid and the inferior clavicle, should be between 11 to 13 mm [16].
  • Bone and joint edema on MRI correlate with AC joint pain [15].
  • Osteophyte formation, sclerotic reaction, and bone cysts are commonly seen on radiographs of the AC joint in osteoarthritis [15].

Classification

  • AC joint osteoarthritis is graded using the Kellgren-Lawrence classification system [61].
  • Cuff tear arthropathy is graded using the Hamada classification system [61].
  • Radiographic signs of AC joint osteoarthritis include joint space narrowing, osteophytosis, and cyst formation [12].
  • Asymptomatic AC joint osteoarthritis is defined by the presence of radiographic signs of osteoarthritis without clinical symptoms such as AC joint tenderness or a positive cross-body adduction test [12].
  • Symptomatic AC joint osteoarthritis is characterized by AC joint pain, tenderness to palpation, and temporary pain relief with intra-articular injection [12].
  • The Rockwood classification is used to evaluate acute acromioclavicular dislocations, including types III and IV [64].
  • The Rockwood classification includes types III through V for severe chronic symptomatic AC joint separations [51].
  • The Rockwood classification includes type V for high-grade acromioclavicular dislocations [19].
  • The AC-DC measurement and Alexander view are used to define watershed cases of AC joint displacement, specifically types IIIA, IIB, and IV [18].
  • Evaluating the integrity of capsuloligamentous structures stabilizing the AC joint provides information on injury severity that may influence treatment decisions [28].

Clinical Presentation

History and Symptoms

  • Patients report activity-related pain localized to the AC joint [15].
  • Pain may radiate anteriorly or along the trapezius [15].
  • Pain is reported with heavy lifting or when sleeping on the affected side [15].
  • Asymptomatic AC-OA remained asymptomatic in 90% of patients over a 7-year course [3].
  • Symptomatic ACJ OA occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years [8].
  • Radiographic severity of arthritis does not always correlate with patient symptoms [15].

Physical Examination

  • Point tenderness is seen at the AC joint [15].
  • Horizontal stability should be assessed during physical examination [15].
  • Pain at the AC joint with terminal elevation and cross-body motion is often seen [15].
  • Selective injection of anesthetic into the AC joint can confirm the diagnosis [15].
  • Tenderness to palpation at the AC joint is a risk factor for subsequent distal clavicle resection after rotator cuff repair [26].
  • Female sex is a risk factor for subsequent distal clavicle resection after rotator cuff repair [26].
  • Surgery on the dominant side is a risk factor for subsequent distal clavicle resection after rotator cuff repair [26].
  • Subsequent distal clavicle resection was performed in 40% of cases with a combination of AC joint tenderness, female sex, and surgery on the dominant side [26].

Imaging

  • An AP view and/or a Zanca view of the shoulder provides good visualization of the AC joint [15].
  • Osteophyte formation, sclerotic reaction, and bone cysts are commonly seen on radiographs [15].
  • CT imaging signs of osteoarthritis at the AC joint include joint space narrowing, osteophytosis, and cyst formation [12].
  • Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [13].

Investigations

Clinical Evaluation

  • Patients with AC joint osteoarthritis report activity-related pain localized to the AC joint, with occasional radiation anteriorly or along the trapezius [15].
  • Pain with heavy lifting or when sleeping on the affected side is reported in patients with AC joint osteoarthritis [15].
  • Physical examination of symptomatic AC joint osteoarthritis includes point tenderness at the AC joint [15].
  • Horizontal stability of the AC joint should be assessed during physical examination [15].
  • Pain at the AC joint with terminal elevation and cross-body motion is often seen in patients with AC joint osteoarthritis [15].
  • Selective injection of anesthetic into the AC joint can confirm the diagnosis of symptomatic AC joint osteoarthritis [15].

Imaging

  • An AP view and/or a Zanca view of the shoulder provides good visualization of the AC joint for evaluating osteoarthritis [15].
  • Osteophyte formation, sclerotic reaction, and bone cysts are commonly seen on radiographs of the AC joint in patients with osteoarthritis [15].
  • Patients with edema on MRI are more likely to present pain than patients without edema [60].
  • Subchondral bone edema on histologic examination is more frequent in patients with pain [60].
  • The radiographic severity of arthritis does not always correlate with patient symptoms [15].
  • The AC-DC measurement and use of the Alexander view provides a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) [18].
  • Normal coracoclavicular distance on an AP radiograph should be less than 11 to 13 mm [15].
  • The normal CC distance on an AP radiograph should be between 11 to 13 mm [16].

Diagnostic Injections and Prognostic Indicators

  • A distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome following preoperative acromioclavicular injection [7].
  • Asymptomatic AC-OA remained asymptomatic in 90% of patients over 7 years [3].
  • Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [4].
  • Preventive arthroscopic distal clavicle resection is not recommended in patients with radiological but asymptomatic ACJ arthritis [65].
  • Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed [2].

Treatment

Non-Operative Management

  • Rest, ice, and NSAIDs are used initially for AC joint osteoarthritis [15].
  • Corticosteroid injections can be used for diagnostic or therapeutic purposes in AC joint osteoarthritis [15].
  • Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management [22].
  • AC injections offer a 1-year success rate of 47% in patients with acromioclavicular osteoarthritis [27].
  • A distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome following preoperative injection [7].
  • Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections for isolated acromioclavicular osteoarthritis [24].
  • Asymptomatic AC-OA remained asymptomatic in 90% over 7 years [3].
  • Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option [46].
  • Type V AC dislocations may be given a trial of conservative therapy [19].

Operative Management

  • Surgical indications for AC joint osteoarthritis include persistent pain and failure of nonsurgical treatment [15].
  • Relative contraindications for surgical treatment of AC joint osteoarthritis include a previous low-grade separation with persistent horizontal plane instability [15].
  • Biomechanical evidence suggests a resection of 5 mm is needed to prevent contact between the clavicle and the acromion in the absence of instability during arthroscopic distal clavicle excision [15].
  • Care should be taken to preserve the posterior and superior AC ligaments during arthroscopic distal clavicle excision [15].
  • Pain relief is reliable in >90% of patients following arthroscopic distal clavicle excision in the absence of instability [15].
  • Previous traumatic instability is associated with persistent pain in 30% to 40% of cases following distal clavicle excision [15].
  • One systematic review showed slightly better results with arthroscopic excision than with open distal clavicle excision [15].
  • Direct comparison studies have shown similar or better results with arthroscopic excision than with open techniques for distal clavicle resection [15].
  • Between 5 and 10 mm of the distal clavicle should be resected during an open distal clavicle resection (Mumford procedure) [15].
  • Meticulous repair of the deltotrapezial fascia is important during open distal clavicle resection [15].
  • Limited distal clavicle excision of patients with AC joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up [10].
  • The biplanar reconstruction procedure aims to preserve the lateral portion of the clavicle whenever possible, limiting resection exclusively to cases of AC joint osteoarthritis or irreducible joints [9].
  • Some persistent pain and osteoarthritis progression remain concerns following revision of failed open anterior stabilization of the shoulder [5].
  • Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results in acute high-grade dislocations [6].

Rehabilitation

  • Acute rehabilitation (zero to 7 days postoperative) for distal clavicle excision includes a sling, ice, and pendulum exercises [15].
  • Subacute rehabilitation (1 to 6 weeks postoperative) for distal clavicle excision involves gradually increasing shoulder ROM, gentle passive stretching and ROM as tolerated, reducing sling use as pain permits, and avoiding heavy lifting or strengthening exercises [15].
  • Late recovery (more than 6 weeks postoperative) for distal clavicle excision involves full shoulder ROM and stretching, initiation of rotator cuff, scapular stabilizer, and deltoid strengthening, and heavy weight lifting and return to full activities as tolerated [15].
  • Residual pain or soreness can persist for 3 to 4 months after distal clavicle excision and can be aggravated by heavy lifting [15].
  • Activity progression after distal clavicle excision should be modified according to symptoms [15].

Complications

Post-operative Osteoarthritis and Joint Degeneration

  • Patients with loss of immediate postoperative reduction after AC joint dislocation repair more often developed radiologic and symptomatic AC osteoarthritis than those in whom the AC joint was anatomically restored [17].
  • Osteoarthritis is associated with poorer final clinical outcomes following rotator cuff repair [48].
  • An unhealed or re-torn rotator cuff increases the risk of osteoarthritis following rotator cuff repair [48].
  • Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [13].

Surgical Technique and Stability Complications

  • Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results [6].
  • Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis, though each has a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique [14].

Natural History and Diagnostic Considerations

  • Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure [4].
  • The outcomes of a retrospective study suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome [7].

Recovery

Non-Operative

  • Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of cases over a 7-year period [3].
  • Acromioclavicular injections offer a 1-year success rate of 47% in patients with acromioclavicular osteoarthritis [27].
  • Outcomes suggest that a distinction between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis is unnecessary, as all patients were equally satisfied with the outcome following preoperative injection [7].
  • Type V acromioclavicular dislocations may be given a trial of conservative therapy [19].

Operative

  • Symptomatic acromioclavicular joint osteoarthritis occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years [8].
  • Osteoarthrotic changes were always associated with fair or poor results in surgical treatment of acromioclavicular dislocation [30].
  • Treatment of acromioclavicular dislocation by synthetic ligament reconstruction gave satisfactory results in terms of recovery of strength, but evolution is not risk-free with the onset of significant early osteolysis [70].
  • Outcomes after arthroscopic coracoclavicular reconstruction for chronic, type V acromioclavicular dislocations show sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and maintenance of active-duty military status at long-term follow-up [56].
  • Short-term follow-up of patients treated with minimally invasive coracoclavicular ligament augmentation for total acromioclavicular joint dislocation reveals excellent radiologic and clinical results, with no subluxations or dislocations of the acromioclavicular joint noted [68].

General Principles

  • Choice of treatment for acromioclavicular dislocation should not be influenced by the potential development of acromioclavicular osteoarthritis [1].
  • Anatomic techniques that address both coracoclavicular ligaments and the acromioclavicular capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation [11].
  • No long term disability results from the loss of the coraco-acromial ligament from its normal site [50].

Key Evidence

  • [L4] Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC OA. [1] (10.2106/jbjs.rvw.24.00085)
  • [L2] Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. [2] (10.1007/s00167-014-3114-2)
  • [L2] Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. [3] (10.1016/j.jse.2019.04.004)
  • [L2] Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. [4] (10.1007/s00167-020-06098-y)
  • [L4] Some persistent pain and osteoarthritis progression remain concerns. [5] (10.1016/j.arthro.2009.04.073)
  • [L3] Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. [6] (10.1177/0363546519862850)
  • [L4] The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome. [7] (10.5397/cise.2023.00073)
  • [L4] Symptomatic ACJ OA occurred in 15.9% of patients after total anatomic shoulder replacement with follow-up of up to 12 years. [8] (10.1177/17585732221114796)
  • [L5] The procedure aims to preserve the lateral portion of the clavicle whenever possible, limiting resection exclusively to cases of AC joint osteoarthritis or irreducible joints. [9] (10.1016/j.eats.2024.103104)
  • [L4] Limited distal clavicle excision of patients with AC joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up. [10] (10.1016/j.otsr.2016.01.008)
  • [L5] Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation. [11] (10.1016/j.arthro.2019.01.038)
  • [L3] [12] (10.1007/s00402-019-03258-9)
  • [L3] Radiographic ACJ osteoarthritis is common in patients undergoing RSA. [13] (10.1016/j.jseint.2021.11.008)
  • [L5] Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis, though each has a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique. [14] (10.1177/0363546513485359)
  • [L4] [17] (10.1016/j.otsr.2017.11.001)
  • [L4] The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations. [18] (10.1016/j.jse.2019.12.014)
  • [L4] This suggests that Type V AC dislocations may be given a trial of conservative therapy. [19] (10.1177/2325967115s00017)
  • [L4] Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. [22] (10.1007/s00167-020-06377-8)
  • [L4] Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections. [24] (10.5397/cise.2023.00311)
  • [L3] Risk factors for subsequent DCE included tenderness to palpation at the AC joint, female sex, and surgery on the dominant side, with subsequent DCE performed in 40% of cases with a combination of these 3 factors. [26] (10.1177/2325967119844295)
  • [L4] AC injections offer a 1-year success rate of 47%. [27] (10.5397/cise.2023.00031)
  • [L1] Evaluating the integrity of the capsuloligamentous structures stabilizing the AC joint is reproducible and gives additional information on the severity of the injury, which might also influence the treatment decision. [28] (10.1016/j.jse.2020.10.026)
  • [L5] [29] (10.5435/00124635-199905000-00004)
  • [L4] Osteoarthrotic changes, however, were always associated with fair or poor results. [30] (10.1016/0020-1383(83)90092-x)
  • [L5] Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. [31] (10.1177/03635465221095231)
  • [L5] The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation. [33] (10.1177/0363546512458571)
  • [L5] Scapular and clavicular kinematics were affected in AC separation models. [34] (10.1016/j.jse.2013.01.004)
  • [L4] Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. [46] (10.1007/s00402-020-03630-0)
  • [L4] Osteoarthritis is associated with poorer final clinical outcomes, and an unhealed or re-torn cuff increases the risk of osteoarthritis. [48] (10.1016/j.otsr.2017.03.007)
  • [L4] No long term disability results from the loss of the coraco-acromial ligament from its normal site. [50] (10.1016/s0020-1383(80)80045-3)
  • [L4] Severe chronic symptomatic AC joint separations (Rockwood types III through V) can be repaired entirely by arthroscopy safely and effectively by transferring the coracoacromial ligament with a bone block in the distal clavicle. [51] (10.1016/j.arthro.2009.08.008)
  • [L4] Outcomes after arthroscopic CC reconstruction for chronic, type V AC dislocations in an active-duty military patient population show sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and maintenance of active-duty military status at long-term follow-up. [56] (10.1016/j.arthro.2025.05.008)
  • [L4] Patients with edema on MRI were more likely to present pain than patients without edema, and subchondral bone edema on histologic examination was more frequent in patients with pain. [60] (10.1016/j.jseint.2020.03.007)
  • [L3] [61] (10.5397/cise.2023.00465)
  • [L4] [64] (10.1016/j.otsr.2010.10.004)
  • [L1] Preventive arthroscopic DCR is not recommended in patients with radiological but asymptomatic ACJ arthritis. [65] (10.1177/0363546514547254)
  • [L4] [67] (10.1302/2058-5241.3.170027)
  • [L4] The short-term follow-up of 15 recently operated patients reveals excellent radiologic and clinical results, with no subluxations or dislocations of the acromioclavicular joint noted. [68] (10.1016/j.arthro.2006.12.015)
  • [L5] [69] (10.5435/jaaos-d-24-00360)
  • [L4] Treatment of ACD by synthetic ligament reconstruction gave satisfactory results, notably in terms of recovery of strength, but evolution is not risk-free with onset of significant early osteolysis. [70] (10.1016/j.otsr.2010.06.004)

References

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[31] Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095231

[33] The Function of the Acromioclavicular and Coracoclavicular Ligaments in Shoulder Motion. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512458571

[34] Acromioclavicular joint ligamentous system contributing to clavicular strut function: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.004

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