Home
中文
English தமிழ் Português 中文 Tiếng Việt Filipino ਪੰਜਾਬੀ 自动翻译 — 英文版本为权威版本。

肩锁关节骨关节炎 资料

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

疼痛位于肩部的顶端，即锁骨与肩胛骨交汇的小关节处。疼痛可能向前方肩部或向上延伸至从颈部到肩部的肌肉。提起重物往往会诱发疼痛。夜间侧卧在该侧也会引发疼痛。

有些人发现疼痛在活动后最为明显，而有些人在刚醒来时感到疼痛。跨越身体进行动作，例如伸手去够安全带或将包举到桌子远端，可能会引起疼痛。将手臂完全举过头顶也可能导致肩部顶端该部位的疼痛。

这里有一个值得了解的要点：影像学检查发现的关节炎并不总是与疼痛程度相符。有些人在影像上显示该关节存在退行性骨关节炎，却完全没有感觉。事实上，大多数在扫描中显示有骨关节炎但无痛的人，在随后的几年里仍保持无痛状态。另一些人扫描结果看起来轻微，却感到剧烈疼痛。重要的是您的症状，而不仅仅是扫描图像上的表现。

如果您的肩部疼痛，外科医生会检查肩部顶端该确切部位的压痛，并测试您的手臂活动情况。有时，向关节内注射麻醉剂用于确认该关节是疼痛的来源。如果注射后疼痛缓解，这就能告诉我们疼痛的来源。

实际发生了什么

您肩部顶端的关节是锁骨与肩胛骨交汇之处。它是一个小而灵活的关节，而非僵硬的关节。当您的肩胛骨围绕胸部摆动时，它会向各个方向轻微活动。可以将其想象为一个既能滑动又能旋转的小铰链，使两块骨骼在手臂活动时保持同步。

两块骨骼之间有一个柔软的垫层，类似于密封垫圈。它缓冲关节并保持表面平滑滑动。随着时间推移，这个垫层会磨损。问题由此开始。关节表面开始相互摩擦，骨骼通过在边缘生长小的骨刺来做出反应。这就是磨损性关节炎。

这种关节炎通常从中年早期开始出现。它在从事大量重复性过头顶工作或重物搬运的人群中更为常见。即使是多年前发生的轻微肩关节脱位，也可能导致该关节日后出现疼痛性关节炎。

当关节磨损时，疼痛恰好出现在您感觉到的位置：肩部顶端的那个点。提重物、手臂横过身体以及侧卧在该侧都会使磨损的表面相互挤压，这就是为什么这些动作会引起疼痛。之前描述的疼痛来源是骨刺和粗糙的关节表面。

这里最关键的一点是：扫描显示的内容并不决定您的感受。许多人在该关节有关节炎却从未察觉。其中大多数人在随后的几年里保持无痛状态。另一些人仅有轻微的外观磨损，但确实感到疼痛。您的症状，而非扫描图像，才是指导任何治疗决策的依据。

我们能做什么

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会从适合您病情的最微创方案入手。患者通常由全科医生（GP）转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊，才有资格享受 Medicare 报销。在您的首次就诊时，我们会采集病史，检查您的肩部，并在必要时安排影像学检查。由于这是一种长期的磨损问题，我们通常首先采用非手术治疗。

第一步很简单：避免引发疼痛的活动，并在疼痛发作时进行冰敷。抗炎药物（可减轻疼痛和肿胀）常在早期使用。物理治疗旨在帮助关节恢复舒适的运动范围，并增强肩部周围肌肉的力量，从而分担关节的负荷。在考虑进一步治疗之前，请给予这些措施充分的尝试时间。

如果上述措施未能缓解症状，接下来是注射治疗。皮质类固醇注射将抗炎药物直接注入关节内。这有助于确认疼痛的来源，也能缓解疼痛本身。在约 47% 的人群中，注射后一年仍被视为治疗成功。并非所有人都能获得持久的缓解，但对于部分患者而言，它能带来一段较长的舒适期。

当上述所有措施后疼痛持续存在时，手术便成为选项。该手术切除锁骨远端的一小块骨片，从而阻止磨损且带有骨刺的表面相互摩擦。我们只会在较简单的治疗已尝试过之后才与您讨论手术方案，且决定始终由我们共同做出。

预期情况

对大多数人而言，这是一种进展缓慢的疾病，而非突发状况。疼痛往往随活动情况而波动：较重的活动会诱发疼痛，而较轻松的几周则会使其缓解。有些人发现通过简单的措施即可使病情稳定，并在很长一段时间内保持无症状。另一些人则发现病情持续数月或数年，在过度劳累时出现发作。

如果您没有疼痛，预后则较为明确。大多数在影像学检查中显示关节炎但无症状的人，在七年随访期内仍保持无症状状态。这种您无法感知的关节磨损通常会保持原样。

如果您的肩部已经出现疼痛，非手术治疗值得进行充分尝试。休息、物理治疗和抗炎药物可使许多人的症状得到缓解。如前所述，皮质类固醇注射在一年后对约半数接受注射的人仍被视为成功。当注射有效时，无论您的影像学检查显示磨损程度是严重还是轻微，似乎都无关紧要：两组人群在术后报告了相同程度的满意度。

如果尽管采取了上述所有措施，疼痛仍然存在，从锁骨远端切除一小块骨片的手术可以可靠地消除疼痛并改善肩部功能。这种缓解效果在随后的几年中持续存在，而不仅仅是在最初几个月。

如果不加干预，该关节的疼痛性关节炎通常不会损害肩部的其他结构。此处未治疗的磨损不会妨碍其他肩部修复手术的效果，也不是在其他肩部手术中切除部分锁骨的理由。不治疗的主要风险仅仅是疼痛持续存在。

一个诚实的提醒：手术并非万能药。每次手术都有其自身的一系列潜在并发症，精细的技术可以降低这些风险，但无法完全消除它们。在做出任何决定之前，我们会与您详细讨论实际情况，选择始终是我们共同做出的。

何时就医

如果肩部顶端的疼痛反复出现，尤其是在提举物体、手臂横过身体或侧卧于患侧时，请咨询您的全科医生。如果经过合理尝试后，简单的措施仍未缓解症状，或疼痛干扰睡眠或影响工作，请要求专科医生评估。如果疼痛尖锐且集中在肩部顶端的那一小块区域，则值得更早进行检查，因为该处的压痛是判断问题所在位置的有用线索。此病并非急症，无需当日紧急处理。但持续不缓解的疼痛值得仔细评估，因为前述治疗方法在问题长期困扰您之前效果最佳。

深入探讨

本节内容超出了您自身治疗决策所需的范围。肩锁关节（AC joint）的关节炎值得额外阅读，原因令人不适：它在影像学检查中极为常见，常被归咎为肩部疼痛的原因，而治疗该关节能带来益处的证据，比本站上几乎任何其他内容都更为薄弱。

现有证据未能证实任何疗法有效

一项针对原发性肩锁关节（AC joint）骨关节炎治疗的系统综述汇总了 1,902 例患者，并得出了一个极少被如此直白表述的结论：各研究在适应证、干预措施及质量方面存在差异，且未能提供证据表明非手术或手术干预均有效 [1]。

这并不等同于说没有任何疗法有帮助。这意味着旨在证明疗效的试验尚未达到足以支持该结论的标准。远端锁骨切除术是一项历史悠久的手术，其基于合理的力学逻辑，即去除磨损的关节面即可消除疼痛；但“历史悠久且力学上合理”并不等同于证据，在做出决策时，了解这一区别至关重要。

将其附加于其他手术并不会改善该手术的效果

最直接的检验来自同时接受其他手术的患者。在208例肩袖撕裂患者中，附加远端锁骨切除术并未带来更好的临床评分或更好的活动范围 [2]。

这一点至关重要，因为正是在这种情况下关节最常接受切除：外科医生已经进入肩关节，影像学显示肩锁关节存在退变，且切除几毫米的骨骼非常快捷。证据表明，患者并未获得可测量的获益。如果建议将其作为肩袖修复的附加手术，那么就此提出疑问是合理的。

技术并非关键问题

开放手术与关节镜切除术的比较已反复进行，结论一致： 在 319 例患者中，两种入路均显示出相似的功能和临床疗效 [3]， 此前对 429 例患者的比较也未明确倾向于任何一方 [4]。

当两种截然不同的技术方法产生相同的结果时，诚实的推断是： 决定疗效的不是技术，而是患者选择。

为何在此处的选择如此困难

随着衰老，几乎所有人的肩锁关节（AC joint）都会发生退变。这是一个小而承受高负荷的关节，其关节盘较薄且早期磨损，因此扫描报告中描述的肩锁关节退变在中老年人群中更接近预期发现，而非诊断结果。

存在可测量的结构对应关系：在有症状的退变性肩锁关节中，远端锁骨和肩峰均增大，而在无症状人群中，两者之间的关系保持不变 [5]。这是一个有用的提示，表明有症状的退变与偶然发现的退变在结构上存在差异，但这是一个群体层面的观察结果，而非可应用于您肩部的测试。

实际上，这正是为什么在此处关节内诊断性注射具有实际分量的原因。如果局部麻醉药准确注入肩锁关节后疼痛消失，则该关节很可能是疼痛来源。如果疼痛未消失，则扫描上的退变可能只是旁观者，切除它不太可能有帮助，这正是上述证据所警示的情况。

参考文献

[1] Welch M, Rankin S, How Saw Keng M, Woods D. 原发性肩锁关节骨关节炎治疗的系统综述。Shoulder Elbow. 2023;16(2):129-44. https://doi.org/10.1177/17585732231157090

[2] Wang J, Ma J, Zhu S, Jia H, Ma X. 远端锁骨切除术能否减轻肩袖撕裂患者的疼痛或改善肩部功能？一项荟萃分析。Clin Orthop Relat Res. 2018;476(12):2402-14. https://doi.org/10.1097/CORR.0000000000000424

[3] Hohmann E, Tetsworth K, Glatt V. 开放与关节镜下肩锁关节切除术：系统综述与荟萃分析。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. 开放与关节镜下远端锁骨切除术。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. 正常及有症状的退行性肩锁关节中肩峰与远端锁骨的关系。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

[1] Choice of Acromioclavicular Dislocation Treatment Should Not Be Influenced by Risk of Development of Acromioclavicular Osteoarthritis. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.24.00085

[2] Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full‐thickness rotator cuff tear. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3114-2

[3] Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.004

[4] Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06098-y

[5] The Role of Arthroscopy in Revision of Failed Open Anterior Stabilization of the Shoulder. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.073

[6] Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519862850

[7] Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.00073

[8] The incidence and treatment of symptomatic acromioclavicular joint osteoarthritis following total shoulder arthroplasty. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221114796

[9] Biplanar Reconstruction With Pectoralis Minor Tendon and Coracoacromial Ligament Transfer for Chronic Acromioclavicular Joint Dislocations. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103104

[10] Limited distal clavicle excision of acromioclavicular joint osteoarthritis. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.01.008

[11] Editorial Commentary: Why We Have To Respect The Anatomy In Acromioclavicular Joint Surgery And Why Clinical Shoulder Scores Might Not Give Us The Information We Need!. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.01.038

[12] The relationship of the acromion to the distal clavicle in normal and symptomatic degenerated acromioclavicular joints. Archives of Orthopaedic and Trauma Surgery. 2019. DOI: 10.1007/s00402-019-03258-9

[13] Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty. JSES International. 2022. DOI: 10.1016/j.jseint.2021.11.008

[14] Degenerative Joint Disease of the Acromioclavicular Joint. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513485359

[15] Aaos Comprehensive Orthopaedic Review 3. Disorders of the Acromioclavicular Joint > III. Atraumatic and Degenerative Conditions of the AC Joint.

[16] Aaos Comprehensive Orthopaedic Review 3. Disorders of the Acromioclavicular Joint > II. Traumatic Conditions of the AC Joint.

[17] Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2017.11.001

[18] Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.014

[19] Successful Conservative Therapy in Rockwood Type V Acromioclavicular Dislocations. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00017

[22] No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-020-06377-8

[24] Isolated acromioclavicular osteoarthritis and steroid injection. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00311

[26] Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119844295

[27] Mid- to long-term success rate and functional outcomes of acromioclavicular injections in patients with acromioclavicular osteoarthritis. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00031

[28] The ligamentous injury pattern in acute acromioclavicular dislocations and its impact on clinical and radiographic parameters. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.10.026

[29] Painful Conditions of the Acromioclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199905000-00004

[30] Surgical treatment of acromioclavicular dislocation: A review of 39 patients. Injury. 1983. DOI: 10.1016/0020-1383(83)90092-x

[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

[41] Orthopaedic Knowledge Update Sports Medicine 6. Disorders of the Acromioclavicular Joint, Sternoclavicular Joint, and Clavicle > AC Joint Injuries.

[46] Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon’s experience. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03630-0

[48] Osteoarthritis after rotator cuff repair: A 10-year follow-up study. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.03.007

[50] Disruption of the acromioclavicular joint: surgical anatomy and biological reconstruction. Injury. 1980. DOI: 10.1016/s0020-1383(80)80045-3

[51] All‐Arthroscopic Weaver‐Dunn‐Chuinard Procedure With Double‐Button Fixation for Chronic Acromioclavicular Joint Dislocation. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.08.008

[56] Arthroscopic Coracoclavicular Ligament Reconstruction With Double‐Bundle Soft Tissue Allograft for Chronic Type V Acromioclavicular Dislocations Shows Excellent Patient Outcomes and Return to Duty and Sport at Minimum 10‐Year Follow‐Up. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.05.008

[60] Histologic and magnetic resonance image evaluation in acromioclavicular joint osteoarthritis. JSES International. 2020. DOI: 10.1016/j.jseint.2020.03.007

[61] Concomitant open distal clavicle excision is associated with greater improvement in range of motion without increased risk of acromial stress fracture after reverse total shoulder arthroplasty: a retrospective cohort study. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00465

[64] Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament. Outcomes at 12 months. Orthopaedics & Traumatology: Surgery & Research. 2011. DOI: 10.1016/j.otsr.2010.10.004

[65] Is Arthroscopic Distal Clavicle Resection Necessary for Patients With Radiological Acromioclavicular Joint Arthritis and Rotator Cuff Tears?. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514547254

[67] Acromioclavicular joint injuries: diagnosis, classification and ligamentoplasty procedures. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170027

[68] Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.12.015

[69] Effect of Acromioclavicular Joint Injuries on the Acromioclavicular Joint Complex and Scapulohumeral Rhythm: A Functional and Mechanical Perspective. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00360

[70] Acute grade III and IV acromioclavicular dislocations: Outcomes and pitfalls of reconstruction procedures using a synthetic ligament. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.06.004

专业协会这些代表什么？→