Arthritis of the AC joint leads to pain at the top of the shoulder. This happens more frequently in laborers and weight-lifters, but is very common in the general population as well. The diagnosis of AC joint arthritis is best made on physical examination. This is because arthritic changes of the AC joint are extremely common on X-rays and MRI. In fact, 90% of people over the age of 30 have AC joint arthritis on X-ray and/or MRI. However, seeing some arthritis on X-ray or MRI doesn’t mean that the AC joint is actually causing pain; more commonly, it is a ‘red herring’, and not the cause of problems.
If pain is coming from the AC joint, the first treatment is non-operative. Weight-lifters can try widening or narrowing their grip on the bar to see if helps. A steroid injection can be helpful, at least temporarily. If the steroid wears off, then the pain can be lived with or addressed surgically.
The surgery involves removing a small amount, 5-7 mm, of bone from the outside of the clavicle. This creates a space where the AC joint was so that the two bones, the acromion and the clavicle, don’t rub together anymore. Distal clavicle excision can usually be accomplished arthroscopically, except in circumstances where a bone spur has grown so far outside the joint that an open incision is required to remove it.
The distal clavicle excision is usually performed in conjunction with any other necessary arthroscopic shoulder procedures. Arthroscopic distal clavicle excision requires no specific post-operative activity limitations. While the bone may be sore for a few months, this procedure usually provides lasting relief from the pain of AC joint arthritis. Distal clavicle excision is a commonly performed very successful outpatient procedure that has been performed for decades and has “stood the test of time”.