From the Guidelines
The best initial management for a step deformity at the AC joint with early arthritis is conservative treatment, focusing on reducing pain and inflammation, and improving shoulder mechanics. This approach is based on the principles outlined in the American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee 1. While these guidelines do not specifically address AC joint arthritis, the recommended management strategies for osteoarthritis in other joints can be applied to the AC joint, given the similar goals of reducing pain and inflammation, and improving joint function. Key components of conservative management include:
- Oral non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen to reduce pain and inflammation
- Activity modification to avoid aggravating symptoms
- Ice application to reduce pain and inflammation
- Physical therapy focusing on rotator cuff and scapular stabilization exercises to improve shoulder mechanics
- Consideration of a corticosteroid injection for temporary relief of persistent symptoms. It is essential to prioritize conservative management, as many AC joint deformities remain asymptomatic or minimally symptomatic with proper management, and the natural history of early AC arthritis often responds well to non-surgical interventions 1. Surgical options should only be considered after conservative measures have failed for at least 3-6 months.
From the Research
Initial Management for Step Deformity at the AC Joint
The initial management for a step deformity at the AC joint in keeping with early arthritis can be considered based on the following points:
- Non-surgical treatment is typically recommended for type I and II injuries, which may include immobilization, pain medication, cryotherapy, and physiotherapy 2, 3.
- For more severe injuries, such as type III and V, the decision between non-surgical and surgical treatment is more controversial, and the optimal approach may depend on various factors, including the patient's overall health and activity level 2, 4.
- Surgical techniques for AC joint reconstruction have been extensively studied, and various methods have been described, including coracoclavicular screw fixation, coracoacromial ligament transfer, and anatomic CC ligament reconstruction 2, 5.
- The use of intra-articular non-steroidal anti-inflammatory drug (NSAID) injections has been explored as a potential treatment option for osteoarthritis-related pain, including in the AC joint, and may offer a beneficial alternative to traditional treatments 6.
Considerations for Treatment
When considering the initial management for a step deformity at the AC joint, the following factors should be taken into account:
- The severity of the injury and the degree of joint instability
- The patient's overall health and activity level
- The potential risks and benefits of non-surgical versus surgical treatment
- The availability and efficacy of various surgical techniques and rehabilitation protocols
- The potential role of intra-articular NSAID injections in managing osteoarthritis-related pain 2, 4, 6, 3, 5.