From the Research
The management plan for a patient with hypertrophic bony changes at the acromioclavicular (AC) joint should prioritize conservative treatment, with surgical options considered only if conservative measures fail to provide relief, as supported by the most recent and highest quality evidence 1. The initial management includes:
- Rest and activity modification to avoid painful overhead movements
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation
- Physical therapy focusing on rotator cuff strengthening, scapular stabilization, and range of motion exercises for 6-8 weeks, with 2-3 sessions per week If conservative measures fail to provide relief, a corticosteroid injection into the AC joint (typically 1-2ml of methylprednisolone 40mg/ml mixed with 1ml of 1% lidocaine) can be administered, with effects lasting 3-6 months. For patients with persistent symptoms despite these interventions, surgical management may be considered, typically involving distal clavicle resection (Mumford procedure) either arthroscopically or through open surgery, as recommended by studies such as 2 and 3. Post-surgical rehabilitation includes immobilization for 1-2 weeks followed by progressive range of motion exercises and strengthening over 3-4 months. It is essential to note that hypertrophic AC joint changes often result from degenerative arthritis, repetitive overhead activities, or previous trauma, causing pain through mechanical impingement on surrounding soft tissues and inflammation, as discussed in studies such as 4 and 5.