Treatment of Acromioclavicular (AC) Joint Bursitis
The optimal treatment for AC joint bursitis consists of rest, ice application, NSAIDs, and intra-articular corticosteroid injections when conservative measures fail. 1, 2
Diagnostic Approach
- Standard radiographs (AP, lateral, axillary views) should be obtained to assess for underlying bone abnormalities, calcifications, or joint degeneration
- Ultrasound can help distinguish bursitis from other soft tissue pathologies
- MRI may be necessary in cases with complex anatomical variations or when symptoms persist despite treatment
Treatment Algorithm
First-Line Treatment (0-4 weeks)
- Conservative Management
- Rest and activity modification: Avoid movements that exacerbate symptoms
- Ice application: Apply ice or cool packs for 15-20 minutes several times daily
- NSAIDs: Naproxen 500mg twice daily or ibuprofen 400-800mg three times daily for 1-2 weeks 3
- Physical therapy: Focus on gentle range of motion exercises and gradual strengthening
Second-Line Treatment (4-8 weeks)
If symptoms persist after 4 weeks of conservative management:
- Corticosteroid Injection
- Intra-articular injection of long-acting corticosteroid (e.g., betamethasone 6mg with 1% lidocaine) 1, 4
- Proper aseptic technique is mandatory, including surgical gloves, skin preparation, and changing needles between drawing medication and injecting 2
- Limit injections to no more than 3-4 per year to avoid tendon weakening and other complications
Third-Line Treatment (8-12 weeks)
If symptoms persist after corticosteroid injection:
- Advanced Rehabilitation
- Progressive strengthening exercises focusing on the rotator cuff and scapular stabilizers
- Manual therapy techniques to improve joint mobility
- Functional exercises specific to patient's occupational or recreational activities
Refractory Cases (>12 weeks)
For cases not responding to conservative measures and injections:
- Surgical Intervention
- Arthroscopic bursectomy and/or AC joint resection may be considered
- Surgery should only be considered after failure of 3-6 months of well-managed conservative treatment 2
Special Considerations
Medication Precautions
- NSAIDs should be used with caution in patients with renal impairment, cardiovascular disease, or gastrointestinal risk factors
- Consider gastroprotective agents for patients at high risk of GI complications 1
- Acetaminophen can be used as an alternative if NSAIDs are contraindicated 2
Injection Technique
- Proper positioning of the patient is crucial for accurate needle placement
- Post-injection care includes avoiding overuse of the injected area for 24 hours
- Provide clear instructions for monitoring and follow-up 2
Common Pitfalls to Avoid
- Failing to rule out infection before administering corticosteroid injections
- Overreliance on injections without addressing underlying biomechanical issues
- Returning to full activity too quickly after symptom resolution
- Neglecting to strengthen the surrounding musculature to prevent recurrence
Follow-up and Monitoring
- Regular assessment at 2,6, and 12 weeks to evaluate pain levels, range of motion, and functional improvement
- Consider referral to a specialist if no improvement occurs after 6-8 weeks of conservative treatment 2
- Return to full activity is permitted when the patient demonstrates complete resolution of pain, full range of motion, and strength symmetry compared to the uninjured side
By following this structured approach to AC joint bursitis treatment, most patients will experience significant improvement in symptoms and function without the need for surgical intervention.