What is the initial treatment for mild to moderate degenerative acromioclavicular joint arthrosis?

Initial Treatment for Mild to Moderate Degenerative Acromioclavicular Joint Arthrosis

The initial treatment for mild to moderate degenerative acromioclavicular (AC) joint arthrosis should consist of conservative management with nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, activity modification, and possibly corticosteroid injections for 6-12 months before considering surgical intervention.

Conservative Management Approach

First-Line Treatments

• NSAIDs should be initiated as part of initial therapy to reduce inflammation and pain, after evaluating gastrointestinal, renal, and cardiovascular status 1, 2
• Physical therapy focusing on strengthening exercises and range of motion should be prescribed for a period of 6-12 months 1, 3
• Activity modification with avoidance of exacerbating activities (particularly overhead movements) is essential during the initial treatment phase 1, 4

Second-Line Treatments

• Intra-articular corticosteroid injections can be considered when NSAIDs and physical therapy provide inadequate relief 5, 2
  • For AC joint injections, a single injection can provide significant pain relief, though effects may be temporary 5
  • Long-acting corticosteroids are preferred for intra-articular injections to maximize duration of effect 5

Treatment Duration

• Conservative management should be attempted for a minimum of 6 months and up to 12 months before considering surgical options 1, 2
• The majority of patients respond well to conservative management 1, 4

Monitoring and Progression

• Regular assessment of pain levels, functional limitations, and response to treatment should guide progression of therapy 5
• If symptoms persist despite 6-12 months of appropriate conservative management, surgical options may be considered 1, 6

Surgical Considerations

• Surgical intervention should only be considered after failure of comprehensive conservative management 1, 2
• Arthroscopic distal clavicle resection is the preferred surgical approach when conservative management fails 6, 2
• The arthroscopic technique offers advantages of rapid rehabilitation with excellent functional results compared to open procedures 1, 6

Common Pitfalls and Caveats

• Failure to adequately trial conservative management before considering surgery 1, 2
• Inadequate duration of conservative treatment (should be 6-12 months) 1, 3
• Overlooking activity modification as a critical component of treatment 4, 3
• Not considering corticosteroid injections as an intermediate step before surgery 5, 2

Special Considerations

• Manual laborers and overhead athletes may experience more persistent symptoms but should still undergo initial conservative management 4, 3
• Patients with concomitant shoulder pathology (such as rotator cuff disease) may require additional treatment approaches 2
• Elderly patients or those with significant comorbidities may benefit from longer trials of conservative management before considering surgical options 2