Management of Acromioclavicular Joint Degenerative Changes with Glenoid Osteophytes
X-ray Interpretation Summary
Your imaging shows chronic degenerative changes in the AC joint with early glenohumeral arthritis (glenoid osteophytes), but no fracture or acute injury requiring immediate surgical intervention. 1, 2
First-Line Conservative Management
Begin with a structured conservative approach combining pain control, activity modification, and physical therapy—this is the standard of care for AC joint osteoarthritis without acute injury. 1, 2
Pain Management Algorithm
Start with acetaminophen (up to 4 grams daily) as first-line therapy, which provides comparable pain relief to NSAIDs without gastrointestinal toxicity 2
Add topical NSAIDs (diclofenac gel, methyl salicylate) to the AC joint region for localized pain relief without systemic side effects 1, 2
If inadequate relief after 2 weeks, trial oral NSAIDs (ibuprofen 400-600mg TID or naproxen 500mg BID), but limit duration to minimize gastrointestinal, renal, and cardiovascular risks 1, 2
Consider intra-articular corticosteroid injection into the AC joint if pain persists despite oral medications—this provides targeted relief for inflammatory flares and can be both diagnostic and therapeutic 2, 3, 4
Physical Therapy Protocol
Avoid overhead pulleys which encourage uncontrolled abduction and may worsen AC joint pain 2
Focus on range of motion exercises emphasizing external rotation and abduction through controlled stretching and mobilization techniques 2
Progress to strengthening exercises of the rotator cuff and scapular stabilizers once pain-free range is achieved 1
Apply ice for 10-minute periods through a wet towel after activities to reduce pain and inflammation 1
Duration of Conservative Trial
Commit to at least 6 months of conservative management before considering surgical options—this is the evidence-based threshold used in most surgical studies for AC joint osteoarthritis. 4
- Most patients with AC joint OA respond adequately to non-operative treatment 5, 4
- Injection therapy shows mean 50% improvement in pain levels at 7.5 months follow-up 4
- The tiny glenoid osteophytes indicate early glenohumeral arthritis but do not change initial management 1
Indications for Surgical Referral
Refer to orthopedic surgery only if persistent pain and functional limitations remain after 6 months of appropriate conservative management. 5, 4
Specific surgical indications include:
- Persistent pain interfering with activities of daily living or work despite 6+ months of conservative care 4
- Large, distally projecting osteophytes causing mechanical impingement symptoms 3
- Failed injection therapy (no relief after 2-3 AC joint corticosteroid injections) 4
Surgical options when indicated:
- Arthroscopic distal clavicle excision (0.5-2 cm resection) is the gold standard procedure with mean functional outcomes of 87.8% 4
- No significant difference exists between open versus arthroscopic approaches—both yield good outcomes 4
Critical Pitfalls to Avoid
Do not assume this requires surgery based on radiographic findings alone—degenerative changes are common and often asymptomatic 1
Do not use NSAIDs long-term without gastroprotection, especially in patients over 60 or with cardiovascular risk factors 2
Do not ignore the glenoid osteophytes—while they don't change initial treatment, they indicate early glenohumeral OA that may become symptomatic and require separate management 1
Do not inject the AC joint without proper technique—the joint space is small and requires precise needle placement for therapeutic benefit 3, 4
Expected Outcomes
- Conservative management succeeds in the majority of AC joint OA cases when properly implemented 5, 4
- Patients may retain a visible "step deformity" at the AC joint even with successful pain relief—this cosmetic finding does not correlate with functional outcomes 6
- The degenerative changes are permanent, but symptoms can be effectively controlled 1, 4