What is the current treatment for a 45-year-old female with mild acromioclavicular (AC) joint arthropathy and labral thickening in the axillary area suggestive of frozen shoulder, who experiences limitation of range of motion and soreness after engaging in jiujitsu?

Treatment of Mild AC Joint Arthropathy with Labral Thickening Suggestive of Frozen Shoulder

For this 45-year-old female jiujitsu athlete with mild AC joint arthropathy and findings suggestive of frozen shoulder, initiate conservative management with activity modification, oral analgesics (acetaminophen 650-1000 mg every 6 hours as first-line), and consider image-guided corticosteroid injection to the AC joint for short-term pain relief, while implementing stage-appropriate physical therapy focusing on range of motion restoration. 1, 2, 3

Initial Conservative Management Approach

Pain Control Strategy

• Start with acetaminophen 650-1000 mg every 6 hours (maximum 4 grams daily) as first-line analgesic therapy, particularly given the patient's age and to avoid NSAID-related gastrointestinal, renal, and cardiovascular risks 4
• Oral anti-inflammatories can be considered for short-term use if acetaminophen provides insufficient relief, though prolonged NSAID use should be avoided 1

Activity Modification

• Modify jiujitsu training to avoid positions that stress the AC joint and limit extreme ranges of motion that exacerbate symptoms 1
• Activity modification is emphasized as a core component of AC joint arthropathy management, as therapeutic exercise plays only a minor role in this specific condition 1

Corticosteroid Injection for AC Joint Arthropathy

Evidence for Injection Therapy

• Image-guided corticosteroid injection into the AC joint provides significant short-term pain relief and partial improvement in range of motion, particularly in extension and horizontal flexion 3
• In patients with radiographic evidence of degenerative AC joint disease, injection produces significant improvement in horizontal flexion range (p < 0.05) 3
• Pain scores improve significantly (p < 0.001) two weeks post-injection 3

Important Caveat

• Corticosteroid injections do not alter the natural progression of AC joint osteoarthritis, and their judicious use remains somewhat controversial among experts 1
• If diagnostic local anesthetic injection provides relief, this supports proceeding with corticosteroid injection 1

Stage-Appropriate Management for Frozen Shoulder Component

Understanding the Clinical Stages

The frozen shoulder component follows three distinct stages, each lasting 4-6 months, requiring stage-adjusted treatment 2:

Stage 1 ("Freezing"): Progressive loss of passive motion with worsening pain

• Analgesics and joint injections are recommended 2
• This patient's presentation with limitation of range of motion and soreness suggests she may be in this stage

Stage 2 ("Frozen"): Continuing stiffness with improvements in pain and inflammation

• Physiotherapy combined with manual therapy becomes the primary intervention 2

Stage 3 ("Thawing"): Restriction decreases and ROM increases

• Continue physiotherapy and manual therapy 2

Physical Therapy Considerations

For Acute Presentation (Duration < 2 months)

• Focus on range of motion exercises, particularly external rotation and abduction, as these correlate most significantly with joint space capacity improvement 5
• External rotation improvement correlates most significantly with increased joint space capacity (r = 0.77, p < 0.05), followed by abduction (r = 0.43) 5
• Avoid overhead pulleys initially, as uncontrolled abduction may stress the affected structures 6

For Chronic Presentation (Duration > 2 months)

• ROM restoration can occur independent of joint space capacity changes 5
• Stretching of contracted soft tissues around the shoulder, beyond just the adhesive capsule, contributes to recovery in chronic cases 5

Escalation Criteria if Conservative Management Fails

Minimum Conservative Trial Period

• A minimum of 6 months of unsuccessful conservative treatment should be completed before considering surgical options 1

Surgical Considerations for AC Joint

• Open or arthroscopic distal clavicle resection is indicated after failed conservative management 1

Surgical Considerations for Frozen Shoulder

• Passive exercise under interscalene block, manipulation under general anesthesia, or arthroscopic arthrolysis should be considered if conservative measures fail 2

Clinical Monitoring

Follow-up Assessment

• Document range of motion measurements at each visit using standardized techniques to objectively track treatment response 3
• Monitor pain scores using visual analogue scale 3
• The condition is self-limiting and may resolve with partial restitution, though the full course can take 12-18 months 2

Key Clinical Pitfalls to Avoid

• Do not overlook the AC joint as a pain source when evaluating shoulder pain, as it is frequently neglected despite being a common cause 1
• Physical therapy has limited benefit specifically for AC joint arthropathy itself, unlike other shoulder conditions where it plays a major role 1
• The frozen shoulder component is benign and follows a regular course; avoid overly aggressive early intervention 2
• Proper diagnosis of AC joint arthropathy requires thorough physical exam, plain-film radiograph, and diagnostic local anesthetic injection 1