From the Guidelines
Treatment for moderate to severe AC joint osteoarthritis should begin with conservative measures, including rest, ice, and over-the-counter NSAIDs, followed by physical therapy and potentially a corticosteroid injection, with surgical options considered for persistent severe symptoms. The condition results from wear and tear of the cartilage between the acromion and clavicle, often age-related or due to repetitive overhead activities, causing pain particularly with cross-body movements and overhead activities.
Conservative Management
- Rest and ice for 15-20 minutes several times daily to reduce pain and inflammation
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily with food) for pain and inflammation 1
- Physical therapy focusing on shoulder strengthening and range of motion exercises, recommended 2-3 times weekly for 4-6 weeks
Interventional Management
- A corticosteroid injection into the AC joint (typically containing 40mg methylprednisolone mixed with lidocaine) may provide temporary relief for 3-6 months if pain persists
- Activity modification to avoid overhead movements and heavy lifting is important
Surgical Management
- For persistent severe symptoms unresponsive to these treatments for 3-6 months, surgical options including distal clavicle resection (Mumford procedure) could be considered, as suggested by studies on shoulder osteoarthritis management 1
From the Research
Diagnosis and Treatment of AC Joint Osteoarthrosis
- The diagnosis of AC joint osteoarthrosis requires a thorough physical exam, plain-film radiograph, and a diagnostic local anesthetic injection 2.
- Initial treatment options for AC joint osteoarthrosis include oral analgesics or anti-inflammatories and activity modification 2, 3.
- Physical therapy has limited benefits in treating AC joint osteoarthrosis, but may be used in conjunction with other treatments 2.
- Corticosteroid injections may provide short-term pain relief, but their use is controversial and they do not alter the natural progression of the disease 2, 3.
Surgical Options
- Surgical options for AC joint osteoarthrosis include open or arthroscopic distal clavicle resection, which are typically considered after at least 6 months of unsuccessful conservative treatment 2, 3.
- The choice of surgical approach depends on factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain 3.
- Patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthrosis are important considerations in determining the best course of treatment 3.
Alternative Treatment Options
- Intra-articular non-steroidal anti-inflammatory drug (NSAID) injections may be a safe and efficacious alternative to traditional treatments for osteoarthritis, including AC joint osteoarthrosis 4.
- IA NSAIDs have been shown to have a similar efficacy to oral NSAIDs and intra-articular corticosteroids in treating OA-related pain, with a potentially lower risk of systemic side effects 4.