From the Research
Treatment for acromioclavicular (AC) joint disease should begin with conservative management, including rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs), with surgical options reserved for patients with persistent pain and functional limitations despite adequate conservative management, as supported by the most recent study 1.
Conservative Management
Conservative management includes:
- Rest, ice, and NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation
- Activity modification to avoid overhead movements and heavy lifting during the acute phase
- Physical therapy focusing on rotator cuff and scapular strengthening exercises, typically for 6-8 weeks, after the acute pain subsides
- Intra-articular corticosteroid injections, such as methylprednisolone 40mg mixed with lidocaine 1%, for persistent pain, limited to 2-3 injections per year to prevent tendon weakening and cartilage damage
Surgical Options
Surgical options, including distal clavicle resection (Mumford procedure) or AC joint reconstruction for cases with instability, are typically reserved for patients with chronic AC joint arthritis unresponsive to conservative measures for at least 6 months, as discussed in 2 and 3.
Treatment Approach
The treatment approach should be tailored based on the severity of disease, patient age, activity level, and functional demands, considering the potential benefits and risks of each treatment option, as highlighted in 4 and 1.
Key Considerations
Key considerations in the management of AC joint disease include:
- Patient selection for surgical treatment, with factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain, as discussed in 5 and 3
- The potential benefits and risks of each treatment option, including the use of corticosteroid injections and manual therapy, as compared in 1