From the Research
Mild to moderate acromioclavicular joint osteoarthritis can be effectively managed with conservative treatments, and surgical options should only be considered if these measures fail after 3-6 months. The most recent and highest quality study, 1, a systematic review of the treatment of primary acromioclavicular joint osteoarthritis, found that both non-operative and operative interventions are effective, but there was no significant difference between open or arthroscopic distal clavicle excision.
Conservative Management
Conservative treatments should be the initial approach, including:
- Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) 1
- Applying ice to the affected shoulder for 15-20 minutes several times daily to reduce inflammation
- Physical therapy focusing on shoulder strengthening and range-of-motion exercises, aiming for 2-3 sessions weekly for 4-6 weeks
- Activity modification to avoid overhead movements and heavy lifting to prevent symptom exacerbation
Corticosteroid Injections
For persistent pain, consider a corticosteroid injection (typically methylprednisolone 40mg mixed with lidocaine) into the AC joint, which may provide relief for several months, as shown in 1.
Surgical Options
If conservative measures fail after 3-6 months, surgical options like distal clavicle resection might be considered, but most patients improve with non-surgical management, as found in 2. The decision to proceed with surgery should be based on individual patient needs and the severity of symptoms.
Key Considerations
- The presence of symptomatic ACJ osteoarthritis does not necessarily require routine distal clavicle excision, even in patients undergoing arthroscopic rotator cuff repair, as found in 2
- Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure, and routine distal clavicle excision is not absolutely necessary, as shown in 2