Acromioclavicular Arthritis: Difference between revisions
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== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
To learn about [[Acromioclavicular Joint|Acromioclavicular joint.]] | To learn about [[Acromioclavicular Joint|Acromioclavicular joint here.]] | ||
== Epidemiology == | == Epidemiology == | ||
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* The most sensitive tests for ACJ pain are acromioclavicular point tenderness and the [[Paxino's test|Paxinos test.]]<ref name=":1" /> | * The most sensitive tests for ACJ pain are acromioclavicular point tenderness and the [[Paxino's test|Paxinos test.]]<ref name=":1" /> | ||
* | * [[Resisted AC Joint Extension Test|Resisted AC joint extension test]] also helps to identify AC joint pathology. | ||
* Acromioclavicular joint involvement can be confirmed by an injection of a local anesthetic. Injection of 0.5–2 mL of 1% or 2% lidocaine or 0.5 mL of 0.25 or 0.5% bupivacaine into the AC joint should provide a significant reduction in symptoms. A continuation of pain following anesthetic injection suggests other shoulder pathologies, most commonly rotator cuff injury.<ref name=":0" /> | * Acromioclavicular joint involvement can be confirmed by an injection of a local anesthetic. Injection of 0.5–2 mL of 1% or 2% lidocaine or 0.5 mL of 0.25 or 0.5% bupivacaine into the AC joint should provide a significant reduction in symptoms. A continuation of pain following anesthetic injection suggests other shoulder pathologies, most commonly rotator cuff injury.<ref name=":0" /> | ||
* Radiographic images: | * Radiographic images: | ||
Revision as of 12:18, 22 January 2021
Original Editor - User Name
Top Contributors - Manisha Shrestha, Lucinda hampton, Kim Jackson and Jacob Bischoff
Introduction[edit | edit source]
Osteoarthritis is the most common cause of shoulder pain originating from the acromioclavicular (AC) joint. It is a frequent finding in middle-aged people.[1] Most of the patients are asymptomatic, and they may present as an incidental finding in shoulder X-Ray or Magnetic resonance imaging (MRI). Patients may present with complaints of pain over the joint while doing overhead and cross-body activities.[2] AC joint arthritis is caused due to early degeneration of the cartilage and intraarticular disc.
Arthritis is often associated with distal clavicular osteolysis.[3] Damage to the ACJ can be synchronous with damage to the supraspinatus tendon and osteophytes from the arthritic joint may contribute to subacromial impingement exacerbating and producing further shoulder pain.[3]
Clinically Relevant Anatomy[edit | edit source]
To learn about Acromioclavicular joint here.
Epidemiology[edit | edit source]
The incidence of ACJ pain is reported to be between 0.5 to 2.9/1000/year in primary care.[3]
Etiology[edit | edit source]
Type of AC joint arthritis: based on the etiology
- Primary osteoarthritis: It is articular degeneration without any apparent underlying cause. It more commonly affects the AC joint than a glenohumeral joint. It develops as a consequence of constant stress on the joints, often in people who perform repeated overhead lifting activities.
- Secondary osteoarthritis: It is due to other associated causes like post-trauma or other underlying diseases such as rheumatoid arthritis. Post-traumatic AC joint arthritis is even more prevalent due to the high incidence of injury to the joint. Arthritic symptoms have been demonstrated in Grade I and II sprains of the AC joint in 8% and 42% of patients, respectively.[1]
Diagnosis[edit | edit source]
Accurate diagnosis and localization of pathology to the AC joint is vital in determining the correct treatment protocol in order to avoid persistent shoulder pain. The proper diagnosis of acromioclavicular joint osteoarthritis requires a thorough physical exam, plain-film radiograph, and a diagnostic local anesthetic injection.[4]
History[edit | edit source]
- History of trauma: direct impact on the joint or a fall on an outstretched arm.
- Occupational history: an occupation that requires repeated overhead activities,
On examination[edit | edit source]
- AC joint may be tender to palpation.
- Pain elicited by the motion of forward flexion to 90° with horizontal adduction (cross-over test) or straight-ahead pushing (as in the bench press exercise).[1]
- The most sensitive tests for ACJ pain are acromioclavicular point tenderness and the Paxinos test.[3]
- Resisted AC joint extension test also helps to identify AC joint pathology.
- Acromioclavicular joint involvement can be confirmed by an injection of a local anesthetic. Injection of 0.5–2 mL of 1% or 2% lidocaine or 0.5 mL of 0.25 or 0.5% bupivacaine into the AC joint should provide a significant reduction in symptoms. A continuation of pain following anesthetic injection suggests other shoulder pathologies, most commonly rotator cuff injury.[1]
- Radiographic images:
- are the initial diagnostic imaging modality of choice, with anterior-posterior views demonstrating degenerative changes, subchondral cysts, sclerosis, osteophytes, and joint-space narrowing.
- The Zanca view, which consists of angling the X-ray source 10–15° superiorly and decreasing the kilovoltage to 50% standard exposure, is helpful in evaluating AC joint pathology by allowing visualization of distally projecting osteophytes of the acromion.
- Magnetic resonance imaging has the ability to detect capsular hypertrophy, effusions, and subchondral edema.
Differential Diagnosis[edit | edit source]
- Calcific tendonitis
- Glenohumeral arthritis
- Adhesive capsulitis
- Rotator cuff impingement syndrome[1]
Management[edit | edit source]
Resources[edit | edit source]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Docimo S, Kornitsky D, Futterman B, Elkowitz DE. Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Current Reviews in Musculoskeletal Medicine. 2008 Jun 1;1(2):154-60.
- ↑ Vaishya R, Damor V, Agarwal AK, Vijay V. Acromioclavicular arthritis: A review. Journal of arthroscopy and joint surgery. 2018 May 1;5(2):133-8.
- ↑ 3.0 3.1 3.2 3.3 Chaudhury S, Bavan L, Rupani N, Mouyis K, Kulkarni R, Rangan A, Rees J. Managing acromio-clavicular joint pain: a scoping review. Shoulder & Elbow. 2018 Jan;10(1):4-14.
- ↑ Buttaci CJ, Stitik TP, Yonclas PP, Foye PM. Osteoarthritis of the acromioclavicular joint: a review of anatomy, biomechanics, diagnosis, and treatment. American journal of physical medicine & rehabilitation. 2004 Oct 1;83(10):791-7.
