Acromioclavicular Osteoarthritis Treatment

Many nonsurgical treatments, such as rest and medication, can control the pain associated with acromioclavicular osteoarthritis (AC joint arthritis). When nonsurgical treatments fail to relieve persistent, moderate-to-severe pain, shoulder surgery may be an option.

Nonsurgical Treatments for Acromioclavicular Osteoarthritis

Most people who have AC joint arthritis will never need surgery. The recommended nonsurgical treatments include:

Activity modification
Certain activities and exercise will aggravate the acromioclavicular joint. Weight lifting, golfing, and other exercise that requires cross-body arm movement should be avoided if they cause pain. Other daily activities may need to be avoided and alternatives identified.

See Aerobic Exercise for Shoulder Arthritis

Warm or cold compress
People can loosen a stiff AC joint by using moist heat, such as a warming pad or whirlpool, for a few minutes before activity. Icing the shoulder joint for 15 to 20 minutes after activity can decrease swelling and provide some immediate pain relief. These treatments provide temporary symptom relief, and do not treat the underlying causes of AC joint osteoarthritis.

See When and Why to Apply Heat to an Arthritic Joint and 9 Easy Ways to Apply Heat to an Arthritic Joint

Physical therapy
In contrast to treatment for hip osteoarthritis and knee osteoarthritis, which emphasizes physical therapy, experts have found physical therapy less effective for people who have isolated acromioclavicular arthritis.¹Pennington RG, Bottomley NJ, Neen D, Brownlow HC. Radiological features of osteoarthritis of the acromioclavicular joint and its association with clinical symptoms. J Orthop Surg (Hong Kong). 2008 Dec;16(3):300-2. PubMed PMID: 19126894. However, depending on the patient, co-existing conditions, and the specific physical therapy program, exercises that focus on stretching and strengthening muscles and maintaining the shoulder’s range of motion may be helpful.²Shaffer, BS. Painful conditions of the acromioclavicular joint. JAmAcad Orthop Surg 1999;7:176Y188. As cited in Menge TJ, Boykin RE, Bushnell BD, Byram IR. Acromioclavicular osteoarthritis: a common cause of shoulder pain. South Med J. 2014 May;107(5):324-9. doi: 10.1097/SMJ.0000000000000101.

See Shoulder Exercises for Arthritis

Medications for Acromioclavicular Osteoarthritis

The medications listed below can be used to alleviate symptoms and slow the progression of acromioclavicular osteoarthritis.

• Oral analgesics. Pain relievers, such as acetaminophen (the active ingredient in Tylenol), have relatively few side effects and relieve pain.
• Oral non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory medications, such as aspirin, ibuprofen, naproxen, or cox-2 inhibitors (Celebrex), may reduce pain, swelling, and inflammation caused by AC joint osteoarthritis.
• Topical medications. Topical medications come in the form of creams, sprays, gels, and patches and are applied directly to the skin over the painful joint. There are many different types of topical medications. For example, topical NSAIDs reduce inflammation, topical counterirritants distract the brain from joint pain, and topical lidocaine is a numbing agent that interrupts pain signals to the brain.

  See Topical Pain Relief for Arthritis

Topical medications may be a good choice for people with acromioclavicular osteoarthritis who want to minimize gastrointestinal side effects that oral medications sometimes cause. However, side effects are still possible.

See Over-the-Counter Topical Arthritis Pain Relief

Doctor and patient should discuss medication in the context of the patient’s lifestyle, severity of pain and medical history. Potential side effects and interaction with other drugs and vitamins/supplements should always be considered.

See Dietary Supplements for Treating Arthritis

Injections

Steroid injections are the most commonly used injections for treatment of moderate to severe pain from acromioclavicular osteoarthritis.

• The goal of steroid injections is to reduce swelling and thereby alleviate shoulder stiffness and pain.
• The degree of pain relief from injections is variable and temporary. One study found that acromioclavicular arthritis patients who had steroid injections had pain relief ranging from as little as two hours to as long as three months.³Jacob, AK, Sallay, PI, "Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint," Biomed Sci Instrum 1997: 34: 380-5. As cited in Docimo et al, "Surgical Treatment for acromioclavicular joint osteoarthritis" Curr Rev Musculoskelet Med (2008) 1:154-160. PMID: 19468890.
• Steroid injections can also help a clinician verify the diagnosis; when an injection to the AC joint provides pain relief, it confirms that the AC joint is the cause of the pain. However, these injections may weaken the nearby tendons, so they should be used infrequently and only after more moderate treatments fail.⁴Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Review. PubMed PMID: 17682625.

See Cortisone Injections (Steroid Injections)

A doctor may offer regenerative medicine injections, such as a stem cell or platelet rich plasma injections, as an alternative to a cortisone injection. The hope is that these injections will reduce pain and possibly encourage cartilage growth. Very little research has been conducted to find out if these regenerative medicine treatments are effective in treating AC joint arthritis. ⁵Freitag J, Wickham J, Shah K, Tenen A. Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of acromioclavicular joint osteoarthritis. BMJ Case Rep. 2019;12(2):e227865. Published 2019 Feb 27. doi:10.1136/bcr-2018-227865.^,6Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J. 2017;11:163–182. Published 2017 Feb 28. doi:10.2174/1874325001711010163.

See Stem Cell Therapy for Arthritis and Platelet-Rich Plasma (PRP) Therapy for Arthritis

Acromioclavicular Joint Surgery

If osteoarthritis symptoms are severe and activity modification and nonoperative treatments do not succeed, surgery may provide relief.

• The most common surgery recommended is called a resection of the distal clavicle.
• Sometimes called the Mumford procedure, distal clavicle resection involves removing a small portion of the end of the clavicle, thereby eliminating friction between the clavicle and scapula.
• Eventually, scar tissue bridges the gap between the two bones.
• The ligaments surrounding the AC joint are maintained during this procedure to prevent postoperative instability at the joint.

Resection surgery to treat AC arthritis is controversial. Some surgeons do not recommend it, citing research that suggests resection does not reduce arthritis pain and other symptoms.⁷Wang J, Ma JX, Zhu SW, Jia HB, Ma XL. Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis. Clin Orthop Relat Res. 2018;476(12):2402–2414. doi:10.1097/CORR.0000000000000424.

Shoulder surgery may address more than one condition
People who have AC joint osteoarthritis severe enough to consider surgery almost always have other shoulder problems, too. In one study,⁸Brown JN, Roberts SN, Hayes MG, et al. Shoulder pathology associated with symptomatic acromioclavicular joint degeneration (abstract only). J Shoulder Elbow Surg 2000;93:173Y176. researchers examined 218 shoulders with painful AC joint arthritis and found:

• The vast majority—213 shoulders (98%)— also had at least one other problem
• 176 shoulders (81%) had rotator cuff tears
• 72 shoulders (or 33%) had labrum tears

These problems can sometimes be identified and addressed during resection surgery.

The best possible pain relief may come from a combination of two or more treatment options. Treatment, combined with coping techniques, such as meditation, visual imagery, and a positive attitude that focuses on what activities are possible, can substantially reduce shoulder pain.