Acromioclavicular Problems (ACJ)
The ACJ is where the collar bone and the shoulder blade meet. There are two conditions that typically effect the ACJ.
1) The less common of the two is a dislocation of the ACJ. This is usually injury related and often happens in rugby players and people who fall off their bicycles and land o nthe point of their shoulder. When this happens the end of the collar bone will ”Spring-up” and create a bump on the top of the shoulder. This condition is usually treated without intervention in the first instance and in special circumstances can be “reconstructed” if it becomes symptomatic. Different surgeons will approach this problem differently. Some will attempt a repair while the injury is fresh. In this case an attempt to sow the torn ligaments together is performed and the collar bone is held in place with a screw or wires to protect the ligaments while they recover.
Most surgeons feel this is futile and prefer to “wait and see” if the condition becomes a limiting factor in the patients life. Many sportsmen have completed successful international careers with permanently dislocated ACJ’s. In those who are limited a reconstruction of the damaged ligaments is carried out. This is done by taking a locally based ligament and re-routing it through the end of the collar bone to hold the joint in place. This may also be “augmented” by a screw or wires or tapes to help hole the joint in place while the ligament heals.
2) The more common condition is degeneration of the ACJ. This is also referred to as osteoarthritis or arthritis of the acromioclavicular joint. The common way of treating this is to inject steroid into the ACJ. Because of the anatomical location of the ACJ being right above the rotator cuff, it is common to have impingement syndrome and ACJ degeneration simultaneously. As a consequence when the patient is injected for impingement syndrome, their pain may improve but not completely dissipate if the ACJ is part of the cause of their pain.
If the injection is not long lasting, then the surgical option is to resect the outer end of the collar bone. This can be done as an open operation but most shoulder surgeons will do this as key-hole surgery. In many cases the ACJ is “resected” at the same time that the cuff is decompressed.
