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Acromioclavicular joint surgery may not be needed

A May 2022 study (1) questioned treatment methods for people suffering from acromioclavicular joint osteoarthritis that were seeking care for something else.  Here is what the researchers reported: “Radiographic osteoarthritis of the acromioclavicular joint is a common incidental finding and an uncommon reason for people to seek care for shoulder symptoms. . .  Given that a high base rate of incidental disease creates a low pre-test odds that radiological findings of disease correspond with symptoms, diagnosis of symptomatic acromioclavicular joint osteoarthritis is subject to substantial inaccuracy and should be made sparingly, mindful of the potential harms of a diagnosis that can lead to an ablative surgery.”

A May 2022 study (2) asked patients, what where the treatment goals they were seeking from acromioclavicular joint surgery. In this study sixteen patients participated in five patient focus group discussions including 10 patients with acromioclavicular joint instability and six patients with acromioclavicular joint osteoarthritis. What the study revealed is that medical guidelines for assisting these patients did not include solutions to the problems that patients reported as being important to them.

The researchers wrote: “Although many factors affecting the acromioclavicular joint were common to instability and osteoarthritis pathology, several factors appear to be unique to each and do not appear in existing acromioclavicular joint joint metrics.  . . Patients in this study identified several themes relevant to assessment and rehabilitation program development including pain location, type of pain (eg. burning pain), and specific activities that induced pain that do not exist in current existing tools. Our finding that certain themes were only raised in either acromio-clavicular instability or osteoarthritis suggests that there may be differences in important outcomes for patients depending on the underlying cause of the acromio-clavicular joint pathology.”

A study from 2018 (3) demonstrates that acromioclavicular joint pain management remains at issue. “Shoulder pain secondary to acromioclavicular joint pain is a common presentation in primary and secondary care but is often poorly managed as a result of uncertainty about optimal treatment strategies. Osteoarthritis is the commonest cause. Although acromioclavicular pain can be treated non-operatively and operatively, there appears to be no consensus on the best practice pathway of care for these patients, with variations in treatment being common place.”

A 2021 study (4) continued this line of research seeking to clarify the management of acromioclavicular joint osteoarthritis, as well as to identify any existing gaps in the current knowledge of treatment. The researchers examined nineteen studies that assessed 861 shoulders. Mean age of participants was about 49 years old. Average follow-up was about 44 months. Four studies reported functional results after conservative treatment, whereas 15 studies were focused on surgical management. No studies directly compared conservative and surgical treatment. Seven studies reported a surgical approach after failure of previous conservative treatment. All studies reported functional improvement and pain relief. Complication rate was low. Overall methodological quality of included studies was very low. Conclusion: “Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. However, available data did not allow to establish the superiority of one technique over another.”

A March 2022 study (5) looked at the acromioclavicular disk as a potential source of pain in AC joint injuries. The study notes: “Injuries of the acromioclavicular joint are common shoulder injuries that often lead to pain and dysfunction of the affected shoulder. Regardless of operative or nonoperative treatment, a relatively large number of patients remain symptomatic and experience pain. However, the specific source of persistent pain in the ACJ remains ambiguous.” What this study determined was: the presence of nerve fibers within the intra-articular disk of the acromioclavicular joint suggesting that the disk itself could be an independent source of pain after injury and thus a possible explanation for recalcitrant pain after treatment.

1 Rossano A, Manohar N, Veenendaal WJ, van den Bekerom MP, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. Journal of Orthopaedics. 2022 May 20.
2 Aldhuhoori S, Almasri M, Nicholls SG, Pollock JW, Rollins M, Howard L, Lapner P. What outcomes are important in the recovery from acromio-clavicular (AC) joint pathology? A focus group study with patients and surgeons. Disability and Rehabilitation. 2020 Aug 14:1-9.
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.
4 Soler F, Mocini F, Djemeto DT, Cattaneo S, Saccomanno MF, Milano G. No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Jul;29(7):2194-201.
5 Ostermann RC, Moen TC, Siegert P, Bukowsky C, Lang S, Heuberer PR, Pauzenberger L. Acromioclavicular Disk as a Potential Source of Pain in AC Joint Injuries. The American Journal of Sports Medicine. 2022 Mar;50(4):1039-43.



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