The acromioclavicular joint is between the collarbone (clavicle) and the acromion, the highest part of the shoulder blade (scapula).
Related conditions include acromioclavicular joint arthritis, rotator cuff injury, rotator cuff arthritis, clavicle fracture, shoulder blade injury or shoulder dislocation.
What is an Acromioclavicular Joint (ACJ) Injury?
The acromion is felt on the top of the shoulder. It allows a small degree of movement but it is kept relatively immobilised by several ligaments which prevent movement upwards as well as backwards. Following trauma either by landing onto the shoulder or from direct impact, for example following a cycling accident or in a contact sport, these ligaments can be ruptured. This causes the clavicle to become displaced in relation to the acromion. This is a dislocation. The joint itself can also be injured without a complete dislocation leading to pain without significant deformity.
What are the symptoms of an Acromioclavicular (ACJ) Joint Injury?
The main symptom for an acromioclavicular joint injury is pain, and in some cases significant deformity with increased mobility and prominence of the clavicle on the upper aspect of the shoulder. Patients can also describe the feeling of the shoulder “dropping” in more severe cases. Patients struggle to sleep at night and lie on the affected shoulder. In more chronic cases, patients can struggle to get back to over-head activities, including racquet sports and contact sports.
How is an Acromioclavicular Joint (ACJ) Injury diagnosed?
Acromioclavicular joint injuries are diagnosed by taking a careful history and performing a detailed examination. Careful consideration is taken to assess the degree of stability with crossing the arm over the front of the chest. Xray can be used to grade the degree of injury, however, this can under or over-report the injury and therefore clinical assessment is essential. X-ray and CT/MRI can also be used to exclude associated injuries such as clavicle fracture, shoulder blade injury or shoulder dislocation.
How is an Acromioclavicular Joint (ACJ) Injury treated?
Grosvenor Orthopaedic Partners are experts in the treatment of Acromioclavicular Joint (ACJ) Injuries. We regularly see patients each week for diagnosis and treatment, both conservative and surgical. Typical treatment begins with symptomatic management using pain killers and a sling. The degree of joint instability along with medical imaging will then be reviewed and discussed by our consultant team along with the patient. The functional demands of the patient, including their chosen sports and occupation will help to guide treatment options.
Lower-grade injuries can be treated with pain relief and physiotherapy working on a range of movement and gradual return to activities. This can all be managed from our various clinics or treatment hospitals across London (see locations for further information).
Operative treatment will be guided by the severity of the injury, patient preferences and symptoms. Open or keyhole (arthroscopic) procedures, typically day-cases, are used to realign the joint and reconstruct the coracoclavicular ligaments, providing improved stability. These operations can lead to an earlier return to sports and normal daily activities and in most cases lead to a predictable outcome.