Acromioclavicular Arthritis M19.019 715.11

ac arthritis picture











































ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: AC arthritis, AC DJD, acromioclavicular osteoarthritis, AC osteoarthritis, shoulder arthritis

Acromioclavicular Arthritis ICD-10

Acromioclavicular Arthritis ICD-9

  • 715.11 (osteoarthritis shoulder region, localized, primary)

Acromioclavicular Arthritis Etiology / Epidemiology / Natural History

  • Repetitive overhead activity or throwing may lead to repeated microtrauma in the AC joint with susequant arthritis.
  • May occur after Grade 1 AC separations.

Acromioclavicular Arthritis Anatomy

  • Diarthrodial joint which contains a meniscus.
  • Mutiple anatomic variations.
  • Allows approximatley 40° to 50° of rotation.
  • see also Shoulder Anatomy.

Acromioclavicular Arthritis Clinical Evaluation

  • Pain along the anterior and superior shoulder; isolated to AC joint. AC joint palpation reproduces symptoms.  May have radiation into the trapezius and anteriolateral neck.
  • Aggravated by use of arm above shoulder level, or reaching behind the back or across chest
  • Cross-body Adduction Test: arm is maximally adducted with the arm in 90 of forward elevation. Pain localized to the AC joint indicates AC joint patholgy.  Most sensitive test (77%)
  • Adduction, IR and extension isolates posterior AC facet problems
  • Tenderness to A/P translation
  • AC joint pain with impingement maneuvers
  • O’Brien test (arm adducted, 90 forward elevation, thumb-up position causing ACJ pain) (O’Brien SJ, AM J Sports Med 1998;26;610-613).  Most specific test (95%)
  • have pt hold are straight in front at shoulder level, forced horizontal adduction/abduction causes AC pain
  • Evaluate for hx of AC joint separation, generalized OA, weight lifting (distal clavicle osteolysis), repetitive stress (gymnastics).
  • Differential injections in subacromial space and AC joint at different office visits

Acromioclavicular Arthritis Xray / Diagnositc Tests

  • AP, scapular lateral and axillary views show spurring, sclerosis, osteophyte formation and narrowing of AC joint
  • AC joint best viewed with a Zanca view of clavicle.
  • Weighted views indicated if instability is a concern.
  • AC joint local anesthetic and corticosteriod injection often indicated to confirm diagnosis. Relief of symptoms after injection confirms AC joint pathology as the cause of symptoms.

Acromioclavicular Arthritis Classification / Treatment

  • Non-operative: NSAIDS, physical therapy, activity modifications, ACJ injections
  • Operative: open vs arthroscopic distal clavicle resection generally considered only after failure of 3-6months of non-operative treatment.
  • See Distal Clavicle Resection Technique
  • Must ensure pain is secondary to arthritis and not instability.  If there is AC instability Ca ligament reconstruction +/-DCR is indicated
  • Open excision may be indicated for patients with hypertrophic osetoarthritis.

Acromioclavicular Arthritis Associated Injuries / Differential Diagnosis

Acromioclavicular Arthritis Complications

  • Instability(excessive resection)
  • Continued symptoms (inadequate resection)
  • Ectopic calcification
  • Reactive bursitis
  • Clavicle/acromion fracture
  • Infection

Acromioclavicular Arthritis Follow-up Care

  • 71% excellent, 16.5% good, 12.5% failure (Levine WN Arthroscopy 1998;14:52-6).
  • Post-op: sling as needed with pendulum ROM exercises.
  • 1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start at 3 weeks. Avoid cross-body adduction for 6 weeks.
  • 6 weeks: progressive sport specific activity.
  • 3 months: Return to sport / full activities.
  • IF in association with SAD, or RTC repair use those rehab protocols.
  • Outcome measures: ASES score, pain scales.

Acromioclavicular Arthritis Review References

  • Burkhart SS, A Cowboy's Guide to Advanced Shoulder Arthroscopy, 2006
  • Shaffer BS, JAAOS 1999;7:176 
  • Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR Jr. Degenerative joint disease of the acromioclavicular joint: a review. Am J Sports Med. 2013 Nov;41(11):2684-92