Acromioclavicular Osteoarthritis Treatment

Acromioclavicular osteoarthritis (AC joint arthritis) is a progressively degenerative disease that cannot be reversed; however, a few steps may be taken to slow the degenerative process and control pain.

The primary treatments are activity modification and over-the-counter medications that reduce pain and inflammation, called NSAIDs. Physical therapy, a staple of most osteoarthritis treatment plans, has not shown much success in treating acromioclavicular arthritis. Steroid injections have been shown to have short-term success in treating pain.

Below are the steps that can be used to relieve pain from this type of shoulder osteoarthritis. When non-surgical treatments fail, surgery is an option for people with persistent moderate-to-severe symptoms.

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Non-Surgical Treatments for Acromioclavicular Osteoarthritis

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.

Warm or cold compress. Patients can loosen a stiff joint by using moist heat, such as a warming pad or whirlpool, for a few minutes before activity. Icing the shoulder joint for 15 or 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.

Physical therapy. In contrast to treatment for hip osteoarthritis and knee osteoarthritis, which emphasizes physical therapy, experts have found physical therapy less effective for acromioclavicular patients.6 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.

Medications for Acromioclavicular Osteoarthritis

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

  • Oral analgesics. Pain relievers, such as acetaminophen (e.g., 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 (e.g., Advil), naproxen (e.g., Aleve), or cox-2 inhibitors (e.g., 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.
    • Topical analgesics. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.
    • Topical non-steriodal anti-inflammatory drugs (NSAIDs). Like topical analgesics, topical NSAID creams should be applied directly to the painful shoulder. Topical medications containing the NSAID diclofenac have been found effective in treating isolated pain due to knee and hand osteoarthritis.7 Topical NSAIDs are available only with a prescription and are sold under the names Voltaren, Flector, Pennsaid, and Solaraze.
    • Lidocaine patches. Lidocaine is a topical numbing agent that interrupts pain signals to the brain. Adhesive patches containing 5% lidocaine that are applied directly to the affected joint may reduce or alleviate osteoarthritis pain.8 These patches are available only with a prescription.

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. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.

Supplements and Injections for AC Joint Arthritis

Glucosamine and chondroitin sulfate. Glucosamine and chondroitin sulfate occur naturally in the body’s cartilage. In clinical trials conducted by the American College of Rheumatology, some patients with knee osteoarthritis reported benefits from taking supplements containing glucosamine sulfate or a combination glucosamine sulfate with chondroitin sulfate. Experts agree more study is needed to fully understand how these supplements affect the symptoms of osteoarthritis.9

Injections. Steroid injections are normally used for treatment of 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.10 These injections may weaken the nearby tendons, so they should be used infrequently and only after more moderate treatments fail.11,12 However, injections can be helpful to help clinician isolate the problem and allow more direct treatment.

Coping techniques. To manage the pain, patients may employ techniques such as relaxation (e.g., relaxation tapes, meditation), visual imagery, biofeedback or hypnosis. For many, these techniques, along with a positive attitude that focuses on what activities are possible, can have an impact in moderating the shoulder pain.

Acromioclavicular Joint Surgery

If osteoarthritis symptoms are severe and activity modification and nonoperative treatments do not succeed, surgery may provide relief. Surgeries to relieve osteoarthritis of the shoulder’s acromioclavicular joint include:

  • AC joint arthroscopy to remove loose pieces of damaged cartilage
  • AC joint osteotomy to shave off osteophytes and reduce friction between bones
  • Resection of the distal clavicle, sometimes called distal clavicle excision, to remove 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. This surgery can be done with an arthroscope and seems to provide pain relief to most people suffering from moderate-to-severe acromioclavicular arthritis,13,14 however, there have been no large studies comparing the efficacy of surgical and non-surgical treatments.15

The best possible pain relief may come from a combination of two or more treatment options. Over time, a patient and doctor can work together to optimize an individualized treatment plan.


References

  1. Docimo et al, “Surgical Treatment for acromioclavicular joint osteoarthritis” Curr Rev Musculoskelet Med (2008) 1:154-160. PMID: 19468890 [PubMed]
  2. Derry S, Moore RA, Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007400. doi: 10.1002/14651858.CD007400.pub2. Review. PubMed PMID: 22972108.
  3. See Full References
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