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  • Management of The Degenerative AC Joint

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    Tefera Letebo
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    This document discusses the management of degenerative AC joints. It covers diagnosis through clinical exams and investigations like x-rays and MRIs. Conservative management includes analgesics, rehabilitation, and injections, which can provide pain relief for up to a year. Operative options include open excision or arthroscopic excision, either directly through the joint or indirectly through the bursa. Arthroscopic management may have better outcomes and involves carefully resecting the joint surfaces without causing instability. Complications can occur if too little or too much tissue is resected.

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    Ac joint

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    AC Joint

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    This document discusses the management of degenerative AC joints. It covers diagnosis through clinical exams and investigations like x-rays and MRIs. Conservative management includes analgesics, rehabilitation, and injections, which can provide pain relief for up to a year. Operative options include open excision or arthroscopic excision, either directly through the joint or indirectly through the bursa. Arthroscopic management may have better outcomes and involves carefully resecting the joint surfaces without causing instability. Complications can occur if too little or too much tissue is resected.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    10 views14 pages

    Management of The Degenerative AC Joint

    Uploaded by

    Tefera Letebo
    This document discusses the management of degenerative AC joints. It covers diagnosis through clinical exams and investigations like x-rays and MRIs. Conservative management includes analgesics, rehabilitation, and injections, which can provide pain relief for up to a year. Operative options include open excision or arthroscopic excision, either directly through the joint or indirectly through the bursa. Arthroscopic management may have better outcomes and involves carefully resecting the joint surfaces without causing instability. Complications can occur if too little or too much tissue is resected.

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    © All Rights Reserved
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    of 14

    Management of the

    Degenerative AC Joint
    Dave Cloke
    Overview
     Diagnosis
     Clinical
     Investigations
     Conservative Management
     Operative Management
     Open
     Arthroscopic
    History
     Carefully evaluate in all shoulder problems
     ACJ is common cause of failure of Rx
     ACJ rarely painful in isolation
     Injuries
     Beware instability
     Site of pain
     Exacerbating factors
     Concomitant pathology
     SAI - ? cause
     Intraarticular – SLAP
     Level of pain and function
    Examination
     (Neck)
     Tenderness
     Cross –chest adduction
     “Scarf” test
     Signs of other pathology
     Impingement / Cuff
     SLAP – O’Brien may be +ve – check site of
    pain
     Instability
    Investigations
     XR
     Sensitivity/specificity?
     Views, stress views
     US
     MRI
     ? Arthrogram - ? Intraarticular lesion
     L/A Injection

     ? Other causes of ACJ arthritis – infection etc


    Conservative management
     Analgesia
     Rehab
     No specific ACJ treatments
     Injections:
     Good improvement up to 1 yr, maintained 5
    yrs
     Hossain et al, JSES 2008
     Diagnosis
    Operative
     Open excision
     Direct arthroscopic excision
     Indirect (bursal) arthroscopic excision

     Maybe better results from arthroscopic


     Meta-analysis Rabalais & McCarty, CORR
    2007
    Anatomy
    Principles
     Stabilise if unstable
     Superior ligament important in AP stability
     As little as 5mm medial to joint in females
     Coraco-clavicular ligts important restraint
    to superior displacement
     11mm medial to joint
     Studies of CA ligt augmentation
     Resect joint surfaces without destabilising
     Repair capsule if open, avoid if arthroscopic
    Indirect
     ASD
     Anterior approach to ACJ
     Preserve superior capsule
     Excise generous shaver width
     Direct vision to confirm excision
     Posterosuperior often missed
     May consider just coplaning inferior surface
     Neviaser portal

     Video
    Direct
     ACJ only
     If isolated pathology
     Small joint scope

     ? More instability and inadequate


    resections
    Complications
     Too little…
     Inadequate resection
     Posterosuperior

     Too much…
     Instability

     New bone formation


    Thank you
    Discussion

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