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Acromio-Clavicular Joint (ACJ)
The acromio-clavicular joint (ACJ) is the small joint at the top of the shoulder where the collarbone meets the acromion. Although it has only a small range of movement, it plays an important part in normal shoulder function. Problems in this joint are usually caused either by an injury or by arthritis.
(A) Injury
ACJ injuries commonly happen after a fall directly onto the shoulder or a direct blow. The damage can range from a mild sprain to a complete separation of the joint, and sometimes there may also be an associated fracture. Symptoms usually include pain on the top of the shoulder, swelling and, in more severe injuries, a visible bump or deformity.
Diagnosis
Diagnosis is made by specialist assessment and X-rays. In some cases, further imaging such as CT or MRI scan may be needed if the injury pattern is unclear or if there is concern about associated damage.
Treatment
Most ACJ injuries can be treated without surgery. This usually involves a short period of rest in a sling, pain relief, ice, and then physiotherapy to restore movement, strength and function. Surgery is mainly considered for more severe or unusually displaced injuries, or when pain and instability continue. The operation aims to reduce and stabilise the joint and may involve fixation, ligament reconstruction, or both, using either a small open procedure or, in selected cases, keyhole surgery.
(B) Arthritis
The ACJ can also develop arthritis, most commonly as a result of wear and tear, although it can also follow a previous injury or occur with inflammatory arthritis. This usually causes pain at the top or tip of the shoulder and is often worse when reaching across the chest, lifting the arm above shoulder level, or lying on that side.
Diagnosis
Diagnosis is usually based on the history and clinical examination. X-rays can help show arthritic change, and in some patients a local anaesthetic or steroid injection into the joint can help confirm that the ACJ is the source of the pain.
Treatment
Treatment usually starts with activity modification, pain relief or anti-inflammatory medication, physiotherapy, and sometimes a steroid injection. If symptoms continue despite these measures, surgery may be recommended. This involves excision of a small part of the end of the collarbone to stop the joint surfaces rubbing together. This can be performed by keyhole surgery and, in some cases, through a small open procedure.
Further detailed information and the appropriate treatment option will be provided to you by Mr. Ayoub during the consultation. Back...
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