Shoulder arthritis is the term given to the wear and tear that takes place in the ball socket joint of the shoulder over time.
Patients generally present with pain on the top of the shoulder approximately where the bra strap lies in a female. It can cause problems with lifting overhead and lying on the side at night. If severe it can lead to grating feeling if the bones are rubbing against each other. Commonly people report difficulty reaching for the seatbelt ton the opposite side or pain of the seatbelt rubbing against the ACJ.
In an acute injury you will notice a new lump at the top of shoulder, which is the end of the collar bone sticking up. It will be painful for the first 3-4 weeks after which the pain starts to settle.
In all cases you will be referred for physiotherapy to help with mobility of the shoulder.
To assist both with confirming the diagnosis and helping with the pain, a steroid injection is usually the first line of treatment. For many patients, the combination of an injection and physiotherapy is enough to settle the pain.
However, if the pain continues or you have sustained a dislocated traumatic injury to the ACJ surgery maybe required.
Surgery for ACJ degeneration involves key hole surgery to clear out any inflamed tissue and excise any arthritic bone. We usually have to remove 5 mm of the collar bone to create a good space in the ACJ.
Surgery for traumatic dislocated injuries involves relocated the ACJ into its normal position and holding it there whilst it heals. There are various techniques for holding the ACJ in place. If your surgery is within 3 weeks of injury then a plate is inserted to allow the ACJ to heal. This plate will require removal at a later date, thereafter you will have no implants in your body. If your surgery is after 3 weeks then you will require a ligament reconstruction. We use the LARS ligament which is a highly tensile synthetic ligament to reconstruct the ACJ. This allows early mobilisation through a very stable construct of the shoulder.
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You will generally be discharged home the same day and have a large bulky dressing covering your wound for 48 hours. This is then removed to expose the sticky dressing underneath at 48hours until 14 days following your operation. The wound require inspection at 14 days either with your GP or back in hospital whichever is the most convenient for you.
Physiotherapy is crucial in the post-operative period and will be a big factor on how good your outcome is after surgery.
Like with any surgery there are a number of small risks associated with this operation.
If you do not comply with physiotherapy there a potential to develop a stiff shoulder which can prolong the rehabilitation of your shoulder.
Anaesthetic in the modern era are extremely safe however there are still minor risks associated with the different techniques which the anaesthetist will discuss with you before your surgery.
(1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Swelling and Stiffness
Can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint or dressing, active.
Is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
Is an unusual complication. You may however find that the symptoms recur some time after the original operation having completely settled initially. In this rare event a second operation may be necessary.
Complex Regional Pain
Syndrome is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months (see section on Complex Regional Pain Syndrome).