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Acromioclavicular Joint

Shoulder arthritis is the term given to the wear and tear that takes place in the ball socket joint of the shoulder over time.

It is generally more prevalent as people get older however it possible to get shoulder arthritis even if you are young.
Most patients we see in clinic have degeneration (wear and tear) in the ACJ this is usually due to repetitive motion in the shoulder commonly with overhead activities. Many younger patients will have been going to gym and performing weights overhead or bench press over a long period of time. Older patients will develop degeneration due to natural wear and tear, and may have had a previous injury to the ACJ which originally settled but then later on in life started to give problem in the shoulder. A small proportion of patients will have had an acute traumatic injury to the shoulder which will have caused an injury to the ACJ. If severe the ACJ is completely disrupted and dislocated this may require urgent surgery.

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.

When you come to clinic a thorough history and clinical examination is usually sufficient to come to the diagnosis. You will be sent for an X-ray and sometime an Ultrasound or MRI scan to assist in treatment.

Physiotherapy

In all cases you will be referred for physiotherapy to help with mobility of the shoulder.

Steroid Injection

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.

Surgery

However, if the pain continues or you have sustained a dislocated traumatic injury to the ACJ surgery maybe required.

Degenerative ACJ

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.

Dislocated 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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Shoulder problems including pain, are one of the more common reasons for clinic visits for musculoskeletal symptoms. The shoulder is the most movable joint.

Aftercare

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.

This depends on the nature of your work. For a sedentary occupation the time off is normally 2-4 weeks. For a manual occupation this can be as long as 3-4 months.
It is normally safe to drive within 14 days of your operation but can take up to 6 weeks before you are completely comfortable to start driving.
This depends on the intensity of the sport and can range from 3 to 6 months off.

Like with any surgery there are a number of small risks associated with this operation.

Stiffness

If you do not comply with physiotherapy there a potential to develop a stiff shoulder which can prolong the rehabilitation of your shoulder.

Anaesthetic Risk

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.

Infection

(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.

Nerve Injury

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.

Recurrence 

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).

What our patients who have treated in our Clinic did say?

Patient
Patient
BMI The Beardwood Hospital
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From start to finish I received the utmost care and consideration from Mr Hadi. He took time to listen to my history and then go through the procedure with myself . The course of treatment provided was very effective as was the aftercare. I do not feel he could have done anymore.
Patient
Patient
BMI The Beardwood Hospital
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What a lovely man. Explained everything fully and gave me options regarding treatment including surgical repair which I opted for. I was treated with kindness and respect. The surgery was carried out efficiently and after care was superb. Would definitely recommend Mr Hadi.
Patient
Patient
Royal Blackburn Teaching Hospital
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Recently needed an operation on my shoulder. The treatment I received was second to none. Mr Hadi explained everything fully beforehand, making sure I was fully informed and again was exceptional in my aftercare and recovery. I felt supported and valued as a patient. Professional and approachable throughout. Highly recommend! Thank you.
Patient
Patient
BMI The Beardwood Hospital
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I could not have asked for better care. Excellent bedside manner, totally professional, would highly recommend.
Patient
Patient
BMI The Beardwood Hospital
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The information i was given during treatment was great, al my questions were answered in a way I understood. I was never made to feel my questions were stupid. Really great experience
Patient
Patient
BMI The Beardwood Hospital
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Mr Hadi has a real understanding of making patients feel assured and at ease at all stages of treatment. He explains the pros and cons of the procedure and gives you time to decide if you want to go ahead
Patient
Patient
BMI The Beardwood Hospital
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I have had a few operations over the years on my shoulder, and I didn't see results straightaway, I was told it may not improve at all, however last year I underwent another operation on my shoulder. 12 months later I am less pain now than I was from my original operation in 2008.
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