Case Manager's Corner

Mechanism of Injury:

Blunt trauma to the acromioclavicular (AC) joint may result in post-traumatic arthritis. Alternatively, repetitive overhead activities such as those associated with impingement syndrome may lead to degenerative changes within the AC joint.

Subjective Symptoms:

Dorsal shoulder pain often made worse with bringing the arm across the chest and with overhead activities.

Objective Signs:

AC joint tenderness to direct palpation, elicitation of pain with cross-arm adduction, elimination of pain with injection of local anesthetic into the AC joint, confirmation of joint space narrowing with radiographs or increased uptake with a bone scan.

Natural History:

In most instances, once the pain is initiated, it will persist or increase especially if the inciting event is not eliminated.

Nonsurgical:

NSAIDs, cortisone injection into the AC joint, limited physical therapy.

Surgical:

Arthroscopic (or open) distal clavicle excision (i.e., Mumford procedure).

Nonsurgical:

8-12 weeks*

Limit lifting, repetitive machinery, overhead activities

Surgical:

12-16 weeks

Limit lifting, repetitive machinery, overhead activities