Acromioclavicular Pain (ACJ)

Pathophysiology

The Collarbone is called the Clavicle, the joint at the end of the collar bone near the shoulder is called the Acromioclavicular joint (ACJ). Causes of ACJ pain can be either after injury (for example falling on an outstretched hand or sporting injuries) or without injury (gradual onset, often related to osteoarthritic changes).

Symptoms

  • Specific pain at the point of the joint (ACJ), pain may radiate into the soft tissues adjacent
  • Pain when lying on your sides
  • Osteoarthritis more commonly in those aged >50
  • May be affected by posture e.g desk based workers sitting position
  • Pain with overhead activities e.g plasterers and athletes
  • With trauma the ACJ may appear raised or more prominent than the other side
  • Localised swelling over the ACJ
  • Reduced movement of the shoulder with pain at extremes of movement
  • Pain with daily tasks e.g brushing hair, reaching behind your back and reaching forwards whilst twisting
  • Pain when reaching across your body
  • Painful clicking

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy

Investigations

  • If there has been trauma with an increased prominence of the ACJ and significant reduction in shoulder movement then a fracture or dislocation may be suspected, in this case an x-ray is likely to be needed via A&E to rule out these pathologies.
  • In severe cases should patients fail to respond to 6 months of conservative management via Physiotherapy the Physiotherapist will refer on to Orthopaedics for further investigation and possible invasive treatment.

Exercises to try:

ER

Supported External Rotation

Sitting next to a table with a pillow supporting your upper arm

Bend your elbow to 90 degrees

Gently rotate your lower arm towards the table and away

Shoulder Abduction

Weighted Abduction

In standing or sitting

Holding a light weight (water bottle or tin) or unweighted

Lift your arm to the side until you reach 90 degrees if able

Slowly return to starting position and repeat

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