Acromioclavicular arthrosis

If it makes you a problem to lift your hand above your head, keep your hand in a horizontal position, scratch your neck, all that can be caused by arthrosis of the AC joint. In this article we will try to explain your the issues of this problem and offer you options of treatment from a physiotherapeutic point of view.

ACROMIOCLAVICULAR JOINT

acromioclavicular joint (AC joint) is a joint of the collarbone (clavicle) and acromion - bony process of the scapula (shoulder blade). The space between these two bones is filled with ligamentous disc, whose function is to lower the pressure, which is involved on the cartilages on the ends of the bones, which occurs for example when we fall down on the shoulder, hitting the shoulder etc… AC joint is surrounded by ligament, which enables a flexible movement of both bones - joint play. The occurrence of arthrosis in AC joint is not such a unique condition. These problems often trouble athletes who burden their arms by throwing or impacts, or people who during their work lift heavy objects.

What happens in the joint?

Very often the joint is damaged by a fall on the shoulder, repeated impacts or insufficiently treated previous injuries. During such damage there is a smaller injury of the joint alone as well as ligaments. The disc and cartilages get also damaged, and the joint becomes unstable. The cartilage will start to thin out, it can even completely disappear. After that, the bones become unprotected, they are being damaged which is accompanied by a strong pain during all movements in the shoulder joint. Osteophytes may start to occur subsequently (bony spurs on the spine) and inflammation may also occur if we keep burdening the the joint. All these symptoms have to be treated individually and in time, in order to prevent any further development of arthrosis (painful illness of the joints).

Subjective problems

The main problem which troubles people with this damage is pain when they try to lift their arm into horizontal position, and when they try to reach their neck on the back. The pain can also occur when you lift your arm up into the air or when you try to move it backwards. The movement can be accompanied by creaking in the joint, AC joint is sensitive on touch as well.

PHYSIOTHERAPY

In acute stages it is recommended to keep peaceful regime and not burden the shoulder, so that you wouldn’t provoke any pain. Another possible alternative is Desault’s bandage, which will partly fix the shoulder. In physiotherapy we try to release the tension in the joint alone, with for example gentle traction in the AC joint, which often brings relief. Gentle mobilization of the surrounding blocked joints of the shoulder girdle will improve its mobility. Another step is adjustment of the muscle tension, reflexive spasms and trigger points (especially in the trapezius muscle, shoulder blade muscle…). We involve the reflexively weakened muscles (outer rotators of the shoulder, posterior deltoid muscle…) into functional muscle chains and movement programs.

FOCUSED SHOCKWAVE THERAPY

This treatment is about application of highly energetic focused shock wave, which is applied directly into the area of the problems, where it can locate the source of the pain (inflammation, trigger points) and immediately start the natural repairing process in the cells. The effect is fast and permanent. It is ideal to apply the focused shock wave on the muscle spasm in case of damaged AC joint, you can also apply it in the area of increased muscle fibres especially in the trapezius muscle and directly into the area of the inflammation. The pain subdues already after first application, and the shoulder is more mobile. Application should be done 1-3x in range of 7-14 days. After the application of the focused shock wave we will apply functional tape (elastic cotton band), which will help to relieve the affected area, fix and optimize the muscle tension in the shoulder area. In order for the results to be as fast as possible, it is ideal to combine the focused shock wave with physiotherapy.



Author:
 Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

Source: KOLÁŘ, P. et al., Rehabilitation in clinical experience, Praha: Galén, 2012, ISBN: 978-80-7262-657-1; Clinical experience in diagnostics and therapy with use of the focused shock wave therapy

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