- Acromioclavicular joint osteoarthritis is more common than glenohumeral jointy OA
- Often asymptomatic
- Usually in people >60
AC Joint Pain (OA)
General information
Symptoms and signs
- Pointing sign(Patient points directly to AC joint as painful area, not hand clasped around deltoid)
- Localised tenderness over the ACJ, typically made worse by raising the arm and arm across body movements
- End range pain passively in all directions
- Possible painful arc 150-180º.
- Localised pain on horizontal adduction (scarf test)
Initial management
- Reassure and advise to mobilise
- Pain control - Analgesia & NSAIDs as appropriate
- Advise on activity modification, in particular to avoid cross body shoulder adduction
- Refer MSK physiotherapy
- ACJ corticosteroid injection if pain is severe (in GP practice or by MSK Physiotherapist)
Primary Care diagnostics
- X-Ray (2 views- AP and axial) prior to referral
Useful resources
Who to refer
Consider referral for Orthopaedic Shoulder Service opinion if:
- Typically if the person has had symptoms for >3-6 months with failure of conservative treatment (at least 1 steroid injection) and protracted course of physiotherapy
- Patient wishes to consider surgical treatment
- If under the care of the TNHS MSK physiotherapy team, investigations and onward referral to UL service, if appropriate, will be organised by Physiotherapy service without the need for further GP intervention.
- SCI gateway/Orthopaedics-Elbow and shoulder. Please note first point of contact may be advanced practice Physiotherapist
Information to include when referring:
- Duration and any cause of symptoms, dominance, effect on ADL, work, hobbies
- Indicate site/ spread of pain and if pain constant or intermittent, and/or waking at night
- Indicate ROM (+/- painful arc)
- Include treatment to date
- X-ray results