Patient resources
NHS Lothian MSK Self Help Resources Webpage
Definition
- Symptoms arising from the acromioclavicular joint (ACJ)
- May be due to ACJ injury or pathology including osteoarthritis (OA) and osteolysis
Typical signs and symptoms
- Pain usually felt locally over the ACJ
- Typically made worse by raising the arm and arm across body movements
- There may be localised ACJ tenderness, limited range of movement due to pain, high painful arc, positive cross arm test, asymmetry of the shoulder contour
Prevalence and risk factors
ACJ OA:
- Usually affects people > 60 years; more common than GHJ OA
- Radiographic presence of ACJ OA is very common in people over 40 years but is often asymptomatic
- Risk factors: older age, female > male, history of joint trauma, obesity, lifestyle, occupational stresses, genetics, certain metabolic diseases e.g. diabetes, haemochromatosis
Osteolysis:
- Stress fracture of the outer end of the collarbone
- Usually caused by repetitive excess load to the outer clavicle such as activities seen in athletes and weightlifters
- Most common in people < 40 years
- Risk factors: repetitive excess load such as heavy and repetitive horizontal adduction, adduction, internal rotation, and forward/lateral flexion of the shoulder; sports including volleyball, tennis, basketball, swimming
Injury:
- May occur due to direct impact on the joint or a fall onto the outstretched arm
- Injuries range in severity from a mild sprain to complete disruption
Prognosis/ risk factors for poor outcome
ACJ OA:
- OA is not always a progressive condition
- Symptoms may fluctuate with intermittent acute-on-chronic flares
- OA is a complex multi-factorial condition involving genetic, biological (increasing age, obesity, metabolic health, genetics), and biomechanical (joint injury and structural changes) components
Osteolysis:
- Prognosis is generally excellent with conservative management of activity modification/ rest
Injury:
- Prognosis will depend on severity of injury and degree of instability
Other considerations
ACJ pain may exist concurrently with rotator cuff related shoulder pain; osteophytes from an arthritic ACJ may irritate the underlying rotator cuff tendons
Relevant standards and guidelines
NICE Clinical Knowledge Summaries: Acromioclavicular joint disorders
NICE Clinical Knowledge Summaries: Osteoarthritis
P.A & M.A – 15-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
