{"id":14450,"date":"2023-03-13T15:20:16","date_gmt":"2023-03-13T15:20:16","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=14450"},"modified":"2026-07-16T11:03:28","modified_gmt":"2026-07-16T10:03:28","slug":"acromioclavicular-joint-disorders","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/musculoskeletalphysiotherapy\/shoulderelbow\/acromioclavicular-joint-disorders\/","title":{"rendered":"Acromioclavicular joint disorders"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>Patient resources<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u200b<a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/self-help-information\/\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian MSK Self Help Resources Webpage<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Definition<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Symptoms arising from the acromioclavicular joint (ACJ)<\/li>\n\n\n\n<li>May be due to ACJ injury or pathology including osteoarthritis (OA) and osteolysis<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typical signs and symptoms<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain usually felt locally over the ACJ<\/li>\n\n\n\n<li>Typically made worse by raising the arm and arm across body movements<\/li>\n\n\n\n<li>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<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prevalence and risk factors<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">ACJ OA:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Usually affects people &gt; 60 years; more common than GHJ OA<\/li>\n\n\n\n<li>Radiographic presence of ACJ OA is very common in people over 40 years but is often asymptomatic<\/li>\n\n\n\n<li>Risk factors: older age, female &gt; male, history of joint trauma, obesity, lifestyle, occupational stresses, genetics, certain metabolic diseases e.g. diabetes, haemochromatosis<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">Osteolysis:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Stress fracture of the outer end of the collarbone<\/li>\n\n\n\n<li>Usually caused by repetitive excess load to the outer clavicle such as activities seen in athletes and weightlifters<\/li>\n\n\n\n<li>Most common in people &lt; 40 years<\/li>\n\n\n\n<li>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<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">Injury:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>May occur due to direct impact on the joint or a fall onto the outstretched arm<\/li>\n\n\n\n<li>Injuries range in severity from a mild sprain to complete disruption<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Prognosis\/ risk factors for poor outcome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">ACJ OA:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OA is not always a progressive condition<\/li>\n\n\n\n<li>Symptoms may fluctuate with intermittent acute-on-chronic flares<\/li>\n\n\n\n<li>OA is a complex multi-factorial condition involving genetic, biological (increasing age, obesity, metabolic health, genetics), and biomechanical (joint injury and structural changes) components<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">Osteolysis:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Prognosis is generally excellent with conservative management of activity modification\/ rest<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\">Injury:<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Prognosis will depend on severity of injury and degree of instability<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Other considerations<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ACJ pain may exist concurrently with rotator cuff related shoulder pain; osteophytes from an arthritic ACJ may irritate the underlying rotator cuff tendons<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Relevant standards and guidelines<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/shoulder-pain\/management\/acromioclavicular-joint-disorders\/\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Clinical Knowledge Summaries: Acromioclavicular joint disorders<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/cks.nice.org.uk\/topics\/osteoarthritis\/#!scenario\" target=\"_blank\" rel=\"noreferrer noopener\">NICE Clinical Knowledge Summaries: Osteoarthritis<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>P.A &amp; M.A &#8211; 15-7-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who can refer: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners <\/li>\n\n\n\n<li>Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP <a href=\"https:\/\/services.nhslothian.scot\/musculoskeletal\/where-to-find-us\/\" target=\"_blank\" rel=\"noreferrer noopener\">Where To Find Us \u2013 Musculoskeletal Physiotherapy<\/a>)<\/li>\n\n\n\n<li>Secondary care consultants and associated teams<\/li>\n\n\n\n<li>MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes <a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Lothian Integrated Shoulder &amp; Elbow Service<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who and How to refer:<\/h4>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><thead><tr><th>Condition<\/th><th>Referral Type<\/th><th>Referral destination and process<\/th><\/tr><\/thead><tbody><tr><td><strong>Suspected septic arthritis\/ septic bursitis<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected facture or dislocation<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute distal biceps rupture<\/strong><\/td><td>Same day<\/td><td><strong>Orthopaedic registrar<\/strong> via Flow navigation centre on 03000 134000\/ on call Orthopaedic registrar via switchboard 0131 242 1000<\/td><\/tr><tr><td><strong>Suspected acute traumatic rotator cuff tear in the younger patient<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected malignancy\/ tumour specific to shoulder*<\/strong><\/td><td>Urgent<\/td><td><strong>Orthopaedics<\/strong> via SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics- Elbow &amp; Shoulder<\/td><\/tr><tr><td><strong>Suspected inflammatory condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Rheumatology<\/strong> \u2013 see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/rheumatology-2\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Rheumatology.<\/a><\/td><\/tr><tr><td><strong>Suspected neurological condition<\/strong><\/td><td>&nbsp;<\/td><td>Consider referral to <strong>Neurology<\/strong> \u2013 see&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/\" target=\"_blank\" rel=\"noreferrer noopener\">RefHelp Neurology.<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">* <em>Please also see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/sarcoma\/\" target=\"_blank\" rel=\"noreferrer noopener\">Sarcoma \u2013 RefHelp<\/a>. 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&nbsp;detailed on <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatric-radiology\/gpaccesstoctforsuspectedcancernoclinicallyobviousprimary\/\" target=\"_blank\" rel=\"noreferrer noopener\">GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) \u2013 RefHelp<\/a><\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have the presence of significant red flags\/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition &#8211; see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/serious-shoulder-and-elbow-conditions-red-flags\/\" target=\"_blank\" rel=\"noreferrer noopener\">serious shoulder &amp; elbow conditions<\/a><\/li>\n\n\n\n<li>Age &lt;16<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">For further information see associated sections<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Link to NHS Lothian patient internet site including patient information resources \u2013&nbsp;<a href=\"https:\/\/services.nhslothian.scot\/ises\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/ISES\/Pages\/default.aspx<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page shoulder &nbsp;problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/shoulder-problems<\/a><\/li>\n\n\n\n<li>Link to NHS Inform shoulder problems- Patient self help guide&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/self-help-guides\/self-help-guide-shoulder-pain<\/a><\/li>\n\n\n\n<li>Link to NHS Inform page elbow problems&nbsp;<a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/muscle-bone-and-joints\/self-management-advice\/elbow-problems<\/a><\/li>\n\n\n\n<li>Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service&nbsp;<a href=\"http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">http:\/\/intranet.lothian.scot.nhs.uk\/Directory\/physiotherapy\/NHSLIntegratedShoulderandElbowService\/Pages\/default.aspx<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Patient resources &#8203;NHS Lothian MSK Self Help Resources Webpage Definition Typical signs and symptoms Prevalence and risk factors ACJ OA: Osteolysis: Injury: Prognosis\/ risk factors for poor outcome ACJ OA: Osteolysis: Injury: Other considerations ACJ pain may exist concurrently with rotator cuff related shoulder pain; osteophytes from an arthritic ACJ may irritate the underlying rotator<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4425,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[903,1414],"class_list":["post-14450","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-acromioclavicular-joint-disorders","category-https-apps-nhslothian-scot-refhelp-shoulder-conditions"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/https-apps-nhslothian-scot-refhelp-acromioclavicular-joint-disorders\/\" rel=\"tag\">Acromioclavicular joint disorders<\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/musculoskeletal-physiotherapy\/shoulder-elbow\/https-apps-nhslothian-scot-refhelp-shoulder-conditions\/\" rel=\"tag\">Shoulder conditions<\/a>","rttpg_excerpt":"Patient resources &#8203;NHS Lothian MSK Self Help Resources Webpage Definition Typical signs and symptoms Prevalence and risk factors ACJ OA: Osteolysis: Injury: Prognosis\/ risk factors for poor outcome ACJ OA: Osteolysis: Injury: Other considerations ACJ pain may exist concurrently with rotator cuff related shoulder pain; osteophytes from an arthritic ACJ may irritate the underlying rotator","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14450","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=14450"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14450\/revisions"}],"predecessor-version":[{"id":28982,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/14450\/revisions\/28982"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4425"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=14450"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=14450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}