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Bone growths (osteophytes) and inflammation in arthrosis of the ACJ

 

Some joints of our body are subject to faster physiological wearing out. As a result of this process, a disease called osteoarthrosis occurs. This is one of the varieties of inflammatory damage due to degenerative changes in the joint.

In the acromioclavicular joint, osteoarthrosis develops quite often. This disease is accompanied by shoulder pain, and can also lead to difficulty in performing normal daily work.

Humerus consists of three bones: scapula, humerus and clavicle. The process of the scapula, called the acromion, forms the upper part of the shoulder joint. Acromion is connected to the clavicle with the help of acromioclavicular joint (ACJ). This joint in general is designed in the same way as the other joints of our body. It consists of two bones that are firmly connected through the articular capsule and ligaments. At the same time, some mobility remains between the bones, which is necessary to increase the amplitude of movements in the shoulder. The joint ends of bones are covered with articular cartilage. The articular cartilage has a very smooth slippery surface, due to which the friction force during movement of articular ends of clavicle and acromion is minimal. Due to its tight-elastic consistency, articular cartilage also acts as a shock absorber, softening the shock loads on bones of the shoulder girdle.

Throughout life, we constantly make various movements with our hands. As a result, gradual wearing out of the ACJ occurs, which leads to the development of osteoarthrosis. The ACJ experiences significant loads when carrying heavy loads on the shoulders. Persons whose work is associated with such loads are more likely to suffer from the ACJ osteoarthritis, and the disease develops at a younger age. Osteoarthritis of the ACJ can occur after joint injury as a result of a fall or a direct hit. Such damage can lead to partial detachment of articular cartilage. As a result, the congruency (comparability) of articular surfaces is impaired, which leads to disruption of the biomechanics of joint and the development of degenerative changes, often many years after the injury.

In the early stages of the disease, arthrosis of the ACJ is manifested by pain and increased sensitivity during palpation of the joint. Pain is often aggravated by crossing arms on the chest, as in this position the pressure inside the joint increases. The pain can be localized not only in the joint but also radiate to the neck and down the arm. If the trauma was noted in the past, then the joint area may have a changed shape compared to that on the opposite side. During movements in the shoulder, some patients feel clicks and crunching in the area of ​​ACJ.

First, the doctor will ask you in detail about the symptoms that bother you, the duration of the disease, and the general state of health. He may be interested in suffered shoulder injuries, even those from many years ago. Perhaps a question will be asked about the connection of pain with certain movements of the hand.

The diagnosis of arthrosis of the ACJ is most often based on data from the physical examination. In this disease, finger pressure on the ACJ region causes pain. Diagnostic blockade may be performed to confirm the diagnosis of arthrosis. To do this, a small amount of local anaesthetic solution (for example, lidocaine) is injected into the joint cavity. In case of inflammation of the acromioclavicular joint, pain immediately disappears.

To confirm the diagnosis, an X-ray examination of the ACJ area is appointed. At the same time, such signs of arthrosis as narrowing of the joint gap, osteophytes (bone spikes) around articular ends of acromion and clavicle, and “corroded” articular surfaces are found on the radiograph.

X-ray (left) and a schematic representation of arthrosis of The ACJ

Conservative therapy

The initial treatment for arthrosis of the ACJ is to create rest for the affected joint and non-steroidal anti-inflammatory drugs such as Voltaren, Xefocam, etc are used. With severe or protracted pain, a doctor can perform a blockade using suspension of glucocorticoid hormones (Diprospan, Kenalog). These are very effective drugs, the prescription of which allows to quickly stop pain and swelling.

The introduction of a hormonal drug in the area of ACJ

Surgery

If conservative treatment is not effective, surgery may be recommended.

 

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31.03.2020

Травматология

Артроскопия плеча