Acromio-Clavicular Joint Dislocation & Degeneration

The acromioclavicular joint is formed between the outer end of the collar bone or clavicle and the point of the shoulder (the acromion). It is a small joint and has only a small influence on the main shoulder joint. Pains from this joint are felt right on top of it and the area is often tender.
The joint can become inflamed for reasons which we do not understand and it can also be injured in a fall, typically by landing on the point of the shoulder on hard ground. It often occurs when people fall off a motorbike or a horse. With direct trauma the joint can actually dislocate, pushing the end of the collar bone upwards so that it forms a bump on top of the shoulder. The treatment of inflammation of the acromioclavicular joint (ACJ) is with tablets including anti-inflammatories and sometimes physiotherapy. The most powerful ‘quick-fix' treatment is a cortisone injection which does not damage the joint but only has about a 40% chance of cure. If repeated injections fail to give rise to complete benefit, and there is no point trying more than three, then the only alternative is surgery. The body is to an extent over-engineered and the acromioclavicular joint is for the majority of people surplus to need. It is therefore possible to remove the joint, leaving a space which is filled with fibrous scar and the new scar joint is usually pain free and does not compromise shoulder function. These days the joint can be removed as a keyhole procedure. The operation takes about forty minutes but patients tend to stay in that night. They can go in the shower and get dressed the following day and wear a sling for approximately a week. Patients do however feel significant pain for around eight weeks during which time they can work and drive. It takes a further six weeks before patients are able resume strenuous activities such as over-arm swimming and tennis. The success rate of this procedure is around 80% with 10% the same and 10% worse than before the surgery, in which case they simply have more pain in that area although the shoulder still works well. Dislocation of the acromioclavicular joint occurs after a fall. A large proportion of patients once the bruising has settled, have very few symptoms from the dislocation except for the bump. It is not possible to simply put the joint back, like a shoulder, because the structures which hold the joint in place are irreversibly damaged. We usually wait twelve weeks because so many patients then say that their shoulder is satisfactory and do not require any further treatment. If this is unacceptable or if after three months they still have a lot of pain and are unhappy with the bump, then a reconstruction procedure is undertaken. The technique which Mr Kurer adopts is a reconstruction using an artificial ligament and patients having this procedure (Surgilig reconstruction) wear a sling for just one week before going back to all activities over the ensuing weeks. The main significant complication from this is infection and if that occurs then the artificial ligament has to be removed and the surgery fails.