Impingement Syndrome - Acromioclavicular joint arthritis

Our shoulder surgeons at Schoen Clinic have many years of experience in treating AC Joint arthritis. Your shoulders are in the best hands with us.


The subacromial area lies between the top of the arm bone (humerus) and a bony prominence on the shoulder blade (acromion). The coracoacromial ligament completes the arch. A muscle and fluid filled cushion (bursa) lie between the arm bone and acromion. With certain movements and positions these structures can become pinched and inflamed.


Causes & Symptoms

The pain that you have been experiencing is caused by the pinching of the structures in your shoulder and is typically felt on movements such as reaching and putting your arm into a jacket sleeve. Most of the time a dysfunction of the rotator cuff muscles due to wear and tear of the tendons or to a muscular imbalance might be responsible for the conflict between the bony structures and the tendons. Recovery of the muscular balance is crucial to improve this condition and for this reason physiotherapy plays a major role in conservative treatment or in the post-operative phase.

The Acromio-clavicular Joint (ACJ) is a small joint formed between the top of the shoulder blade (acromion) and the collar-bone (clavicle).This joint can be a frequent source of pain in the shoulder region, especially while performing movements at or above the level of the shoulder. Moving ones arm across the chest at shoulder level to touch the opposite shoulder can produce significant discomfort if this joint is affected.


Diagnosis can be reached through an accurate clinical examination supported by x-rays taken in two or three different views and often an ultrasound scan which is useful to exclude any tendon damage.


Conservative treatment includes a course of physiotherapy and a programme of home exercises often combined with  one or two subacromial steroid injections performed under ultrasound. This might be effective in about 65-70% of cases but if symptoms persists more than three to six months a surgical treatment is recommended.

The operation:  Arthroscopic Subacromial Decompression (ASD)

The operation is performed by 'keyhole surgery” usually through two or three 4mm puncture wounds. The operation aims to increase the size of the subacromial area and reduce the pressure on the muscle. It involves cutting the coracoacromial ligament and shaving away part of the acromion bone (ASD). This increases the space of the subacromial area and reduces the pressure on the tendon and bursa allowing them to heal.

Pain may arise as well from the small joint between the shoulder blade and the collar bone Acromio-clavicular (AC) joint due to a cartilage tear or arthritis with wear and tear. In these cases resection arthroplasty of the AC joint with removal of a few millimetres of bone from each side of this joint is performed.

If a rotator  cuff tear is detected during  arthroscopy, your surgeon  may need to repair this torn tendon. This will involve  a different post-operative  regime to ASD - you will not be allowed to use your arm or drive for 4-6 weeks.

As with all surgery there is a risk of some complications. These are rare, but you should be aware of them before your operation.

They include:

•           Complications relating to the anaesthetic

•           Infection

•           Failure to achieve successful result

•           A need to redo the surgery

•           Injury to the nerves or blood vessels around the shoulder

•           Fracture

•           Prolonged stiffness and or pain


You will usually be in hospital either for a day or overnight. 

A supplementary local anaesthetic or nerve block is used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help with this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes.

Your consultant or physiotherapist will see you prior to discharge and you will be taught exercises to do and given further advice to guide you through your recovery. You will be given a sling. This is for comfort only and should be discarded as soon as possible (usually within the first one to two days). After leaving hospital you should exercise the arm frequently throughout the day. The arm may feel sore whilst you are doing the exercises but there should be no intense or lasting pain. Aim for 2-3  exercise sessions per day. 

This is a keyhole operation usually done through two or three 4mm puncture wounds. Often there will be no stitches, only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5-7 days.

You may begin driving one week after your operation or when you feel comfortable.

You should be back at work between one and four weeks depending on your job. If you are in a sedentary job you may return as soon as you feel able usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.

You should avoid sustained, repetitive overhead activities for three months. With regards to swimming you may begin breaststroke as soon as you are comfortable but you should wait three months before resuming front crawl. Golf can begin at six weeks. For guidance on DIY and racquet sports you should speak with your consultant or physiotherapist

You will be made a follow-up appointment at the hospital around three weeks after your surgery. At this stage you will be reviewed by your consultant who will check your progress, make sure you are moving your arm properly, and give you further exercises as appropriate.

Your symptoms should be approximately 80% better after three months but may take a year to totally settle.


Mr Adrian J Carlos

Consultant Orthopaedic Surgeon MB ChB MRCS(Eng) MSc PgD(Orth) FRCS(Tr&Orth)

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