AC Joint Arthritis Surgical Treatment

Surgery may be recommended for patients who have:

• Persistent pain despite nonoperative treatment: Symptoms that continue after a sustained period of activity modification, therapy, and injection.
• Clear, reproducible relief from a diagnostic injection: Temporary but complete relief of pain after an injection into the joint is the strongest predictor of a good surgical result.
• Pain precisely localized to the joint on examination: Tenderness directly over the joint and a positive cross-body adduction test that correspond to the imaging findings.
• Distal clavicle osteolysis that has not resolved: Lifters whose symptoms persist despite a well-executed period of modified training.
• A spur contributing to rotator cuff impingement: Patients undergoing surgery for a cuff problem in whom the AC joint is also symptomatic.

Surgery is generally not recommended when arthritis of the joint is an incidental finding on MRI and the examination points to the rotator cuff, biceps tendon, or neck as the source. In those cases, Dr. Rynecki Baker will say so plainly rather than proceeding.

Arthroscopic Distal Clavicle Excision

The standard operation removes a small amount of bone, typically five to ten millimeters, from the outer end of the collarbone so that the worn surfaces no longer contact one another. Performed arthroscopically through small incisions, the procedure preserves the ligaments above and behind the joint, which is what keeps the collarbone stable after the bone is removed. It is an outpatient procedure, and most patients go home the same day.

Dr. Rynecki Baker approaches this operation with attention to how much bone is removed. Too little leaves persistent contact and continued pain; too much, or disruption of the superior capsule and ligaments, can leave the collarbone unstable and produce a different and more difficult problem. Preserving the top and back of the joint capsule is a deliberate part of the technique.

Open Distal Clavicle Excision

An open approach through a small incision over the joint is used in selected cases, including some revision situations and patients in whom the joint anatomy makes arthroscopic access difficult. The principle is identical, and the same care is taken to preserve the stabilizing ligaments.

Combined Procedures

AC joint arthritis frequently accompanies other shoulder problems, and the distal clavicle excision is commonly performed alongside a subacromial decompression, a rotator cuff repair, or a biceps tenodesis. When this is the case, the recovery timeline is dictated by the larger procedure rather than by the distal clavicle excision, and Dr. Rynecki Baker discusses this in advance, so the plan is clear before surgery.

Surgery for Arthritis with AC Joint Instability

Patients with arthritis following a prior AC separation require a different approach. Removing bone from a collarbone that is already unstable makes the instability worse. In these patients the operation addresses the instability as well, typically by reconstructing the ligaments that run from the collarbone to the coracoid process, with or without a limited excision. Identifying this group before surgery is essential, and it is one reason Dr. Rynecki Baker examines for instability rather than relying on imaging alone.

After an isolated distal clavicle excision

• Sling use: A sling is used for comfort for a few days to a week.
• Early motion: Motion begins immediately, and full elevation and rotation are typically regained within the first few weeks.
• Strengthening: Scapular and rotator cuff strengthening begin once motion is comfortable, usually within two to three weeks.
• Return to activity: Desk work within a few days, light lifting at around four to six weeks, and full pressing and overhead training generally by three months, introduced gradually rather than all at once.

When a rotator cuff repair or a ligament reconstruction is performed at the same time, the protocol follows that procedure. A rotator cuff repair means a sling for four to six weeks, active motion at around six weeks, strengthening at three months, and return to overhead sport between six and nine months.

Every patient receives a written protocol specific to the procedure performed, and Dr. Rynecki Baker works closely with each patient and their physical therapist throughout recovery. For lifters, the return to pressing is staged deliberately, with attention to grip width, range, and volume, because the training pattern that irritated the joint is worth correcting even after the bone has been addressed.