Acromioclavicular Joint/pathology* ; Humans ; Joint Dislocations/pathology*

The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.
Acromioclavicular Joint*/radiography ; Acromioclavicular Joint*/pathology ; Adult ; Aged ; Arthritis/radiography ; Arthritis/pathology ; Arthritis/complications* ; Arthrography ; Cartilage, Articular ; Human ; Male ; Middle Age ; Shoulder Impingement Syndrome/complications*

BACKGROUND: Subacromial erosion remains a major concern after surgical fixation of acromioclavicular (AC) joint using a clavicular hook plate. To minimize postoperative subacromial erosion, we investigated the structural relationship between distal clavicle and acromion around the AC joint by considering the surgical fixation of the joint using the hook plate technique. METHODS: Computed tomography scans of 101 AC joints without any inherent pathology were analyzed. The angle between the distal clavicle and acromion around the AC joint (AC angle), depth of the acromion, differences in height between distal clavicle and acromion (AC height difference), and thickness of distal clavicle and acromion at the AC joint were measured. Descriptive statistics were calculated for each anatomical parameter, and all results were compared between gender groups. RESULTS: The mean AC angle was 17.1°(range, −8.0° to 39.0°), and the mean AC height difference was 3.5 mm (range, −0.7 to 8.7 mm). Both factors showed very high variability (coefficients of variation=62.6% and 46.6%, respectively). The mean AC angle was significantly higher in the female gender than in the male gender (19.8° vs. 13.8°, p=0.048). The mean acromion thickness and distal clavicular thickness were both significantly thinner in the female group than in the male group (p < 0.001) CONCLUSIONS: Taken together, we believe our results might be helpful in minimizing postoperative subacromial erosion when performing surgical fixation of the AC joint using the hook plate, and be valuable in improving future design of the hook plate.
Acromioclavicular Joint ; Acromion ; Clavicle ; Female ; Humans ; Joints ; Male ; Pathology ; Shoulder Fractures

Acromioclavicular joint pain is a common cause of shoulder-related symptoms. Frequently, nonoperative treatment regimens resolve symptoms originating from acromioclavicular joint. However, patients refractory to conservative therapy require operative intervention and the resection of distal end of the clavicle has proven to be a reliable method in these patients. We performed fourteen cases of arthroscopic distal clavicle resection for acromioclavicular joint lesions between February 1995 and February 1997 and reviewed the efficacy of the arthroscopic distal clavicle resection, retrospectively. Causes of acromioclavicular joint pathology were 7 cases of degenerative osteoarthritis, 6 traumatic osteoarthritis and 1 partial instability. Average patient age was 50 years (range 19 to 70 years). Preoperatively all patients had pain, whereas 57% had acromioclavicular tenderness and 86% positive adduction test. The operations were performed with subacromial bursal approach. The average length of distal clavicle resection was 10mm (range 5 to 18mm). At an average follow-up of 18 months (range 8 to 30 months), the ASES score ranked 6 shoulders in excellent (43%), 6 good (43%), 1 fair (7%), and 1 poor (7%). Thus, the overall results suggest that arthroscopic acromioclavicular resection is one of the effective methods for the treatment of acromioclavicular joint pathology.
Acromioclavicular Joint* ; Clavicle ; Follow-Up Studies ; Humans ; Osteoarthritis ; Pathology ; Retrospective Studies ; Shoulder

Acromioclavicular Joint ; pathology ; surgery ; Adolescent ; Adult ; Female ; Humans ; Joint Dislocations ; pathology ; physiopathology ; surgery ; Ligaments, Articular ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Young Adult

In evaluating patients complaining of shoulder pain, ultrasonography is an emerging imaging tool due to convenience, low cost, high sensitivity and specificity. However, normative values of ultrasound dimensions of the shoulder to be compared with pathologic findings in Korean adults are not provided yet. We evaluated the ultrasound dimensions of the rotator cuff, long head of biceps tendon, deltoid muscle and acromioclavicular joint in Korean healthy adults. Shoulder ultrasonography was performed on 200 shoulders from 100 healthy adults. The dimensions of the thickness of rotator cuff (supraspinatus, infraspinatus, subscapularis tendon), deltoid muscle, long head of biceps tendon, subacromial subdeltoid bursa, and acromioclavicular joint interval were measured in a standardized manner. Differences in measurements among sex, age, and dominant arms were compared. The thickness of rotator cuff tendons (supraspinatus, infraspinatus, subscapularis) and deltoid muscle were significantly different between men and women. The thickness of subacromial subdeltoid bursa was significantly different between men and women for non-dominant side. In rotator cuff tendon measurements, the differences between dominant and non-dominant shoulders were not significant, which means the asymptomatic contralateral shoulder can be used to estimate the normal reference values. When stratified by age divided by 10 years, the measurements of supraspinatus, subscapularis and deltoid thickness showed tendency of increase with the age. The acromioclavicular joint interval, on the other hand, revealed decreasing tendency. This report suggests normative values of ultrasound dimensions of healthy Korean population with varying age, and can be useful as reference values in evaluating shoulder pathology, especially in rotator cuff tendon pathology.
Acromioclavicular Joint ; Adult* ; Arm ; Deltoid Muscle ; Female ; Hand ; Head ; Humans ; Male ; Pathology ; Reference Values ; Rotator Cuff* ; Sensitivity and Specificity ; Shoulder ; Shoulder Pain ; Tendons ; Ultrasonography*

An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.
Acromioclavicular Joint ; diagnostic imaging ; injuries ; Aged ; Aged, 80 and over ; Fluoroscopy ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging ; Male ; Range of Motion, Articular ; Shoulder ; physiology ; Shoulder Joint ; pathology ; Tendon Injuries ; pathology