Acromioclavicular Joint (ACJ) Arthritis

The acromioclavicular joint (ACJ) is a small but important joint that joins the clavicle (collar bone) to the scapula (shoulder blade). It is visible at the lateral end of the clavicle as a small depression in slender people. It contains a fibrocartilaginous disc that slowly degenerates over time. Symptoms from the ACJ may appear early on relative to other arthritis, with patients in their 30’s and 40’s presenting due to inflammation, swelling and pain.

They usually have a typical history with pain with overhead activities that is very well localized to the joint. Palpating over the joint is often very tender. Clinicians describe the ‘drop to the floor test’, where palpating on the joint is followed by the patient dropping the shoulder down towards the floor in response.

  • Management


ACJ symptoms may wax and wane, with pain from the joint mostly being able to be managed with pain medication, anti-inflammatories, rest, ice and avoidance of activities causing pain. Very infrequently it is severe enough that a sling might be required.

A local anaesthetic and steroid injection is usually very successful in stopping the pain and often one or two injections allows the joint to settle down and the pain to go away.


Operative management is to excise the joint, which releases the swelling  in the bone and alleviates the pain. The superior joint capsule is left in tact to preserve the integrity of the joint. Sometimes this joint becomes unstable after  an injury or this surgery and may need a subsequent surgery to stabilize it.

Conditions Managed

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