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Search Results for : Acromioclavicular Degenerative Arthritis
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Surgical treatment of an aseptic fistulized acromioclavicular joint cyst: a case report and review of the literature.
Author(s): Murena, L; D'angelo, F; Falvo, DA; Vulcano, E
Journal: Cases J 2009 Nov 18; Vol. 2; Page(s) 8388
[Medline ID - 19918423]

An acromioclavicular joint cyst is an uncommonly reported condition, which seems to result from a massive rotator cuff tear and degenerative osteoarthritis of the acromioclavicular joint. We present the case of an 81-year-old man affected by an acromioclavicular joint cyst, associated to a massive rotator cuff tear, proximal migration of the humeral head and osteoarthritis of the gleno-humeral joint. The mass was 7 x 2.5 cm in size and the overlying skin presented a fistula that drained clear synovial-like fluid. Plain X-ray examination of the left shoulder showed proximal migration of the humeral head migration and osteoarthritis of the gleno-humeral joint, and further MRI evaluation confirmed the clinical diagnosis of a complete rotator cuff tear and observed a large subcutaneous cyst in communication with the degenerative acromioclavicular joint. The patient underwent surgical excision of the cyst and lateral resection of the clavicle to prevent disease recurrence. To the best of our knowledge, this is the first reported case of an acromioclavicular joint cyst complicated by an aseptic fistula resulting from multiple aspirations.

Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?
Author(s): Peterson, C; Hodler, J
Journal: Skeletal Radiol 2010 Apr 10; Vol. 39, Issue 1; Page(s) 11-8
[Medline ID - 19727709]

INTRODUCTION: This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. DISCUSSION: Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. CONCLUSION: When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief.

Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome.
Author(s): Docimo, S; Kornitsky, D; Futterman, B; Elkowitz, DE
Journal: Curr Rev Musculoskelet Med 2009 May 27; Vol. 1, Issue 2; Page(s) 154-60
[Medline ID - 16089089]

Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended prior to surgical interventions. Distal clavicle excision, the main surgical treatment option, can be performed by various surgical approaches, such as open procedures, direct arthroscopic, and indirect arthroscopic techniques. When choosing the best surgical option, factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain must be considered. This article examines patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthritis.

Fractures of the clavicle.
Author(s): Khan, LA; Bradnock, TJ; Scott, C; Robinson, CM
Journal: J Bone Joint Surg Am 2009 Feb 24; Vol. 91, Issue 2; Page(s) 447-60
[Medline ID - 19181992]

Undisplaced fractures of both the diaphysis and the lateral end of the clavicle have a high rate of union, and the functional outcomes are good after nonoperative treatment. Nonoperative treatment of displaced shaft fractures may be associated with a higher rate of nonunion and functional deficits than previously reported. However, it remains difficult to predict which patients will have these complications. Since a satisfactory functional outcome may be obtained after operative treatment of a clavicular nonunion or malunion, there is currently considerable debate about the benefits of primary operative treatment of these injuries. Displaced lateral-end fractures have a higher risk of nonunion after nonoperative treatment than do shaft fractures. However, nonunion is difficult to predict and may be asymptomatic in elderly individuals. The results of operative treatment are more unpredictable than they are for shaft fractures.

Radiological features of osteoarthritis of the acromiclavicular joint and its association with clinical symptoms.
Author(s): Pennington, RG; Bottomley, NJ; Neen, D; Brownlow, HC
Journal: J Orthop Surg (Hong Kong) 2009 May 9; Vol. 16, Issue 3; Page(s) 300-2
[Medline ID - 19126894]

PURPOSE: To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features. METHODS: Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination. RESULTS: Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ. CONCLUSION: Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.

[Trauma and degeneration of the acromioclavicular joint]
Author(s): Loitz, D; Klonz, A; Reilmann, H
Journal: Chirurg 2008 Dec 11; Vol. 79, Issue 12; Page(s) 1169-78
[Medline ID - 19066705]

Osteoarthritis or instability of the acromioclavicular (AC) joint may cause significant impairment or pain in the shoulder. If symptoms of osteoarthritis persist despite conservative treatment, distal clavicular resection is usually curative. Injuries and instability are classified according to Rockwood. Treatment of mild instability due to trauma is nonoperative. An underestimated acute injury to the AC joint may result in chronic instability. Different techniques are presented for operative treatment of significant acute or chronic instability. Arthroscopic methods are now available for treating both acute and chronic instability.

Sonography of the painful shoulder: role of the operator's experience.
Author(s): Le Corroller, T; Cohen, M; Aswad, R; Pauly, V; Champsaur, P
Journal: Skeletal Radiol 2008 Jul 25; Vol. 37, Issue 11; Page(s) 979-86
[Medline ID - 18651142]

OBJECTIVE: The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. MATERIALS AND METHODS: Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. RESULTS: The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7% for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears (kappa = 0.90), supraspinatus tendinosis (kappa = 0.80), abnormalities of the long head of biceps tendon (kappa = 0.84), subacromial bursa abnormalities (kappa = 0.89), and acromioclavicular osteoarthritis (kappa = 0.81). The agreement was only moderate for partial-thickness tears (kappa = 0.63) and intratendinous tears (kappa = 0.57). CONCLUSIONS: Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher.

Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation.
Author(s): Greiner, S; Braunsdorf, J; Perka, C; Herrmann, S; Scheffler, S
Journal: Arch Orthop Trauma Surg 2008 Jul 5; Vol. 129, Issue 6; Page(s) 735-40
[Medline ID - 18600333]

INTRODUCTION: There is still controversy about the optimal operative treatment of acromioclavicular (AC)-joint dislocations. However, in the current literature, only few studies are available on mid- to long-term results of different stabilization methods. This retrospective study presents the clinical and radiographical results after open reduction and stabilization of AC-joint dislocations using polydioxanesulfate (PDS) cerclage augmentation. METHODS: Fifty patients with a mean age of 35 years were treated with open reduction and PDS cerclage augmentation. Rockwood classification showed 44 type V, 5 type III and 1 type IV AC-joint dislocation. The clinical and radiographic follow-up (Constant Score, DASH Score, subjective shoulder value and stress radiographs of the shoulder girdle) were performed postoperatively at an average of 70 months. RESULTS: Clinical scores were good to excellent with a mean constant score of 91.7 +/- 8.7 points. The mean DASH Score was 5 +/- 8.8 points and the mean subjective shoulder value was 92 +/- 10.7. Radiographically, 80% showed a difference of coracoclavicular distance in comparison to the contralateral side of < 5 mm, 14% of 5-10 mm and 6% of > 10 mm. Radiographical signs of osteoarthritis were present in 37 and in 6% of all patients also evident during clinical examination. Coracoclavicular calcifications were seen in 68%. Complications were: one superficial wound infection, one extensive coracoclavicular calcification and two complete secondary redislo cations. CONCLUSIONS: Treatment of AC-joint dislocation using PDS cerclage augmentation leads to good to excellent clinical results. However, mid- to long-term follow-up reveals a high incidence of radiographic signs of osteoarthritis of the AC-joint. Whether this is due to the surgical technique and could be reduced using other, more anatomical fixation techniques or whether the injury itself leads to these changes, need to be shown.

[Treatment of acute AC joint dislocation by transosseal acromioclavicular and coracoclavicular fiberwire cerclage]
Author(s): Rehbein, K; Jung, C; Becker, U; Bauer, G
Journal: Z Orthop Unfall 2008 Jun 19; Vol. 146, Issue 3; Page(s) 339-43
[Medline ID - 18561079]

AIM: Many different procedures are used for the operative treatment of acute AC joint dislocations type Rockwood III - VI. We discuss the clinical results for an exact anatomical reconstruction of the AC-joint by transosseal acromioclavicular and coracoclavicular FiberWire cerclage. METHOD: 56 patients with acute AC joint dislocations type Rockwood III and V underwent operative treatment, using an exact anatomical reconstruction of the AC joint by transosseal acromioclavicular and coracoclavicular FiberWire cerclage. A clinical and radiological follow-up examination was performed. Clinical complications, objective results, radiological results, Constant and Rowe scores were evaluated. RESULTS: 43 patients could be examined on average 15.4 months after surgery. 24 patients (56 %) showed radiological signs of ossification of the acromioclavicular and coracoclavicular ligaments. Minimal postoperative clavicular displacement was observed in 14 patients (33 %). 2 patients (5 %) needed a second surgery due to complications, in one case because of reduction in the range of motion, in the other case due to abacterial inflammation. The advantage of this type of surgery is a minimal rate of complications and a good objective result with a high Constant score of 94 and Rowe score of 93, without the need for a second surgery. CONCLUSION: This procedure for an exact anatomic AC joint reconstruction shows good objective results with a high Constant and Rowe scores for shoulder function. Postoperative ossifications of the AC joint ligaments are common, but seem to have no influence on the clinical results.

[Proceedings in shoulder surgery]
Author(s): Biberthaler, P; Kirchhoff, C; Braunstein, V
Journal: MMW Fortschr Med 2008 Jun 7; Vol. 150, Issue 18; Page(s) 40-1, 43
[Medline ID - 18533608]

ABSTRACT NOT AVAILABLE
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