Acromioclavicular (AC) Joint Problem

Simone Lombardi

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Hi Dr 8a, first of all I wanted to thank you for all your "offline" advice, I have consulted your forum more than once (actually more than I would have liked to..) and always found it very useful. Last December (after a very busy season and a PB) I developed some pain in my left shoulder, around the acromion area and the AC joint. Instead of following common sense and taking few weeks of rest, I pushed on, galvanised by the good results. Needless to say, I soon found myself unable to put on my t-shirt and struggling to sleep on that left shoulder. After few tentative climbing, sessions I took 2 months off, but the pain wouldn't go away. I obviously started to panic and browsed the internet to look for advice (including your forum). The symptoms loosely matched the classic impingement syndrome, bursitis, supraspinatus tendinosis or tendinitis, so I started to follow the protocol to treat it (stretching, hot patches, rotator cuff strengthening exercises etc.) Unfortunately things were not getting better so I went to see an orthopaedic specialist who, after an ultrasound scan, excluded any tears within the rotator cuff but found significant evidence of irritation and inflammation within the AC joint. She then injected cortisone and anaesthetic in the joint, which made the pain go away very quickly and (supposedly) proved that the diagnosis was correct. Since then, I have started to climb again, very gently at first, with good results and little sign of relapse. Since I am struggling to find literature about AC joint overuse injury in climbers (most of the discussion about shoulder injuries available is about supraspinatus impingement bursitis etc..), I was wondering if you have any advice about how to treat and prevent this type of  inflammation or if you can point me towards any good site. Before this mess, I often had mild symptoms of AC Joint irritation in both shoulders after periods of hard training, so this is likely to come back if I don't fully understand what's going on and prevent it correctly. Thanks! Simone

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Clark Paine

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Dubterror, Back in august I had a bike accident and I broke all the AC joints of the left side (grade III severity). I had surgery and after seven months of struggle I am climbing again. My shoulder is not as strong as before but I am confidence that if I keep working I will regain all its capability. However, I have never heard of a AC problem like yours since the AC joint is not over-stress in climbing (different from the shoulder joints which are highly stressed). Sports can be performed even without that joint. ¿Have you ever injured that joint in any other activity apart from climbing? It could happen that you already had a tendinitis on that AC joint (grade I or II) and it is getting worse as you are executing long range arm movements and the far end of the collar bone and the shoulder are developing some kind of osteoarthritis.

Idar Ose

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Had a grade 1 - 2 separation in my AC-joint, left side. The shoulder felt weaker the next months, but after like 4 months i was back in the game climbing harder than before. I started light and gradually increased the intensity. So my guess is that you will be fine.. :) Good luck

Simone Lombardi

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Hi Clark, thanks for your reply. No, I didn't injure the joint previously, the problem came up gradually, as a typical overuse injury. Are you sure that the AC Jojnt is not overstressed in climbing? I am asking this because its function is specifically to allow for the ability to raise the arm above the head, a movement that climbers perform over and over.. Maybe Dr 8a can shed some light on this.. I'm also wondering if my diagnosis is incomplete and my doctor failed to tell me the full picutre. I read that "Osteoarthritis (OA) of the AC joint is not uncommon. It may be caused by a prior trauma (secondary OA) or occur as a chronic degenerative disorder. In the latter cases the condition often co-exist with subacromial impingement ". Not sure how to proceed to clarify if I do have some degree of OA.. Simone

Simone Lombardi

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Hi Idar, thanks for your reply. X ray didn't show any problem in the spacing of the AC Joint so I guess my problem is different from what you had.. Thanks anyway!

Bjoern Alber

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Hi ACL injuries are most likely to occur in contact sports- narrow shouldered woman doing wide bench presses etc will also get an overload of this joint.So I agree on the above speculations that this most likely is not based in your climbing but in an earlier trauma or hard strenght training Björn

Simone Lombardi

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Hi Bjorn, thanks for your reply. It turns out I do have a form of degeneration of the AC Joint (osteoarthritis, inflammation), and I can confirm all I did before feeling pain was climbing (no weight lifting or previous acute injury). I have tried all conservative treatments, including three cortisone injections with no luck (the first one stopped working after 6 weeks). After 7 months of pain and 3 of complete rest, the only available option is resection (brrrr..) of the arthritic end of the clavicle.. At least the procedure is said to be very successful, often done on high level and professional athletes which enable them to return to their previous level of sport. Finger crossed! What really struck me is the complete lack of information about degenerative injuries of the ACJ in climbers, even if all the descriptions I found specify it's quite common in all strenuous overhead activities. This lead to an initial self-misdiagnosis (symptoms are very similar to impingement or supraspinatus problems) and wrong treatments that probably worsened the problem. I'm still not quit sure what's the mechanics involved in my injury (what climbing movement causes compression of the ACJ), but probably every vigorous contraction of the pectoral muscle, combined with bad postureforward rotation of the shoulder puts significant stress on it. Any ideas? I hope this can help other climbers with the same symptoms might benefit from my experience. Thanks, Simone

russell long

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Dubterror, I've developed the exact same problem as you, have tried 9 months of rest and ice, cortisone, etc. but w/o success. The MD is ready to do Mumford. So... yesterday, figuring it really didn't matter anymore since I'm due for the surgery, I did some indoor climbing with a pal, and found that the belaying process was making both Acs very painful -- surprisingly, it wasn't the climbing itself! So, it seems as though the pulling down OR up of the rope was tweaking my both Acs... I may try one more round of shots, but must decide in the next two days. Can you tell me if you did Mumford, and how it went, how long you were in pain, and whether you are back to normal climbing, etc? Thanks! Russell

Clark Paine

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Hi, Like I wrote early this year, I had a bike accident in Agoust 2011and broke the AC joints of my left shoulder. I decided to go for the surgery and although I had a bad time at the beginning now I am stronger than before. I have regained all the strengh in my shoulder. The only pain I feel is when I hang all my body weight with that arm but it is something bearable.

Simone Lombardi

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Hi Russell, going under in 3 weeks, excision of clavicle planned, 3 months of no climbing minimum after that. The shoulder team at the Royal National Orthopaedic Hospital reassured me it's a highly successful procedure, and high level athletes go back to activity with no problem, so finger crossed! I'll post an update when it' all done, thanks. Simone

fontafox

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I'm having similar problem now...I'll keep this thread posted.

Martin Classen

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Maybe you should go to a physiotherapist who could check your "scapulathoracic joint". Dysfuntion can lead to compression in your ac joint/subacrominal space. Wrong contraction patterns, GIRD, posture... are often the reason for the overuse stressed AC joint and impingementproblems for sporters who work with their arms above the head. It is hard to explain everything here, because like I said there can be many reason why it isn't working as it should work. for a bit more information: (ther ccan be more reasons) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010321/