A chronic disorder characterised by osteoarthritic changes to the joint where the collar bone joins the top of the shoulder, causing local pain.

Diagnosis

Chiropractors are trained to take a thorough medical history and perform an examination including neurological and orthopaedic tests to determine what the problem is and whether chiropractic care is appropriate. Usually diagnosed from changes seen on X-Rays or other imaging. The problems associated with very severe degenerative changes may require medical intervention.

Evidence based summary for manual therapy

We are unaware of any randomised controlled trials investigating the chiropractic approach specific to oseoarthritic changes in the acromio-clavicular joint or its symptomatic improvement.

Chiropractic has demonstrated good evidence for pain relieving benefits with osteoarthritic joints in other parts of the body (hip and knee) [53].

There is also moderate evidence that favours the addition of manipulative/mobilization to medical care for shoulder girdle pain and dysfunction [128].

There is RCT evidence that manipulation to the base of the neck and ribs can help shoulder pain relative to usual medical care [128].

In managing this condition we make no claims to cure or permanently alleviate symptoms. There are degrees of severity of osteoarthritis, some of which require referral to other health professionals.

Other effective non-invasive physical treatments or patient education

Why does a joint become osteoarthritic?

When a joint becomes stiff and loses its normal degree of movement, the altered movement pattern causes stress which creates damage to the cells – this is known as “Immobilisation Degeneration.” It is a similar process to the way that skin, if it is repeatedly irritated first becomes inflamed but later thickens. Wear and tear is the phrase commonly associated with this musculoskeletal degeneration of the body.

Any situation that leads to a lack of mobility can cause these degenerative changes in the musculoskeletal system [35,36,37]. These may include excessive loading on joints, conditions such as osteoarthritis, or post traumatic reactions to injuries such as fractures or dislocations. In such cases the additional stresses on tissues often cause pain and dysfunction. Complete lack of mobility is not essential for immobilisation degeneration to occur [38].

The early stages of degeneration start quickly: within a week of onset of reduced movement in a joint there is a measurable loss of proteoglycans within the joint complex and wear changes of the joint surface are measurable within 1 day to 1 week of the onset of the loss of movement [38,39]. It may however take many years to start showing up on an X-Ray.

Joints that are tight have more degenerative changes than those that are not fixed and the degree of degeneration (bone spur formation) is directly dependent on the amount of time it has been fixed [40].

Altered movements and forces on a joint, which occurs during the immobilisation process, is universally recognised as contributing to connective tissue degeneration and local changes in the chemical composition of that tissue [41]. Variations in chemical composition of degenerating connective tissues can result in mechanical failure [38].

Damage in tissues following immobilisation can be reversible upon remobilisation. The sooner the movement is restored, the more repair occurs. If the restoration of normal movement is delayed, the degeneration becomes more extensive and permanent [41, 43, 44].

Liebenson [45] lists the negative effects of immobilisation and provides references for each negative effect. In joints: shrinkage of joint capsule, increase in compressive loading, increase in contracture of the joint, increased synthesis rate of glycosamine-glycans, increase in fibrosis, irrerversible changes after 8 weeks. Ligaments: lower failure or yield point, decreased thickness of collagen fibres. Disk biochemistry: decreased oxygen, glucose, sulphate, proteoglycan content and increased lactate proliferation. Bone: Decreased bone density and eburnation (increased density and damage due to degeneration). Muscle: decreased thickening of collagen fibres, decreased oxidative potential, decreased muscle mass, decreased sarcomeres, decreased cross-sectional area, decreased mitochondrial content, increased connective tissue fibrosis, type 1 muscle atrophy, type 2 muscle atrophy, 20% of loss of muscle strength per week.

To maintain the musculoskeletal system in good health there must be weight bearing, movement and exercise.

Loss of function leads to loss of structure [46]. Animal experiments using rabbits with knee joints immobilised and splinted reported irreversible joint degeneration and osteoarthritic changes after only 2 weeks of complete immobilisation. The most obvious early changes of immobilisation was found to be reduction in mobility, which was initially reversible but after 2 weeks some range of movement was lost permanently. After 2 weeks of immobilisation, the first signs of eburnation (wearing, hardening and exposure of the bone) because of damage to the overlying cartilage was found. These are irreversible and can be identified on X-Ray as narrowing of the joint space, osteophyte (bone spur) formation and subchondral sclerosis (increased bone density beneath the cartilage). This loss of joint mobility was produced by either a single period of immobilisation of two weeks or more or repeated periods of several days of immobilisation.

Cramer and Henderson [47] found in animal experiments that in the period following immobilisation but not in controls, the spinal joints are hypomobile and their neighbours start to have too much movement. Their research shows there is a window of opportunity in the first 4 weeks, in which if the joint is released , it tends to improve.

The term arthritis covers a wide range of conditions involving damage and/or inflammation of the joints of the body. These conditions may variously involve pain, swelling or stiffness. There are over one hundred different types of arthritis and broadly, these can be categorised into inflammatory or non-inflammatory in nature. The most common is osteoarthritis, a non-inflammatory condition caused by degeneration or trauma.

Back-in-Action clinical opinion

Once identified as such, osteoarthritis can be managed by a variety of means depending upon the location and severity. The primary aim of chiropractic care is to restore mobilisation, aid repair and improve posture to reduce stress on the joints. Care options that are open to chiropractors include manual therapies (which may include chiropractic manipulation, mobilisation or massage), acupuncture, exercise, postural work, ergonomics, nutrition, lifestyle advice or orthoses. Chiropractors are qualified to diagnose this condition and determine appropriate treatment strategies for effective symptom relief and functional improvement.

In managing this condition we make no claims to cure or permanently alleviate symptoms. There are degrees of severity of osteoarthritis, some of which require referral to other health professionals.