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General:
Inflammation of this small joint at the top of the shoulder may give rise to local pain and can be caused by:
- degeneration - wear and tear
- trauma - injury
- infection
Presentation:
Nil. Many people have wear and tear of this joint with no pain or symptoms of any kind. Therefore x-ray changes alone do not mean that treatment is necessary.
Pain is the main reason patients seek help for this condition. This pain is usually very localised to the top of the shoulder, at the small lump which represents this small joint. Usually a dull boring or burning type pain - often worse at night but described as unrelenting.
Lump. The lump on top of the shoulder often becomes swollen when the inflammation is active or may be just a sharpening of the former small lump as bone builds up on both sides of the joint over time.
Click or catch with elevation of the shoulder over head or with reaching across the body. This may be caused by a tearing of the cartilage inside the joint in the traumatic type or rubbing of the 2 bone ends once their gliding surfaces have been worn away, and bone grates on bone.
Association with impingement or arthritis of the shoulder joint proper (ball & socket) is common and often needs to be treated at the same time.
Treatment
 Non surgical
rest - avoid working in overhead position, avoid repetitive across body activities or heavy lifting.
tablets - anti inflammatories
cream - anti inflammatory applied to the tender area. It is a very superficial joint
warmth - with a heated wheat/rice bag
physiotherapy - application of heat and other anti inflammatory modalities
injection - cortisone may help to settle the inflammatory component for a while.
 Surgical
Excision of the outer end of the clavicle removes the painful ends of bone as long as a decent space is left between the ends, then they will not touch or rub against each other. This should be between 0.5 and 1 cm. The stability of the 2 bones remains as the major ligaments pass from the finger like projection on the shoulder blade to the collar bone further towards the midline and therefore are left intact by this surgery.
Operation (often combined with a decompression) takes about 1 hour under a general anaesthetic.
Hospital stay in usually 1 night.
Home the next day in a sling for 3 weeks but full range of movements are encouraged immediately, as is normal use of hand and elbow.
Light duties can be undertaken at 3 weeks but avoid lifting (normal duties or sport) for 3 months.
Expect normal function of the shoulder eventually. As with any surgery about the shoulder some ache or stiffness in cold weather may last up to 12 months.
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