(Keywords: acromioclavicular joint, AC joint, chiropractic help, arm pain, frozen shoulder, rotator cuff strengthening)
The AC Joint acts as a pivot giving stability to the shoulder girdle. It's key in the Chiropractic Help understanding of arm pain.
Your shoulder consists of FOUR joints, one of which is the Acromio-Clavicular joint. The acromion is the bone at the highest point of the scapula, right at the tip of your shoulder, lying just above the socket.
The Acromion, part of the shoulder blade (scapula), articulates with the collar bone (or Clavicle ) at the so-called Acromio Clavicular (or, AC-) joint.
The AC-joint contains a small disc and is particularly prone to wear and tear (arthrosis). It is second only to the thumb in the arthritis stakes. Most people by the age of 40 have a degree of degenerative change within the joint, which contributes greatly to the syndromes causing limited shoulder range of motion, so common in the 50+ patient. This is why chiropractic care of the AC is so important, to keep it free and mobile.
During shoulder movements, the clavicle rotates, mediated by the Subclavius muscle. This little muscle sits right under the collar bone, having a very important function in all movements of the shoulder.
Can you see it below the clavicle - collarbone - in pink?
The collar bone is firmly attached to the Acromion and the Coracoid process by very strong ligaments. So strong that often the collarbone will fracture, rather than the ligaments tear. It's fortunate because bones heal better than ligaments.
Here you can see the upper arm ( Humerus ), the Clavicle and three parts of the Shoulder Blade (Scapula):
When raising the arm above the head, the scapula rotates, the collar bone acting a strut, connecting the shoulder to the sternum, or breast bone, giving stability and support to the shoulder girdle.
A fall on the shoulder drives the acromion downwards whilst the collar bone is held up by strong neck muscles (the trapezius and the sterno-cleido-mastoideus), rupturing the AC joint capsule.
Likewise falls onto the outstretched hand can transmit enormous forces to the AC joint – either the ligaments anchoring the clavicle to the scapular may be torn (strain, partial or complete rupture), the AC may rupture, or the clavicle itself may fracture. Usually these heal with immobilisation in a sling for three weeks, with strapping of the AC-joint though occasionally surgery may be required. Many sportsmen have ruptured AC ligaments, allowing the clavicle to pop up. It looks serious, but most attest to the fact it gives little trouble after a few months.
Notice the space between the ball of the humerus and the overhanging acromion. It's through this space that the tendon of the very important supraspinatus muscle passes.
Very occasionally tumours of the lung may invade the shoulder. Smoker? Expect trouble, because it's coming.
Chiropractors are trained to adjust and mobilise the AC joint, vital for the management of shoulder conditions such as Frozen Shoulder , when it feels as though the AC-joint has turned to concrete, causing severe arm pain.
Chiropractic help treatment of many other shoulder conditions, all of which may cause arm pain, such as Rotator Cuff syndrome are also dependent on correction of any AC-joint fixations.
The Acromioclavicular joint is the second most likely (after the thumb) structure to become arthritic. In part, because of so much use - every time you move your arm - and partly because of so many falls on the arm and shoulder.
New research is now proving that when a joint becomes fixated, fluids vital for the healthy nutrition of the joint cartilage are not adequately replenished. This leads to diminished oxygen and nutrients and a build up of noxious wastes in the joint. For more about Immobilisation Arthritis click here. IMMOBILISATION ARTHRITIS ...
DASH - Disability Arm Shoulder Hand
Many folk find it very difficult to assess just how bad their arm pain is. The Quick Dash score gives you a more objective measure of your pain.
Legendary shoulder expert, Dr Neer, proposed that degeneration of the acromioclavicular joint may contribute to subacromial impingement and a number of other authors have supported this hypothesis. Arthritic spurs that protrude inferiorly from the undersurface of a degenerative acromioclavicular joint can contribute to impingement when the supraspinatus tendon passes beneath the joint.
In 1977, Kessel and Watson brought additional attention to the acromioclavicular joint as a cause of subacromial impingement. They found that patients who had so-called painful arc syndrome could be divided into three categories. Approximately two-thirds of the ninety-seven patients in the study had lesions of either the posterior or the anterior aspect of the rotator cuff. All of these patients had resolution of the symptoms after subacromial injection of a local anesthetic and a steroid or division of the coracoacromial ligament. The remaining patients had pain in the superior aspect of the rotator cuff, which usually was associated with degeneration of the acromioclavicular joint. The authors found that excision of the distal one centimeter of the clavicle provided consistent relief of pain.
Penny and Welsh subsequently found that osteoarthrosis of the acromioclavicular joint can lead to failure after the operative treatment of subacromial impingement. However, resection of the acromioclavicular joint should not be performed routinely for all patients who have subacromial impingement; rather, the joint should be resected only if the patient has symptoms in the region of the joint and if osteophytes contribute to the impingement. See Journal of Bone and Joint Surgery (1854)
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