Acromioclavicular Joint Space Research Articles

Acromioclavicular Joint Space Size in a Nigerian Patient cohort

Objective: To establish normative data on the width of the acromioclavicular (AC) joint space using sonography, based on a selected Nigerian cohort without any shoulder injury or pathology. Materials and Methods: A cross-sectional study was conducted on the normal AC joints of randomly selected Nigerians. A sonographer performed the examination and obtained all the width measurements of AC joint space, using a GE LOGIQP6 ultrasound system and a multiple-frequency linear transducer. Results: The width of the AC joint space was equal on both sides, measuring 5.6 ± 1.2 mm for the right and 5.6 ± 1.2 mm for the left ( P = .701). The mean width of both joint spaces differed between men and women, with the men having a wider space ( P < .05). Age had a strong negative predictive relationship, with the AC joint space width and both joint spaces decreasing with age ( P < .001). Weight and body mass index had weak negative predictive relationships with both joint space widths ( P < .001). Participant height had a very weak positive predictive relationship with both joint space widths ( P < .05). Conclusion: Normative data on the width of the AC joint space, in a randomly selected Nigerian cohort, are provided and may be clinically useful in the ongoing sonographic assessment of the AC joint.

RADIOGRAPHIC DETERMINATION OF NORMAL RANGE VALUES OF ACROMIOCLAVICULAR JOINT SPACE IN NIGERIAN POPULATION

Background: Acromioclavicular joint space is one of the most common injuries of the shoulder region. Accurate diagnosis of most acromioclavicular (AC) joint pathologies depends on the knowledge of the normal range values of acromioclavicular joint space. The variation in the normal AC joint spaces among the studied population points to the need to have population-specific reference range values of acromioclavicular joint space while the paucity of data on normal acromioclavicular joint space diameter in our locality necessitated this study. Objective: This study was, therefore, aimed at radiographically determining the normal reference range values of acromioclavicular joint space diameter with age in adult Nigerian and also to find its variation with sex. Methods: This retrospective study was conducted in three tertiary hospitals in Enugu from January 2019 to July 2019. It involved digital anteroposterior shoulder radiographs of 628 adults (18 – 80 years) obtained using Zanca’s view and reported as normal by four consultant radiologists. The acromioclavicular joint space diameter is calculated as an integral of the distances between the superior and inferior borders of the acromioclavicular joint space. Data were analyzed using a linear regression model, Pearson product-moment correlation coefficient, and independent sample t-test. Results: The mean AC joint space diameter ranged from 3.63 mm at ≤ 20 years to 1.14 mm at 76-80 years of age. Acromioclavicular joint space diameter correlated strongly but negatively with age with correlation coefficients of -0.785, -.839, -.797, and -.780. There was a significant difference between the acromioclavicular joint space diameter of males and females (p = 0.000). Conclusion: This study has generated a reference range value of normal acromioclavicular joint space diameter with age in our locality while there is a difference in acromioclavicular joint space between male and female adult Nigerians.

Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty.

BackgroundLittle is known about the role of disorders of the acromioclavicular joint (ACJ) and how they relate to complications after reverse shoulder arthroplasty (RSA). The purpose of this study is to compare the severity of ACJ osteoarthritis in patients undergoing RSA with and without postoperative acromial and scapular spine fractures.MethodsA retrospective review was performed to identify all patients who underwent primary RSA between 1/1/2007 and 10/31/2019 with a postoperative acromial or scapular spine stress fracture from a single institution. Patients who underwent RSA with a fracture were compared with an age-, sex-, and preoperative diagnosis-matched control group (1:4 controls) with a minimum 2-year follow-up. We compared demographics, medical comorbidities, and ACJ osteoarthritis between the 2 groups. Preoperative radiographs and 3-dimensional computed tomography scans were evaluated for ACJ osteoarthritis in all patients. The Petersson classification, a modified Petersson classification, location of the osteophytes, subchondral cysts, ACJ space, and size of the largest osteophyte were recorded and compared between the 2 groups.ResultsThe study included 11 patients who underwent primary RSA (8 women and 3 men) with acromial (6) and scapular spine (5) fractures confirmed radiographically and 44 matched controls (average follow-up 3.1 vs. 4.3 years, P = .17). Average age at surgery was similar between study and control groups (69.6 vs. 70.0 years, P = .86). ACJ osteoarthritis with osteophytes larger than 2 mm was common and similar between the 2 groups (91% of patients with acromial fracture and 66% of controls, P = .15). There was no significant difference in the size or location of the ACJ osteophytes. The Petersson classification was similar between groups. However, the percentage of patients with subchondral ACJ cysts was higher in the fracture group (91% vs. 50%, P = .02), and the percentage of patients with large spanning or fused osteophytes was significantly higher in the fracture group (55% vs. 14%, P = .008).ConclusionRadiographic ACJ osteoarthritis is common in patients undergoing RSA. Severe ACJ osteoarthritis with completely spanning or fused osteophytes may predispose patients to acromial or scapular spine fractures after RSA.

Is conventional radiography still relevant for evaluating the acromioclavicular joint?

IntroductionConventional radiography using an anteroposterior view of the acromioclavicular (AC) joint is the gold standard for evaluating arthritic degeneration. ObjectiveBased on a standardised AP view of the AC joint, the objective of this study was to determine whether this radiographic view is reliable and reproducible for evaluating the AC joint space. MethodsA cadaver scapula–clavicle unit, free of osteoarthritis, was used for this study. The scapula was positioned in a stand; and then with fluoroscopy guidance, a strict AP view of the AC joint was taken. Starting from this “0” position, a radiograph was taken by varying the angle by 5°, 10°, and 15° in every plane in space. All radiographs were taken during a single session to ensure the distance between the X-ray tube and scapula did not change. The images were then exported to OsiriX for processing; the superior and inferior AC distance and the joint area were measured. ResultsThere was no reproducibility in the AC joint measurements as a function of the incidence angle relative to a strict AP view. ConclusionConventional radiography using an AP view of the AC joint cannot be used to do a fine analysis of arthritic degeneration of this joint. It is likely that only CT scan or MRI is sufficient to analyse osteoarthritis in this joint. Level of evidenceIV, basic science study.

Ultrasound guided joint space distance changes during manual traction of acromioclavicular joint in young and healthy adults

Abstract Introduction: Manual traction is a commonly used technique in manual therapy. However, depicting changes in joint space distance via real time imaging during traction is seldomly applied. The aims of the study were to identify ACJ joint space distance changes during manual traction and creation of a classification of the techniques upon the largest change in the resultant parameter (l) representing joint space distance. Material and methods: Thirteen healthy volunteers were examined unilaterally. Acromioclavicular joint space distance changes were measured with dynamic ultrasound imaging during followingmanual traction techniques: International Academy of Orthopedic Medicine technique (IAOM AC), Karel Lewit’s Prague School of Manual Medicine & Rehabilitation technique (LAC) and author’s own proposition (B AC). The differences in joint space distance between resting position (RP) and the traction technique position, created three parameters of displacement - horizontal (x), vertical (y) and (l) - the resultant component. Results: Parameters were not coherent with normal distribution. Statistical differences showed significance in the (x) parameter for IAOM AC compared with L AC (p<0,0183) and B AC (p<0,02). All techniques presented a significant increase of the resultant distance (l), compared with RP as the reference value - IAOM AC p<0,0036, L AC and B AC p<0,0000. In few cases L AC decreased the distance in the (x) parameter, but not significantly. Conclusions: 1.Significant changes of (x) parameter did not correspond with the significance of the resultant parameter (l), which prevented authors from creating a classification of the techniques. 2.All traction techniques used in the study increased the joint space distance compared to RP, which confirms traction’s theoretical assumptions. 3.For clinical purpose the change of (x) parameter may prove crucial for therapy’s effectiveness, despite lack of change in the joint space distance in the resultant parameter (l) by itself.

Acromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species

The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I-VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification. In four human cadavers (seven shoulders), the acromioclavicular and coracoclavicular ligaments were transected stepwise. Radiological correlates were recorded (Zanca view) with 15-kg longitudinal tension applied at the wrist. The resulting acromio- and coracoclavicular distances were measured. Radiographs after acromioclavicular ligament transection showed joint space enlargement (8.6 ± 0.3 vs. 3.1 ± 0.5 mm, p < 0.05) and no significant change in coracoclavicular distance (10.4 ± 0.9 vs. 10.0 ± 0.8 mm). According to the Rockwood classification only type I and II lesions occurred. After additional coracoclavicular ligament cut, the acromioclavicular joint space width increased to 16.7 ± 2.7 vs. 8.6 ± 0.3 mm, p < 0.05. The mean coracoclavicular distance increased to 20.6 ± 2.1 mm resulting in type III-V lesions concerning the Rockwood classification. Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.

The infiltration of the AC joint performed by one specialist: Ultrasound versus palpation a prospective randomized pilot study

Introduction The acromio-clavicular (AC) joint is very susceptible to degenerative processes that result in pain and functional impairment. One common modality of treatment has been local infiltration of the joint space. Although this procedure has produced notable positive results, needle misplacement occurs frequently. The aim of this investigation is to evaluate the effects of an intra articular infiltration by comparing precise needle placement into the joint space using high-resolution-ultrasound with the conventional palpation technique. Methods This prospective and randomized pilot study analysed 20 patients who were assigned either to the “ultrasound” or the “palpation” group. Clinical examinations were performed before treatment and at 1 h, 1 week and 3 weeks after a single infiltration of local anaesthetic and corticoid carried out by one specialist. Results In both groups significant improvement in pain and function was obtained up to one-week post injection. Function remained significantly improved until the last follow-up and did not differ between the two groups. The agent was administered in all patients into the joint space in the ultrasound group. Conclusion Ultrasound guided infiltration of the AC joint is an easily achieved procedure without any complications. However, clinical follow-up did not differ between free-hand and ultrasound-guided AC joint space infiltration.

Osteolysis of the Distal Clavicle: Serial Improvement and Normalization of Acromioclavicular Joint Space with Conservative Care

To discuss a case of osteolysis of the distal clavicle (ODC) in a 29-year-old male chiropractic student who showed interval radiographic and clinical evidence of healing. The patient complained of intermittent left-sided shoulder pain of 8 months' duration that was exacerbated while performing spinal-manipulative procedures. A radiographic examination showed changes consistent with osteolysis involving the distal clavicle. A conservative treatment regimen of physiotherapy, nutritional supplementation, and activity modification resulted in an interval reduction in symptomatology and radiographic findings on serial examinations, ultimately resolving both abnormal clinical and radiographic findings after approximately 14 months of treatment. We specifically observed normalization of the acromioclavicular (AC) joint dimension. In contrast to the posttreatment radiographic outcome seen in our patient, ODC classically does not result in complete resolution of radiographic findings or normalization of AC joint dimension, and such radiographic normalization of joint space is currently not reported in the literature. This case report serves to document and to show this unique occurrence.

Radiographic joint space in rheumatoid acromioclavicular joints: a 15 year prospective follow-up study in 74 patients.

To evaluate radiographically the acromioclavicular joint space in patients with long-term rheumatoid arthritis (RA). A cohort of 74 patients with RA was followed prospectively for 15 yr. At the end point, 148 shoulders were radiographed with a standard method. The acromioclavicular (AC) joint space was examined from the radiographs with a method developed previously for population studies; the joint space was measured at its superior and inferior border, and the average of the two measurements, the integral space, calculated. Mean AC joint space in RA patients was 4.9 (S.D. 3.7), range 0-20.5 mm; 6.2 mm (S.D. 5.1) in men and 4.5 mm (S.D. 3. 0) in women. An AC joint space wider than 7 mm in men was found in 11 (31%) out of 36 joints and wider than 6 mm in women in 17 (15%) out of 112 joints. Joint space widening was associated (r=0.87, 95% CI 0.82-0.90) with increasing destruction (Larsen grading) of the joint and it seems to be an inevitable consequence of AC joint affection in RA. Joint space widening is more progressive on the caudal side because of the nature of the erosive destruction. Degeneration with joint space narrowing was observed in 8 (11%) patients (11 joints, 7%; three bilateral). The largest value of the joint space may be used when evaluating rheumatoid AC joint space. In RA patients, a joint space of >7 mm in men and >5 mm in women is a sign of destructive AC joint affection.

Diminished space in the acromioclavicular joint in forced arm adduction as a radiographic sign of degeneration and osteoarthrosis.

The purpose of this study was to examine the acromioclavicular joint by radiography under forced arm adduction to demonstrate diminished joint space as a sign of cartilage degeneration and osteoarthrosis. A total of 192 right and left joints were investigated in 96 healthy working men. There were three main results from the manoeuvre: in 135 of the 192 joints the space was reduced, in 33 joints it was unchanged, and in 24 joints the joint space was increased. In 43 joints (22% of the total) a marked reduction of the joint space to 1 mm or less occurred during the manoeuvre; in the remaining 92 joints with space reduction the reduction was less pronounced. A narrow acromioclavicular joint space during forced adduction of the arm indicates cartilage thinning and may be interpreted as a sign of osteoarthrosis.

Radiographic joint space in normal acromioclavicular joints.

The acromioclavicular joint space in standard antero-posterior images of 151 normal subjects was measured. The joint space was significantly wider in men. There was a highly significant reduction of the joint space with age in both men and women and in persons past 60 a joint space of 0.5 mm or less is not pathological. A joint space wider than 7 mm in men and 6 mm in women is abnormal. The measuring technique described is useful in population studies. In individual cases a simple measurement with a ruler serves the same purpose.

Osteolysis of the Acromial End of the Clavicle in Rheumatoid Arthritis

Destructive changes in the acromial end of the clavicles have been reported in 11 patients with advanced rheumatoid arthritis by Alpert (1961).We wish to report a similar case which has recently come to our notice.The patient was a 37-year-old male with a three year history of rheumatoid arhtritis. The main radiographic findings were tapering of the acromial end of right clavicle and widening of the acromioclavicular joint space. Two remnants of non-osteolysed bone were seen between the acromion and the end of clavicle. The shoulder joint was not affected. Roentgen examination of another joints were within normal limits.This clavicular lesion must be distinguished from bone destruction caused by hyperparathyroidism, post-traumatic osteolysis, tuberculosis and acro-osteolysis.

Acromioclavicular Changes in Primary and Secondary Hyperparathyroidism

The description of a roentgenologic finding as a presumptive sign is always a matter of general interest, and while no claim of infallibility is made for our observation, we have decided to report it in the hope that it will be checked and commented upon by other workers. We have observed this finding in several cases of hyperparathyroidism, both of the primary type and of the secondary type associated with chronic renal insufficiency (renal rickets, renal osteodystrophy, or osteonephropathy). In one case the observation of the sign in a routine chest film suggested the diagnosis to one of us (L. N.), and this was later confirmed by a roentgen survey of the skeletal system, biochemical analysis of the blood, and by the postmortem finding of a parathyroid adenoma. The bone findings in primary hyperparathyroidism (osteitis fibrosa cystica generalisata) and renal osteodystrophy (or renal rickets, as it is called in the older literature) have been adequately described elsewhere (3, 6, 13, and 14), and it is not our purpose to review them here except as they appear in our cases. We wish merely to call attention to changes which we have observed in the acromioclavicular articulations in these cases, consisting of cupping of the outer end of the clavicle, with fraying due to irregular absorption of the articular surface. Similar though less striking changes may be present in the articular surface of the acromion process, and there may or may not be widening of the acromioclavicular joint space. Although we have never observed an epiphysis in the outer end of the clavicle, nor have we seen one described, the changes simulate the metaphyseal cupping, fraying, and decalcification seen in vitamin D-deficiency rickets. The reason for the localization of these changes is not apparent, but presumably it is related to the activity of the shoulder and its associated joints. Grant (8) has described the motions about the acromioclavicular joint with movement of the scapula, and Oppenheimer (12) has demonstrated roentgenographically that there is motion in the acromioclavicular joint during all movements of the arm except pronation and supination. The latter writer stresses the importance of the joint function, stating that the mobility of the arm depends significantly on the mobility of the scapula, and that the mobility of the scapula in turn depends on the mobility of the shoulder girdle in the sternoclavicular and acromioclavicular joints. The following cases illustrate the changes described as they appear in the various types of hyperparathyroidism. The first case is one of renal osteodystrophy in association with congenital bladder neck obstruction leading to marked bilateral hydronephrosis and hydroureters, with severe impairment of renal function. Case 1: A white male, aged 16 years, was found to have had a congenital urinary defect at the age of five years, when he was investigated for polyuria and enuresis.