Acromioclavicular Joint Osteoarthritis With Joint Effusion

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Acromioclavicular Joint Osteoarthritis With Joint Effusion

Authors, Editors, Case Information Author: Matthew Jorgensen, DO Affiliation: UF Health, Department of Sports Medicine and Orthopedics, Gainesville, FL Co Author(s): Davis Mills MD, AnnMarie Muñecas BS, Sarah L. Chrabaszcz MD, Ryan Mark MD Senior Editor: Alex Houser, DO Clinical Vignette: A 76-year-old male presented to clinic with progressively worsening right shoulder pain without trauma or injury to the shoulder. Pain was superolateral and exacerbated by lifting objects in front of his body. Exam was notable for positive Hawkins test for impingement and tenderness over the acromioclavicular joint. Type of Probe Used: 3-14 MHz Linear array transducer Unlabeled Long Axis View of the Anterior Acromioclavicular Joint Unlabeled long axis view of the anterior acromioclavicular joint with the transducer oriented over the anterior most portion of the joint. Unlabeled Long Axis View of the Acromioclavicular Joint Unlabeled long axis view of the acromioclavicular joint with the transducer oriented directly over the middle portion of the joint. Unlabeled Long Axis View of the Posterior Acromioclavicular Joint Unlabeled long axis view of the acromioclavicular joint with the transducer oriented over the posterior-most portion of the joint. Labeled Long Axis View of the Anterior Acromioclavicular Joint Labeled long axis view of the anterior acromioclavicular joint with the transducer oriented over the anterior-most portion of the joint. Evidence of capsular thickening and anechoic effusion within the joint space. Labeled Long Axis View of the Acromioclavicular Joint Labeled long axis view of the acromioclavicular joint with the transducer oriented directly over the middle portion of the joint. Evidence of anechoic joint effusion, cortical changes to the proximal clavicle and acromion, as well as visualization of underlying supraspinatus. Labeled Long Axis View of the Posterior Acromioclavicular Joint Labeled long axis view of the acromioclavicular joint with the transducer oriented over the posterior-most portion of the joint. Evidence of osteophyte formation within the joint space, as well as cortical changes of the acromion and proximal clavicles, is suggestive of osteoarthritis. Interpretation Image Interpretation: The right acromioclavicular joint demonstrates joint space irregularity with cortical hypertrophy and osteophyte formation, consistent with osteoarthritis. There is a small anechoic fluid collection within the joint, suggestive of a mild effusion with capsular thickening. No significant synovial hypertrophy or hyperemia noted. Teaching Pearl: Ultrasound of the acromioclavicular joint can provide a high-resolution assessment of superficial cortical irregularity, osteophytes, capsular hypertrophy, and joint fluid that may be subtle on radiographs. The transducer should be positioned longitudinally over the joint and correlated with sonopalpation to determine if the AC joint is the pain generator. A small effusion may accompany osteoarthritis, but warmth, marked Doppler hyperemia, systemic symptoms, or acute severe pain should prompt consideration of inflammatory arthritis, crystal arthropathy, or infection. References: 1. Manske RC, Voight M, Page P, Wolfe C. MSK diagnostic ultrasound for the assessment of the acromioclavicular joint. Int J Sports Phys Ther. 2024;19(1):1516-1520. doi:10.26603/001c.90907 2. Precerutti M, Formica M, Bonardi M, Peroni C, Calciati F. Acromioclavicular osteoarthritis and shoulder pain: a review of the role of ultrasonography. J Ultrasound. 2020;23(3):317-325. doi:10.1007/s40477-020-00498-z 3. Flores DV, Goes PK, Mejia Gomez C, Umpire DF, Pathria MN. Imaging of the acromioclavicular joint: anatomy, function, pathologic features, and treatment. Radiographics. 2020;40(5):1355-1382. doi:10.1148/rg.2020200039
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Anterior Acromioclavicular Joint

Unlabeled Long Axis View of the Acromioclavicular Joint

Unlabeled Long Axis View of the Posterior Acromioclavicular Joint

Labeled Long Axis View of the Anterior Acromioclavicular Joint

Labeled Long Axis View of the Acromioclavicular Joint

Labeled Long Axis View of the Posterior Acromioclavicular Joint

Interpretation

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