Acromio-clavicular joint osteoarthritis

Warning

Most ACJ arthritis is caused simply by wear and tear of the joint over several decades. Hence the risk of developing osteoarthritis in the shoulder, as well as physical limitations and pain, increases as you grow older.  Typically people with manual jobs or labouring jobs are at risk, as are weight-lifters and sports people (tennis, rugby, boxing are all common).

An injury to the shoulder can end up leading to arthritis later on, regardless of how old you are.  This is attributed to swelling, pain and even the development of bone spurs, whenever the two bones are rubbing together. Most of the time, the condition occurs in those who are over the age of 50. 

In younger individuals, the condition can result from trauma or injury, such as a sprained or a fractured ACJ, which is known as posttraumatic arthritis.  The condition can also be hereditary. 

Who to refer, who not to refer, how to refer

Who to Refer

  • Those who have failed Primary care management

Urgent Referral Criteria

  • Avascular necrosis or bone death

Who Not to Refer

  • Those who have not completed Primary care management.

Additional Info

  • X-Ray to rule out Sinister causes

Imaging

  • Shoulder X-ray (Ideally xray is < 1yr old)

 

How to refer

We accept referrals through SCI gateway for those who are based in Scotland.

We also accept e referrals through the below email address using the attached form for those who are based just on the other side of the border. 

E- Referral Email address - bor.orthoreferrals@borders.scot.nhs.uk

Referral form - E-Referral to Orthopaedics (Non Sci-Gateway)      

Primary care management

  • NSAIDS if tolerable
  • Activity Modification
  • Physio rehab- strengthening over 6 months
  • CSI X 2-3 if possible and care provider adequately trained.

Resources and links

Primary care shoulder pathway - developed by First Contact Practitioners Primary Knee Pathway

Editorial Information

Last reviewed: 31/07/2025

Next review date: 31/07/2027

Author(s): Mr Roshan Raghavan, Mr Rehan Siddiqi.

Author email(s): Roshan.Raghavan@nhs.scot.