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Conservative Management Of Arthritic AC Joint Harjeet Singh Bhatia Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand. Osteoarthritis of acromioclavicular joint is a common condition of the shoulder, resulting in pain and physical limitations with overhead and cross-body movements. Osteoarthritis is the most common disorder of the AC joint. The AC joint is a diarthrodial joint formed by the junction of anteromedial acromion, lateral clavicle and intra-articular disk. A fibrocartilaginous disk cushions the joint, bear load and corrects for incongruences. Degeneration of intra-articular disk commonly observed in the patient over the age of 50 years, begins as early as second decade of life. The small articular surface area and high loads experienced with every day activity results in very high contact stresses within the joint and accelerate osteoarthritic changes. Degenerative joint disease of AC joint can occur due to age related degeneration of intra-articular disk, post traumatic arthropathy, distal clavicle osteolysis, inflammatory arthropathy, septic arthritis, joint instability and impingement. Common symptoms include pain with passive and active motion of shoulder joint, most notable with overhead and cross body athletic or occupational activities. Mechanical symptoms such as popping, catching, or grinding within the joint can be present as well. A careful examination of the entire shoulder girdle, including scapular kinetics is essential and should be combined with a cervical spine examination to rule out any contribution from cervical lesions. Specific provocative tests for AC joint are the cross body adduction test, AC resisted extension test and the O’Brien active compression test. The AC joint is best visualized on the Zanca view. An axillary lateral radiograph should be part of the radiographic evaluation as this may reveal subtle or gross anterior to posterior instability. The radiographs should be closely evaluated for adjacent lesions such as subacromial impingement, os acromiale, instability and fracture. CT or MRI is advance imaging for concomitant injuries. Non-operative treatment of arthritic AC joint includes physical therapy, activity modification, immobilization, nonsteroidal anti-inflammatory medications and intra-articular injection therapy with corticosteroids. Despite a full course of nonoperative treatment pain and loss of shoulder function continues then operative treatment should be considered.