Radiological features of osteoarthritis of the acromiclavicular joint and its association with clinical symptoms

To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features.

Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination.

Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ.

Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.