My Favourite Condition To Treat
Certain conditions are more ‘fun’ to treat than others. Ask any GP: aspirating an abscess is full of reward and gratification (actually, to be accurate, it’s full of pus) Someone comes in with something incredibly painful and you’ve got a skill that can offer immediate relief. Managing someone’s blood pressure is a much more thankless task.
In my field of Sport and Exercise Medicine one of the most gratifying conditions to treat is ACJ pain.
Why?
Because it is painful, so often misdiagnosed and usually pretty easy to treat.
The typical story is as follows;
- A swimmer, surfer or SUP paddler who has had a sore shoulder for some time.
- They’ve usually seen one or more health professionals who’ve diagnosed them with; {swimmers shoulder/impingement/bursitis/rotator cuff pain/supraspinatus tendonitis (different names for essentially the same condition)
- They often have been sent for an ultrasound which reports “impingement” “bursitis” “bursa thickening” or “tendonitis”
- They get sent for a cortisone injection based on the ultrasound findings
- The cortisone either doesn’t work at all or only works partly or briefly.
- Simply testing their AC joint reveals the true diagnosis without any expensive scans
- Treatment is highly effective and lasting
Why is this such a common story?
1. Firstly, subacromial impingement and bursitis is indeed a very common cause of shoulder pain. It is the most common cause of shoulder pain in swimmers and is highly prevalent in paddlers too. Being common, however means we can sometimes be all-to-quick to blame it for all shoulder pain.
2. Secondly, ultrasound is a highly subjective investigative tool in shoulders. There is no agreement on what a normal bursa size is and there is no evidence that an enlarged bursa on ultrasound correlates to a diagnosis of impingement. Almost every shoulder ultrasound report I will come back concluding that bursitis is present. Also, swimmers and paddlers WITHOUT PAIN will almost always have an ‘enlarged bursa’ on ultrasound.
What is the solution?
Anyone who has had longstanding shoulder pain in this region (particularly if they are a swimmer, surfer or SUP paddler) who has failed to respond to prior treatment should see a Specialist Sport and Exercise Physician. In expert hands, there are a few highly specific clinical tests that can diagnose the condition of ACJ arthropathy in one visit and without expensive tests. In most cases treatment can involve a single injection that can often settle the condition down permanently or at least long term. In the very few absolute worst cases that don’t achieve a lasting improvement the ‘last resort’ is a simple, minimally invasive surgical procedure with excellent results, minimal complications and a quick recovery.
