Q: Well, I'm ready to throw the towel in. I have bad arthritis of my AC joint from an old, old football injury. I've tried everything and the pain is unrelenting. I'm going to have the surgeon lop off the end of the bone. Anything I should know before I head in this direction?

A: The acromioclavicular (AC) joint is located in the front of the shoulder where the acromion meets the clavicle (collar bone). The acromion is a curved piece of bone that comes from the back of the scapula (shoulder blade). It forms a little bony "roof" over the shoulder joint.

Sometimes the end of the clavicle that meets the acromion becomes degenerated and very painful. The standard treatment approach to this problem is conservative (nonoperative) care. Conservative care usually takes care of the problem. The patient takes antiinflammatory medications and works with a physiotherapist. Treatment extends over a period of three to six months. The goal is to reduce pain, restore normal posture and alignment, and improve motion and function.

If you have tried all of these measures and still have chronic pain, then steroid injections (up to three spread out over three to six weeks) may be tried. When all else fails, then surgery becomes a consideration. Make sure before you head this direction, you have covered all your bases with each of the outlined approaches under the conservative care umbrella.

Now if surgery is truly the next step for you, there are two ways the procedure can be done: arthroscopically or with open incision. Here are a few things to know about how these two methods compare. Open incision surgery allows for direct visual inspection of the joint. The surgeon can remove exactly the amount of bone necessary to take care of the problem. But in order to do so, the surgeon must cut through the soft tissues, joint capsule, and ligaments supporting the acromioclavicular (AC) joint.

As you might guess, the arthroscopic procedure has just the opposite advantages and disadvantages. The surgeon does not make a large incision and therefore does not have a wide direct view of all the anatomic structures. But at the same time, none of the soft tissues are cut and therefore do not lose their integrity. Stability of the joint is maintained. And the surgeon can look around inside the joint to see if there are other areas of damage that need repair. That is a big advantage over the open incision approach.

You can certainly ask your surgeon this question -- it's a good one! Having this much information will give you a place to start in discussing this issue with the surgeon. Complications and problems (e.g., infection, fracture, failure of the wound to heal) are always possible with any surgery, no matter how minor. Your surgeon can also fill you in as to the more typical complications he or she sees following this type of procedure.

Reference: William J. Robertson, MD, et al. Arthroscopic Versus Open Distal Clavicle Excision. In The American Journal of Sports Medicine. November 2011. Vol. 39. No. 11. Pp. 2415-2420.