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Acromioclavicular lesion
 Most acromioclavicular -joints have an C4-origin and thus refer pain in the C4-dermatome.
There can be a lesion of the superficial and/or deeper part and this reflects in the clinical image.
The superficial lesion reacts well on deep friction massage ; the deeper lesion reacts better on infiltration.
Acromioclavicular lesion (2)
A lesion of the acromioclavicular joint causes pain at end range on passive elevation and both passive rotations. In such a case, we do a complementary test, the passive horizontal adduction, which is generally clearly positive.
The lesion has a traumatic (75% of the cases)/overuse origin or osteoarthrosis lies at the basis of it.
Deep friction or infiltration are treatment options.
We cannot always choose which option to take. The acromioclavicular joint has a superficial and a deep ligament. When the latter is affected, deep friction is no longer possible (because the structure is not reachable for our finger) and an infiltration is called for. How can we differentiate between superficial and deep ?
When we find the clinical pattern of an acromioclavicular lesion, together with a painful arc, then the deep ligament is at fault ; it gets pinched momentarily during the elevation.
Remark :
sometimes there is radiation of pain in the upper arm, coming from the AC-joint (some AC-joints seem to have a C7-origin instead of C4).
The differential diagnosis between deep lesion of the AC-joint and a chronic subdeltoid bursitis sometimes proves to be difficult : we think of an AC-lesion if the active scapular movements are painful also.
* In the case of an AC-arthritis, there is no passive limitation of movement in the glenohumeral joint.
(Part I, p39 ; Part II, p6)
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