AC Joint Surgery need DR advice

Hi, I am 23 years old and have been having trouble with both AC joints.  A little backround: I had been an avid weightlifter for 6 years put a lot of stress on my AC joints in the process, which has caused them to become abnormal (both joints stick up about a quarter inch).  I have finished my weight lifting career, and my AC joints still bother me.  I have seen two doctors, and have had cortisone shots in both joints.  The cortisone shots have had no effect.  I have had x-rays, MRIs, and a 3 phase bone scan. One of my doctors does not want to do the surgery saying that he does not see any evidence in the x rays, mri, or bonescan that would suggest surgery be an option.  Although you don't need to be a doctor to know that something is wrong with my shoulders when you look at them.

This is what I would like the doctor to do:  I have done some research and propose that the top part of the end of the clavicle and acromion (the pieces that are sticking up, so about a quarter to a half inch) be removed in order to return the shape of the bones to the way they were before I began weight lifting. This surgical option would be instead of cutting off the end of the clavicle vertically. One reason for this is that through excessive lifting, resting the bar on the AC joint when doing swats, flys and military press, and ultimately not providing enough time for the bone to heal between workouts the ends of the acromion and clavicle have calcified as a response.  This calcification has built up over time.  The reason for only cutting off the calcified portion is that removing the ends of both bones would create instability in the joint.  

I would prefer surgery as a fix because I have exhausted all other options.  My question is: Is the surgical option that I propose reasonable?

Some photos are attached.  I appreciate any feedback.

Thank you,

Dan

[S. Kaul, MD]

Hi Dan!

Well, to begin with, it would be inappropriate to comment on the situation without knowing the details and the exact situation of the acromio-clavicular joints. I could not see the films attached, however I will try to be as clear as I can.  If the cause of pain is indeed degeneration, a surgery would be the last feasible option. Joint surgery especially of the smaller bones is not as easy and feasible as described like cutting a cardboard. Bone lengthening or shortening is not usually done by cutting the ends but by selecting a middle portion to be removed while the two ends can be fixed together and this would not be feasible for the acromion anyway. Bone ends are generally not disturbed unless there is an outgrowth, that is malignant or poses a danger to joint stability. One must also understand that a joint does not mean a bone connected directly to a bone; there are a lot of other connective tissues that would need to be disturbed in a surgical/ interventional procedure like the muscles attached to the bones. Regardless of all this, if indeed you were to ‘cut the bone ends’, this would trigger inflammation and would never heal with precision. You may still seek a second opinion with another orthopedician as to a possible management plan.
Hope this was useful.

Take care!