acromioclaviculaerleddet-artrose (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger </h2>
<h3>Definition</h3>
<ul>
    <li>Degenerativ tilstand med nedslidning af brusken og dannelse af osteofytter i ledspalten </li>
    <li>Der er ofte instabilitet, fordi lidelsen ses sekund&aelig;rt til et traume med ligament- og bruskskade </li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Artrose er ganske almindelig hos &aelig;ldre, med de fleste oplever dog ikke smertegener<a href=" " data-type="journal-reference" data-value="Menge TJ, Boykin RE, Bushnell BD, Byram IR, Acromioclavicular osteoarthritis:  a common cause of shoulder pain. South Med J 2014;107: 324-9" data-value-piped="Menge TJ, Boykin RE, Bushnell BD, Byram IR|Acromioclavicular osteoarthritis:  a common cause of shoulder pain|South Med J|2014|107|324-9" data-url="reference-link" title="Menge TJ, Boykin RE, Bushnell BD, Byram IR, Acromioclavicular osteoarthritis:  a common cause of shoulder pain. South Med J 2014;107: 324-9">1</a><sup>,</sup><a title="Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR Jr., Degenerative joint disease of the acromioclavicular joint: a review.. Am J Sports Med.  2013;41: 2684-92" href=" " data-type="journal-reference" data-value="Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR Jr., Degenerative joint disease of the acromioclavicular joint: a review.. Am J Sports Med.  2013;41: 2684-92" data-url="reference-link" data-value-piped="Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR Jr.|Degenerative joint disease of the acromioclavicular joint: a review.|Am J Sports Med. |2013|41|2684-92">2</a></li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Ukendt hos &aelig;ldre </li>
    <li>Traume er ofte udl&oslash;sende &aring;rsag - s&aelig;rligt hos yngre patienter</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Sandsynligvis arvelig disposition</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Lokal palpations&oslash;mhed, krepitation </li>
    <li>Positiv horisontal adduktionstest </li>
    <li>Positiv respons p&aring; injektion af lokalan&aelig;stetika</li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=F29DD722755E4BDBBD9307C4D36C6F49&amp;_z=z">Skuldertendinit</a> </li>
    <li>
    <a href="~/link.aspx?_id=7E23BC0953684F15B86E3F5DDC2AE850&amp;_z=z">Skulderbursit, kronisk</a> </li>
    <li>
    <a href="~/link.aspx?_id=5759722629464405B6A10446F779E350&amp;_z=z">Skuldersynovit</a> </li>
    <li>
    <a href="~/link.aspx?_id=BE550619ADA34549ABD6E508B5892265&amp;_z=z">Cervical &aring;rsag</a>, affektion af C4/C5</li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Hos &aelig;ldre
    <ul>
        <li>Smerterne kommer oftest efter overbelastning (eks repetitivt arbejde over hovedh&oslash;jde)</li>
    </ul>
    </li>
    <li>Hos yngre
    <ul>
        <li>Optr&aelig;der tilstanden efter traume med ligamentskade, luksation eller intraartikul&aelig;r fraktur</li>
    </ul>
    </li>
    <li>Smerter
    <ul>
        <li>Patienten angiver gerne en murrende smerte lateralt p&aring; skulderen svarende til C4-dermatomet </li>
        <li>Patienterne kan ofte lokalisere smerten direkte til AC-leddet</li>
        <li>Smerter fremprovokeres ved adduktion og samtidig rotation (kl&oslash; sig p&aring; ryggen)</li>
    </ul>
    </li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>Der b&oslash;r foretages en systematisk skulderunders&oslash;gelse </li>
    <li>AC-leddet er ofte tydeligt &oslash;mt ved palpation, evt. kan der v&aelig;re synlig h&aelig;velse </li>
    <li>Passiv og aktiv elevation af armen er som regel smertefuld</li>
    <li>Passiv horisontal adduktion ofte smertefuld
    <ul>
        <li>Overarmen holdes i skulderh&oslash;jde, albuen flekteres 90 grader, unders&oslash;geren presser overarmen medialt </li>
        <li>Alternativt presser&nbsp;patienten h&aelig;nderne mod hinanden i skulderh&oslash;jde </li>
        <li>Er smertefuld og nogle gange nedsat </li>
    </ul>
    </li>
    <li>Injektion af <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/225030">lokalan&aelig;stetikum</a>
    <ul>
        <li>Giver smertelindring og er diagnostisk</li>
    </ul>
    </li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<ul>
    <li>CRP og serologi ved mistanke om tilgrundliggende infekti&oslash;s eller inflammatorisk systemsygdom</li>
</ul>
<h3>Andre unders&oslash;gelser</h3>
<ul>
    <li>Endelig artrosediagnose stilles p&aring; r&oslash;ntgen</li>
</ul>
<h3>Hvorn&aring;r skal patienten henvises?</h3>
<ul>
    <li>Vurdering med henblik p&aring; operation med lateral clavicularesektion hos ortop&aelig;dkirurg b&oslash;r foretages ved l&aelig;ngerevarende og st&aelig;rke smerter, hvor skuldertr&aelig;ning og eventuelt fysioterapi ikke har haft effekt.</li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og regionale pakkeforl&oslash;b [ICPC]</li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Symptomlindring</li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Prim&aelig;rbehandlingen er konservativ med aktivitetsoml&aelig;gning, <a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">kortisoninjektion</a>&nbsp;og evt&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a></li>
    <li>Ved manglende effekt af konservativ behandling kan kirurgisk behandling med rejektion af laterale clavikel &aring;bent eller artroskopisk overvejes<a href=" " data-type="journal-reference" data-value="Chaudhury S, Bavan L, Rupani N, Mouyis K, Kulkarni R, Rangan A, Rees J, Managing acromio-clavicular joint pain: a scoping review. Shoulder Elbow 2018;10: 4-14" data-value-piped="Chaudhury S, Bavan L, Rupani N, Mouyis K, Kulkarni R, Rangan A, Rees J|Managing acromio-clavicular joint pain: a scoping review.|Shoulder Elbow|2018|10|4-14|29276532" data-url="reference-link" data-pubmedid="29276532" title="Chaudhury S, Bavan L, Rupani N, Mouyis K, Kulkarni R, Rangan A, Rees J, Managing acromio-clavicular joint pain: a scoping review. Shoulder Elbow 2018;10: 4-14">#</a></li>
</ul>
<h3>Hvad kan patienten selv g&oslash;re?</h3>
<ul>
    <li>Undg&aring; bev&aelig;gelser som fremprovokerer smerter </li>
    <li>Undg&aring; immobilisering af skulder</li>
</ul>
<h3>Medikamentel behandling</h3>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a> vil som regel lindre smerterne midlertidig</li>
</ul>
<h4><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/171050">Kortisoninjektion</a></h4>
<ul>
    <li>Ved artrose, overbelastning eller forstuvning i AC-leddet, har injektion af steroid (evt blandet med lokalan&aelig;stesi) intraartikul&aelig;rt samt i ligamentf&aelig;sterne p&aring; begge sider ofte god effekt&nbsp; &nbsp; &nbsp;
    <ul>
        <ul>
        </ul>
    </ul>
    </li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>Tr&aelig;ning med&nbsp;<a href="~/link.aspx?_id=53CEA00218DB44EEBD4E17E8E92AA51E&amp;_z=z">skulder&oslash;velser</a>&nbsp;evt i form af regul&aelig;r fysioterapi</li>
    <li>Kirurgi kan v&aelig;re aktuelt ved st&aelig;rke kroniske smerter<a title="Rabalais RD, McCarty E., Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review.. Clin Orthop Relat Res. 2007;455: 30-7" href=" " data-type="journal-reference" data-value="Rabalais RD, McCarty E., Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review.. Clin Orthop Relat Res. 2007;455: 30-7" data-url="reference-link" data-value-piped="Rabalais RD, McCarty E.|Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review.|Clin Orthop Relat Res.|2007|455|30-7">3</a></li>
</ul>
<h2>Forl&oslash;b, komplikationer og prognose</h2>
<h3>Forl&oslash;b</h3>
<ul>
    <li>Kan udvikle sig til kroniske smerter</li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>God, almindeligvis er det tilstr&aelig;kkelig behandling at undg&aring; udl&oslash;sende aktiviteter eks arbejde med armene over hovedh&oslash;jde</li>
</ul>
<h2>Opf&oslash;lgning</h2>
<h3>Plan</h3>
<ul>
    <li>Patienten b&oslash;r normalt f&oslash;lges op</li>
</ul>
<h3>Hvad b&oslash;r man kontrollere</h3>
<ul>
    <li>Behandlingseffekt </li>
    <li>Erhvervsm&aelig;ssige konsekvenser</li>
</ul>
<h2>Patientinformation</h2>
<h3>Hvad man b&oslash;r informere patienten om</h3>
<ul>
    <li>Berolige og informere om &aring;rsag til smerterne samt behandlingsmuligheder samt den generelt gode prognose</li>
</ul>
<h3>Hvad findes af skriftlig patientinformation</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=1CD55A78E42E4F9F90AA6FCE0426DBCE&amp;_z=z">Information om smerter i AC-leddet</a> </li>
    <li>
    <a href="~/link.aspx?_id=3A210B2BEAD24C89BF4A7C7DEC4C3F3F&amp;_z=z">Kortisoninjektion</a></li>
</ul>
<h3>Tr&aelig;ningsfilm for skulderen</h3>
<ul>
    <li><a href="~/link.aspx?_id=CC188691765C40D1A150CDA2CC2056BF&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser</a><br>
    <br>
    <a href="~/link.aspx?_id=53CEA00218DB44EEBD4E17E8E92AA51E&amp;_z=z"><img alt="" height="84" width="135" src="F29C024F18294B948DCBD5C5BE19CD28-135-84" style="height: 84px; width: 135px;"></a></li>
    <li><a href="~/link.aspx?_id=9F6E392D800F48B18D827DF35EF95F3C&amp;_z=z">&Oslash;velsesprogram, 3 &oslash;velser med arabisk tale - فيديوهات تمارين رياضية باللغة العربية</a><br>
    <br>
    <a href="~/link.aspx?_id=8425CFC13C1647309B1A14D3B31AF98D&amp;_z=z"><img alt="" height="84" width="135" src="ECD34BA7D13E4B0BA41E5E9B16E3E3D7-0-0"></a></li>
</ul>
<p> </p>
<h2>Illustrationer</h2>
<h3>Plancher eller tegninger</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=742F588B090A496FBE7F5C94E30F92F9&amp;_z=z">Skulderled-tegning</a> </li>
</ul>
<h3>Video</h3>
<ul>
    <li><a href="~/link.aspx?_id=53CEA00218DB44EEBD4E17E8E92AA51E&amp;_z=z">Skulder&oslash;velser, tr&aelig;ningsprogram til hjemmebrug</a></li>
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