https://osteopathie-adhesiolyse.com In 1/3 of acromioclavicular instabilities, Wagner found a dynamic instability (Fig. 4, 5), which has never been described before, and which seems to potentiate the risk of conflict. Indeed, we find this dysfunction 1 in 2 times in the case of a complete tear of the cuff. This instability is linked with a hyper-laxity, which adds to the arthrosis of the joint. During the abduction, it is as if the clavicle were pulled downwards at the same time as the acromion follows the motion of the humerus. This phenomenon appears to be cased by a retraction of the anterior fascia and especially by a contraction of the subclavicle muscle, which is painful when put under pressure. Manual de-contracting manipulation can be proposed.

1. With rotator cuff pain, the importance of the acromioclavicular joint is often overlooked.
If the role of osteophytes is well understood, P. Wagner showed that in almost half of acromioclavicular
arthropathies, an “INFERIOR INSTABILITY” increases the agressiveness of the clavicle against the rotator
cuff.
He described a dynamic ultrasound test showing this inferior instability of the clavicle. This inferior
instability is correlated to the severity of the injury to the rotator cuff.
In the two tiers of rotator cuff pathology, Wagner found osteophytosis (Fig. 1) at the upper part of the
acromioclavicular joints. In these cases of acromioclavicular osteoarthritis (Fig. 2), it is probable that an
inferior osteophytosis could be aggressive against the rotary cuff. Radiological assessment with Lamy
incidence must be demonstrated. This arthrosis is often accompanied by synovitis, sometimes very
inflammatory either with or without effusion. The acromioclavicular joint space may be in communication
with the BSAD. An infiltration permits visualization of the passage of liquid from one compartment to the
other.
A subcutaneous synovial cyst (Fig. 3), from a acromioclavicular point of view, is also a manifestation of this
effusion.
Fig 1. Rounded osteophystosis of the distal end of the
clavicle
Fig. 2 Acromioclavicular arthrosis with the production of
osteophytes at the upper part of the joint. The lower side is
likely identical, with potential aggression on the cuff.
Requires a radiographic incidence centered on the joint.
Fig. 3. The subcutaneous cyst is an “evagination” of the joint
cavity. Careful examination indeed shows communication
with the spacing.
Acromio-clavicular degenerative syndrome of the ROTATOR CUFF: Wagner’s test
Thierry Ho-Pun-Cheung, sport doctor, osteopath, Montpellier June 2014
Pierre Wagner, physician, Nimes
Degenerative acromioclavicular osteophytes and synovites

2. Fig. 6a 6b. Same anomaly. Patient who has had
a resection of the distal end of the clavicle.
- supraspinatus at
neutral rotation
- infra-spinous at
forced medial
rotation
- sub-scapular at
forced lateral
rotation
In 1/3 of acromioclavicular instabilities, Wagner found a dynamic instability (Fig. 4, 5), which has never been
described before, and which seems to potentiate the risk of conflict. Indeed, we find this dysfunction 1 in 2
times in the case of a complete tear of the cuff. This instability is linked with a hyper-laxity, which adds to
the arthrosis of the joint. During the abduction, it is as if the clavicle were pulled downwards at the same
time as the acromion follows the motion of the humerus. This phenomenon appears to be cased by a
retraction of the anterior fascia and especially by a contraction of the subclavicle muscle, which is painful
when put under pressure. Manual de-contracting manipulation can be proposed.
Acromioclavicular instability
Fig. 4. Inferior instability
of the clavicle. Due to the
subclavicle muscle,
sometimes associated
with scapular dyskinesia,
the clavicle does not
follow the rocking motion
of the scapula, creating
an ultrasound impression
of the lower discrepancy.
Fig. 5. Acromioclavicular in adduction: the upper surface of the
clavicle (C) is higher than the acromion (A). Joint disjunction allows
observation of bursitis through the acromioclavicular space. The
synovial under the upper ligament is a little too visible (arrow).
During the anterolateral elevation of the arm, the clavicle will be
lower and closer to the acromion, driving the synovial below the
superior ligament.
Surgical resection (Fig. 6) of the distal end of
the clavicle is often ineffective, as it aggravates
the instability (Fig. 7, 8).
Fig. 7. Evolution of the resection: changes with scar fibrosis and inflammation.
Fig. 8. This patient continues to suffer three years after
the intervention; the articular space is very modified
and remains inflammatory, in spite of several cortisone
infiltrations.
We understand that lower
osteophytosis attacks the cuff,
particularly:
Acromioclavicular atypia (Fig. 9, 10)
Fig. 9. Abnormalappearanceand bilateralof an acromioclaviclar,without
history. The two sides are separated by 6.5 mm. The space is filledupon
ultrasound:remainsof meniscus or fibrosis?
Fig. 10. An incidental discovery, without history, the
clavicle is dislocated in the upper position.