Questionnaire/history: Tenderness over the acromioclavicular joint, which is made worse by raising the arm up high or when the arm is brought across the body? Weight lifting? Trauma? Older 60 years of age? Past medical history? Current medication? Drug allergies? Examination: Asymmetry of the shoulder contours? Tenderness localised to the AC joint? Limited ROM due to pain? High arch pain? Cross arm test positive? Investigations: X-ray Management: AC osteoarthritis: Advised: On activity modification, in particular to avoid cross body shoulder adduction (for example in a golf swing) and to avoid heavy lifting Paracetamol +/- ibuprofen +/- codeine when required Physiotherapy offered X-ray and referral to orthopaedics if no, or only temporary, improvement following the above measures AC joint injury: Referral to A&E Resource(s): NICE CKS: Scenario: Acromioclavicular joint disorders