Painful conditions of the acromioclavicular joint without instability can be treated successfully with arthroscopic methods. The direct approach is best suited for isolated acromioclavicular pathology. It also can be used to address the acromioclavicular joint during shoulder arthroscopy and bursoscopy, but two additional acromioclavicular portals are needed. In patients with both subacromial and acromioclavicular joint pathology, the bursal approach to the acromioclavicular joint can be used. In some patients with narrow or medially inclined overriding clavicles, the distal clavicle is not easily resected with the bursal approach. The direct approach is an alternative in these situations. Either method has been shown to be an effective treatment and can return the patient to full activity much sooner than with a traditional open resection.