Distal Clavicle Osteolysis

Overuse Injury Commonly Seen in Weightlifters

bench press
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Distal clavicle osteolysis is a condition that causes shoulder joint pain at the end of the collarbone. The name is so derived because the pain is the result of bone damage ("osteo-" for bone and "-lysis" for disintegration) at the outer (distal) end of the collarbone (clavicle).

It is considered an overuse injury caused by repeated microfractures that the body attempts to repair. However, with each microfracture, the remodeling of bone becomes more jagged and uneven, placing stress on the end of the clavicle and causing the deterioration of cartilage on the adjacent acromioclavicular joint (AC joint) where the clavicle meets the shoulder blade.

The condition is seen most commonly in weightlifters but can affect anyone who repeatedly lifts and/or carries heavy objects overhead. The force exerted across the AC joint can lead to progressive injury and the premature development of arthritis.

Symptoms and Diagnosis

The most common symptom of distal clavicle osteolysis is a sharp pain at the junction of the AC joint and collarbone. While the pain is usually felt during activity, there may also be a persistent tenderness around the joint during non-activity. Inflammation and swelling are also common.

Pain when reaching across the chest is a typical symptom of AC joint problems. Doctors can confirm this by performing a cross arm adduction test. Any pain caused by pressing the arm laterally across the chest is considered a positive result.

The test would then be followed up with X-rays of the shoulder. On X-ray, the injury would show up as an area of poor bone density or abnormal bone mineralization.

It would be similar in appearance to osteoporosis, a condition where more bone is absorbed by the body than created.

Alternately, a magnetic resonance imagining (MRI) scan may be ordered for if there are believed to be other causes of shoulder pain, either in addition to or separate from the suspected distal clavicle osteolysis.

Treatment

Distal clavicle osteolysis is usually treated conservatively with rest, restriction of movement, ice application, and anti-inflammatory drugs. Any activity associated with the injury would need to be stopped.

If there is severe pain, the shoulder may need to be held in a fixed position with an orthopedic sling. When the shoulder is reasonably healed and the inflammation has ceased, physical therapy would be started to safely restore range of motion and strength to the affected shoulder.

In some cases, surgery may be needed if more conservative measures fail to provide relief. The surgery would involve the removal the end of the clavicle, a technique doctors refer to as the Mumford procedure. It is a common surgery used to correct other conditions affecting the AC joint, including severe osteoarthritis. It can be performed either through a small incision or arthroscopically.

Most people who undergo the procedure can resume normal activities with no loss of function. The recovery time is usually around three months, although some can return to activity faster with a structured course of physical therapy and rehabilitation.

Source:

Ha, A.; Petscavage-Thomas, J.; and Tagoylo, G. "Acromioclavicular Joint: The Other Joint in the Shoulder." Am J Roentgen. 2014; 202:375-85. DOI: 10.2214/AJR.13.11460.

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