Distal Clavicle Osteolysis
The bones of the shoulder girdle create two distinct joints: 1) the glenohumeral joint is the ball and socket joint, where most of the shoulder motion occurs; 2) the acromioclavicular (AC) joint is where the collar bone (clavicle) attaches to the shoulder blade (acromion).
Distal clavicle osteolysis refers to a pathologic process that affects the end (ie the distal part) of the collarbone (also known as the clavicle). The terminal osteolysis literally means “resorption of bone”. In distal clavicle osteolysis, the end of the collarbone becomes inflamed and ultimately resorbed.
The exact etiology of the distal clavicle osteolysis is unclear. Distal clavicle osteolysis can follow an acute traumatic injury to the AC joint. More commonly, however, distal clavicle osteolysis occurs in patients who perform repetitive heavy weightlifting exercises, such as bench press, military press, or dips.
Signs & Symptoms:
Pain on the top of the shoulder, in the area of the AC joint, is the most common symptom of distal clavicle osteolysis. The pain is typically exacerbated by weight lifting activities, especially bench press, shoulder press, push-ups, and dips. Occasionally shoulder stiffness and/or swelling may also be present.
The diagnosis of distal clavicle osteolysis is typically made on the basis of the patient’s history, the physical examination findings, and x-ray findings.
The treatment of distal clavicle osteolysis is initially non-operative. The goal of treatment of osteolysis of the distal clavicle is to reduce pain while the clavicle “remineralizes”. Treatment modalities include: rest, activity modifications, ice, and anti-inflammatory medications. If these measures are not effective a cortisone injection into the AC joint may be performed. In most cases, the clavicle slowly remineralizes (over 4 to 6 months). In some cases, the bones do not remineralize and symptoms may persist. In this scenario, surgical treatment may be considered. Surgery is performed using arthroscopic techniques to resect the affected portion of the clavicle.