|
https://upload.orthobullets.com/topic/3048/images/distal_clav..jpg
https://upload.orthobullets.com/topic/3048/images/distal clavicle osteolysis.jpg
https://upload.orthobullets.com/topic/3048/images/distal clavicle osteolysis xr.jpg
Introduction
  • Pathophysiology
    • pathoanatomy
      •  caused by repetitive stress and micro-fracture in distal clavicle which leads to osteopenia
  • Epidemiology
    • demographics
      • patients in their 20s, mostly male
      • commonly seen in weightlifters 
    • risk factors
      • history of traumatic injuries
Anatomy
  • Osteology
    • clavicle is
      • S-shaped bone
      • last bone to fuse
  • Medial growth plate fuses early 20s
  • Diarthrodial joint with fibrocartilage meniscus 
  • Ligamentous
    • AC ligaments: horizontal stability
    • CC ligaments: vertical stability
Presentation
  • Similar to AC joint arthritis
  • Symptoms
    • pain
      • located at distal clavicle and anterior superior shoulder
      • insidious in onset
      • exacerbated by repetitive loading (ie. bench press or push-ups)
  • Physical exam
    • palpation
      • tenderness at the distal end of clavicle and AC joint
    • provocative test
      • pain with cross-body adduction
Imaging
  • Radiographs
    • recommended views
      • AP clavicle
      • Zanca view (15 degrees cephalad tilt) 
    • findings of the distal clavicle (should not involve the acromion)  
      • cysts   
      • osteopenia
      • resorption and erosion
      • tapering of distal clavicle
      • AC joint widening
  • Advanced Imaging
    • MRI: increased signal of T2 sequences and bone marrow edema
    • bone scan:  increased uptake in the distal clavicle (may be seen earlier than radiographic changes)
Treatment
  • Nonoperative
    • activity modification, NSAIDs
      • indications
        • first line of treatment
      • modification
        • avoid aggravating weight-lifting exercises or modify technique
          • ie. moving hand grip closer together and ending weight descent to 4 to 6 cm above the chest
    • corticosteroid injections
      • indications
        • diagnostic and therapeutic
      • technique
        • more accurate with ultrasound
  • Operative
    • open or arthroscopic distal clavicle excision
      • indications
        • persistent symptoms that have failed nonoperative treatment
      • technique
        • need to address associated pathology to the rotator cuff and long head of biceps
      • outcomes
        • open vs. arthroscopic based on surgeon preference and comfort
          • arthroscopic resection has the advantage of allowing evaluation of the glenohumeral joint
            • good results are shown with arthroscopic treatment 
            • quicker recovery and return to activity
          • open procedures require meticulous repair of deltoid-trapezial fascia
Techniques
  • Arthroscopic distal clavicle resection (Mumford procedure) 
    • should resect only 0.5-1cm of the distal clavicle
    • too large a resection can lead to AC joint instability
Complications
  • Horizontal instability
    • avoid violating the posterosuperior capsule during distal clavicle excision as will lead to horizontal instability
 

Please rate topic.

Average 3.9 of 18 Ratings

Questions (1)

(OBQ08.250) A 31-year-old professional bodybuilder reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint. Based on the radiograph shown in Figure A, which treatment is likely to provide the most successful result? Review Topic

QID: 636
FIGURES:
1

Glenohumeral joint injection

1%

(12/1566)

2

Periscapular muscle strengthening

5%

(79/1566)

3

Labral repair

1%

(15/1566)

4

Arthroscopic resection of the distal clavicle

92%

(1447/1566)

5

Capsular release

1%

(8/1566)

Select Answer to see Preferred Response

PREFERRED RESPONSE 4
EVIDENCE & REFERENCES (6)
VIDEOS (1)
GROUPS (1)
Topic COMMENTS (1)
Private Note