Updated: 10/1/2018

Distal Clavicle Osteolysis

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Introduction
  • Caused my repetitive micro-fractures in distal clavicle which lead to causes osteopenia
  • Epidemiology
    • commonly seen in weight lifters
    • history of traumatic injuries
Anatomy
  • Osteology
    • clavicle is
      • an S-shaped bone
      • last bone to ossify
    • medial growth plate fuses early 20s
Presentation
  • Symptoms
    • pain at distal clavicle
  • Physical exam
    • tenderness at distal end of clavicle
Imaging
  • Radiographs
    • recommended views
      • AP clavicle
    • findings
      • cysts
      • osteopenia
      • tapering of distal clavicle
Treatment
  • Nonoperative
    • activity modification, corticosteroid injections, NSAIDS
      • indications
        • first line of treatment
      • technique
        • (quit weight lifting or modify technique by move arms further apart)
  • Operative
    • open or arthroscopic distal clavicle excision
      • indications
        • severe symptoms that have failed nonoperative treatment
      • outcomes
        • open vs. arthroscopic based on surgeon preference and comfort
          • arthroscopic resection has the advantage of allowing evaluation of the glenohumeral joint
            • good results shown with arthroscopic treatment 
          • open procedures require meticulous repair of deltoid-trapezial fascia
Techniques
  • Arthroscopic distal clavicle resection 
    • should resect only 0.5-1cm of distal clavicle
 

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(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%

(17/2288)

2

Periscapular muscle strengthening

5%

(104/2288)

3

Labral repair

1%

(20/2288)

4

Arthroscopic resection of the distal clavicle

93%

(2129/2288)

5

Capsular release

0%

(10/2288)

L 1

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