Distal Clavicle Osteolysis Workup

  • Author: Brett D Owens, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: Jul 15, 2011
 

Imaging Studies

Plain radiographs

Obtain anteroposterior and 10-15° cephalic tilt views.

Radiographs often appear normal in the early clinical course.

With time, loss of subchondral bone detail in the distal clavicle, microcystic changes in the subchondral area, and widening of the AC joint may be seen.

The acromion is spared from lytic changes. The presence of panarticular disease should lead to the consideration of other diagnoses (eg, inflammatory disease).

Bone scan

If plain radiographs are nondiagnostic, technetium-labeled bone scans have been shown to help confirm the diagnosis of distal clavicle osteolysis, as increased radiotracer uptake is seen in the distal clavicle.

Magnetic resonance imaging (MRI)

Some authors have recommended the use of MRI to rule out additional shoulder pathology.[7]

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Diagnostic Procedures

Because of a moderate incidence of concomitant shoulder pathology (eg, rotator cuff pathology, labral pathology, subacromial impingement, glenohumeral instability), a lidocaine injection into the acromioclavicular (AC) joint may help achieve a more accurate diagnosis.[8]

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Contributor Information and Disclosures
Author

Brett D Owens, MD  Associate Professor of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of Health Sciences

Brett D Owens, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Society of Military Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Q Terrill, MD  Assistant Professor, Department of Orthopedic Surgery, University of Massachusetts Medical Center

Robert Q Terrill, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Anthony Schena, MD  Consulting Surgeon, ProSports Orthopedics; Associate Professor, Department of Orthopedics, Tufts Medical School

Anthony Schena, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America

Disclosure: genzyme Honoraria Speaking and teaching

Specialty Editor Board

Cato T Laurencin, MD, PhD  Vice President for Health Affairs, Dean of the School of Medicine, Van Dusen Endowed Chair and Professor in Academic Medicine, Distinguished Professor of Orthopedic Surgery, and Chemical, Materials, and Biomolecular Engineering, University of Connecticut School of Medicine

Cato T Laurencin, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Pekka A Mooar, MD  Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

References

  1. Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am. Sep 1982;64(7):1053-8. [Medline].

  2. Schwarzkopf R, Ishak C, Elman M, Gelber J, Strauss DN, Jazrawi LM. Distal clavicular osteolysis: a review of the literature. Bull NYU Hosp Jt Dis. 2008;66(2):94-101. [Medline].

  3. Scavenius M, Iversen BF. Nontraumatic clavicular osteolysis in weight lifters. Am J Sports Med. Jul-Aug 1992;20(4):463-7. [Medline].

  4. Matthews LS, Simonson BG, Wolock BS. Osteolysis of the distal clavicle in a female body builder. A case report. Am J Sports Med. Jan-Feb 1993;21(1):150-2. [Medline].

  5. Brunet ME, Reynolds MC, Cook SD. Atraumatic osteolysis of the distal clavicle: histologic evidence of synovial pathogenesis. A case report. Orthopedics. Apr 1986;9(4):557-9. [Medline].

  6. Tao HM, Chen J, Ji YY. Post-traumatic osteolysis of the distal clavicle, pubis and ischium in 7 patients. Chin J Traumatol. Aug 2004;7(4):247-52. [Medline].

  7. Kassarjian A, Llopis E, Palmer WE. Distal clavicular osteolysis: MR evidence for subchondral fracture. Skeletal Radiol. Jan 2007;36(1):17-22. [Medline].

  8. Shaffer BS. Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg. May-Jun 1999;7(3):176-88. [Medline].

  9. Flatow EL, Cordasco FA, Bigliani LU. Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy. 1992;8(1):55-64. [Medline].

  10. Flatow EL, Duralde XA, Nicholson GP. Arthroscopic resection of the distal clavicle with a superior approach. J Shoulder Elbow Surg. Jan-Feb 1995;4(1 Pt 1):41-50. [Medline].

  11. Auge WK, Fischer RA. Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. Am J Sports Med. Mar-Apr 1998;26(2):189-92. [Medline].

  12. Freedman BA, Javernick MA, O'Brien FP, Ross AE, Doukas WC. Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg. Jul-Aug 2007;16(4):413-8. [Medline].

  13. Nuber GW, Bowen MK. Arthroscopic treatment of acromioclavicular joint injuries and results. Clin Sports Med. Apr 2003;22(2):301-17. [Medline].

  14. Zawadsky M, Marra G, Wiater JM. Osteolysis of the distal clavicle: long-term results of arthroscopic resection. Arthroscopy. Sep 2000;16(6):600-5. [Medline].

  15. Rabalais RD, McCarty E. Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review. Clin Orthop Relat Res. Feb 2007;455:30-7. [Medline].

  16. Charron KM, Schepsis AA, Voloshin I. Arthroscopic distal clavicle resection in athletes: a prospective comparison of the direct and indirect approach. Am J Sports Med. Jan 2007;35(1):53-8. [Medline].

 
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An anteroposterior radiograph of a 26-year-old male weight lifter with symptomatic distal clavicle osteolysis that responded to conservative measures.
Left distal clavicle excision for distal clavicle osteolysis performed with a bone-cutting shaver placed in the anterior portal as viewed from the direct posterior-superior portal.
 
 
 
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