Distal Clavicle Osteolysis 715.11

distal clavicle osteolysis   
ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: distal clavicle osteolysis, weight lifter's shoulder,

Distal Clavicle Osteolysis ICD-9

  • 715.11 = osteoarthritis shoulder region

Distal Clavicle Osteolysis Etiology / Epidemiology / Natural History

  • Repetitive overhead activity / throwing can lead to microtrauma to the AC joint and osteolysis of the distal clavicle.
  • Most often occurs in weightlifters/body builders and football players. Also occurs in hockey players (Norfray JF, AJSM 1977;5:275) has been reported in lacrosse players.
  • More often occurs in men, but has been reported in female bodybuilders.

Distal Clavicle Osteolysis Anatomy

  • Diarthrodial joint which contains meniscus
  • Mutiple anatomic variations
  • See also Shoulder Anatomy.

Distal Clavicle Osteolysis Clinical Evaluation

  • Pain localized to the AC joint which is exacerbated by overhead motion and cross-body adduction.
  • AC tenderness
  • Cross-body Adduction Test: arm is maximally adducted with the arm in 90 of forward elevation. Pain localized to the AC joint indicates AC joint patholgy.

Distal Clavicle Osteolysis Xray / Diagnositc Tests

  • AP, scapular lateral and axillary views show spurring, sclerosis and narrowing of AC joint
  • AC joint best viewed with Zanca view.
  • Weighted views indicated if instability is a concern.
  • AC joint local anesthetic and corticosteriod injection often indicated to confirm diagnosis. Relief of symptoms after injection confirms AC joint pathology as the cause of symptoms.

Distal Clavicle Osteolysis Classification / Treatment

  • Non-operative treatment: NSAIDS, physical therapy, activity modifications, ACJ injections
  • Operative: indicated for failure of non-operative treatment (6 months). See Distal Clavicle Resection technique. Can be done via subacromial approach or direct anterior approach (Charron KM, AJSM 2007;35:53).

Distal Clavicle Osteolysis Associated Injuries / Differential Diagnosis

Distal Clavicle Osteolysis Complications

  • Instability(excessive resection)
  • Continued symptoms (inadequate resection)
  • Ectopic calcification
  • Reactive bursitis
  • Clavicle/acromion fracture
  • Infection

Distal Clavicle Osteolysis Follow-up Care

  • Post-op: sling as needed with pendulum ROM exercises.
  • 1 week: Start PT focused on ROM and strengthening. AAROM, PROM.  AROM, free weights start to 3 weeks. Avoid cross-body adduction for 6 weeks.
  • 6 weeks: progressive sport specific activity.
  • 3 months: Return to sport / full activities.
  • IF in association with SAD, or RTC repair use those rehab protocols.
  • Outcomes: average 18.7month followup 100% return to sport (average 3.2 days) and to their preoperative weight training program (average, 9.1 days). (Auge WK, AJSM 1998;26:189).

Distal Clavicle Osteolysis Review References

 

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