Distal Clavicle Osteolysis | Bone Loss in Shoulder

Osteolysis or bone loss is a condition that occurs when the body stops producing enough new bone cells to replace the old bone cells. The distal or end portion of the clavicle or collarbone which forms the AC Joint can get inflamed due to osteolysis setting in over a period of time. Distal clavicle osteolysis that results in shoulder joint pain because of the bone disintegration and damage is most commonly seen in weightlifters or other athletes performing bench presses regularly, in tennis players, swimmers and also among construction workers or military personnel. Though rare, Ddistal Clavicle Osteolysis can also happen from direct trauma to the collarbone during a fall or direct blow.

In Distal Clavicle Osteolysis, a sharp or aching pain at the junction of the acromioclavicular joint (AC joint) and collarbone is usually felt during activity, but persistent tenderness around the joint during non-activity or inflammation and swelling are also other symptoms. Reduced strength and reduced mobility can also happen gradually. The diagnosis of this shoulder condition is usually made by physical examination, although imaging tests can also be used to confirm the diagnosis or rule out other causes of shoulder pain. Blood tests are sometimes performed to rule out infection in the bone.

The treatment plan for Distal Clavicle Osteolysis depends on the amount of bone loss. Avoiding or modifying of activities that cause the symptoms along with anti-inflammatory medicines and ice can should allow the clavicle to re-mineralize. The condition may take at least two years to resolve completely and the symptoms could also recur if the earlier activities are restarted. Steroid injections can also give long term pain relief. As for surgical intervention to manage the condition, the most common form of surgery for distal clavicle osteolysis is a distal clavicle resection, or arthroscopic distal clavicle resection, in which the affected portion of the bone is removed. The recovery period for this could be anywhere from one to two weeks.

As for the prevention of Distal Clavicle Osteolysis many athletes may not be able to completely eliminate bench pressing from their weightlifting routine, but some modifications can be made to ease the stress on the joint and collarbone like reducing the hand spacing on the barbell or placing towels on the chest to protect it during the descent phase of the bench press. For those recovering from the condition, work out with the doctor the exercises that can or cannot be done to avoid any further trauma to the AC joint.

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Q&As on Distal Clavicle Osteolysis

What happens in distal clavicle osteolysis?

In distal clavicle osteolysis, there is pain in the shoulder joint at the collarbone end because of bone damage and disintegration. The two most common signs are inflammation and swelling. The patient will experience sharp pain at the junction of the collarbone and the acromioclavicular joint. And even though the pain is felt mainly during activities, there might be some persistent tenderness at the joint at the time of non-activity as well.

What are the various causes of distal clavicle osteolysis?

Distal clavicle osteolysis is an overuse injury that is caused by repeat microfractures that the body tries to repair. But with every microfracture, the bone remodeling becomes rough, causing stress on the clavicle end and leading to cartilage deterioration in the neighboring AC joint, where the shoulder blade meets the clavicle. Distal clavicle osteolysis is commonly seen among weightlifters and other such athletes who carry out heavy bench-pressure exercises for a long time. Anybody who lifts objects overhead and carries heavy weights can get distal clavicle osteolysis. Some rare causes include trauma to the collarbone because of a fall or direct blow.

When should you see a healthcare provider for distal clavicle osteolysis?

If you experience pain in your AC joint because of acute trauma or there is tenderness and inflammation, make sure you visit your healthcare provider. Specifically, if you are a weightlifter or have been repeatedly moving your shoulder and experiencing symptoms of distal clavicle osteolysis, it’s important to get a proper diagnosis and timely treatment. In several cases, some of the AC joint disorders respond well to conventional therapies such as ice and anti-inflammation medicines. But if, in case, the pain persists for a long time, make sure you consult an orthopaedist, as sometimes surgery may be needed.

Will a thorough physical examination by an orthopedic doctor diagnose distal clavicle osteolysis?

Distal clavicle osteolysis can be diagnosed by a proper physical examination by a good orthopedic doctor or any sports medicine doctor. Sometimes, other different tests may also be required. For instance, when pain reaches the chest area, it’s a major symptom of AC joint issues. Doctors can confirm this by carrying out a cross-body adduction test. If putting pressure on the arm crosswise around the chest causes pain, it is a positive result. The healthcare provider also assesses the steadiness of the AC joint. It is done by holding the distal collarbone in between the forefinger and the thumb and moving the collarbone in various directions. At this point, the acromion is stabilized. Moreover, during a diagnosis, the shoulder joint is also examined to check the shoulder motion.

How is distal clavicle osteolysis treated?

In the initial phase, distal clavicle osteolysis is treated conventionally through rest, movement restriction and application of ice on the AC joint. All activities that involve the joint are avoided, and in case the pain is severe, an orthopaedic sling is used to hold the shoulder in a fixed position. Other than rest and ice application, medications for decreasing inflammation and relieving pain are also used. After healing, physical therapies are started to securely restore the movement and strength of the shoulder. In some cases, where all conservative treatment fails, surgery might be required to offer relief.