Osteolysis of the Distal Clavicle

General Considerations

• Sequela of trauma from contact sports, falls and motor vehicle accidents
• Incidence increased with weight lifting/training
  • Other sports include football, swimming
• More often seen in males
• Unilateral
• Atraumatic causes are more common than traumatic
• Continued stress on the joint may play a role in its development

Clinical Findings

• Dull aching pain over AC joint

Imaging Findings

• Diagnosis can usually be made with conventional radiography and history
• Resorption of distal clavicle
• Osteopenia of distal clavicle
• Periarticular swelling
• Periarticular cyst-like erosions
• Periostitis of clavicle
• Bone scan will be positive in distal clavicle

Differential Diagnosis

• Hyperparathyroidism
• Rheumatoid arthritis
• Scleroderma

Treatment

• Non-steroidal anti-inflammatory drugs
• Steroid injections
• Distal clavicle resection

Complications

• Higher incidence in patients with a prior AC separation
• Permanently widened AC joint and persistent pain

Prognosis

• Self-limiting about 1-2 years following modification of activity which caused disease
• Osteolysis may reverse

Distal Clavicular Osteolysis. There is resorption of the distal clavicle and small cysts in the distal clavicle in this young weight lifter with pain in this region for several months (white arrows).
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Essential Orthopaedics. Mark D. Miller, Jennifer Hart, John M. MacKnight. Saunders, 2009.