Sunday, 1 September 2013
Friday, 17 May 2013
Do I Need Surgery for my Labral Tear in My Shoulder? - YouTube
Uploaded on 3 Nov 2011
What is the shoulder labrum, why does the labrum tear? Do I need surgery for my shoulder labral tear? What do you need to do to improve likelihood of success after labral surgery?
Arthroscopic repair of a labral tear - YouTube
Uploaded on 5 Apr 2011
www.onsmd.com - Shoulder labral tears can result from a variety of activities or events. Most often the labrum is torn secondarily to a dislocation or some form of trauma like a fall while skiing or sudden impact while playing sports. When the shoulder dislocates, excessive stress is usually directed to the labrum, causing it to tear.
Also common among athletes is recurrent micro-trauma. As opposed to a solitary traumatic event, repetitive overhead motions and activities can progressively damage the labrum causing pain and labral damage. Individuals whose work entails lifting heavy objects are also susceptible, but a simple slip and fall on the ice can result in a labral tear.
Although many labral tears can be treated non-surgically with a comprehensive physical therapy program to strengthen the surrounding muscles, certain tears require surgery. Additionally, an athlete with a labral tear who plays a contact sport is at high risk for re-dislocation, which may cause even greater damage, so surgery is usually recommended. For predictable and faster return to sports activity, arthroscopic repair of the labrum is a highly successful treatment. Repairs can even be customized to the patient, depending upon the type of activities they do.
Sports Medicine Specialist Paul Sethi, MD explains shoulder labral repair. http://bit.ly/hnCyDq
Also common among athletes is recurrent micro-trauma. As opposed to a solitary traumatic event, repetitive overhead motions and activities can progressively damage the labrum causing pain and labral damage. Individuals whose work entails lifting heavy objects are also susceptible, but a simple slip and fall on the ice can result in a labral tear.
Although many labral tears can be treated non-surgically with a comprehensive physical therapy program to strengthen the surrounding muscles, certain tears require surgery. Additionally, an athlete with a labral tear who plays a contact sport is at high risk for re-dislocation, which may cause even greater damage, so surgery is usually recommended. For predictable and faster return to sports activity, arthroscopic repair of the labrum is a highly successful treatment. Repairs can even be customized to the patient, depending upon the type of activities they do.
Sports Medicine Specialist Paul Sethi, MD explains shoulder labral repair. http://bit.ly/hnCyDq
Shoulder Injuries (Part 1) - YouTube
Uploaded on 21 Sep 2008
About the Video:Shoulder injuries are among the most common types of sports-related injuries. These injuries can include, among others, tendonitis and rotator cuff tears. In this two-part interview with Dr. James Dreese, viewers can learn about the variety of treatment options available for these injuries.
Specific topics covered in part one of this two-part interview include:
Shoulder injuries and athletes
Shoulder tendonitis -symptoms, causes and treatments
Rotator cuff tears-symptoms and causes
About the Expert:
Dr. James Dreese is a sports medicine specialist at the University of Maryland Medical Center and University of Maryland Orthopaedics at Kernan Hospital. He is also an assistant professor of orthopaedics at the University of Maryland School of Medicine.
Related Links:
Dr. James Dreese
http://www.umm.edu/doctors/james_c_dr...
Shoulder Injuries (Part 2)
http://www.youtube.com/watch?v=Q4fFV0...
UMMC Division of Sports Medicine
http://www.umm.edu/sportsmedicine/ind...
Shoulder and Elbow Program
http://www.umm.edu/orthopaedic/should...
Video: Patient Success Story
http://www.umm.edu/videos/fyh/sam_suc...
Bankart repair for unstable dislocating shoulders: Concavity compression - YouTube
Uploaded on 28 Oct 2010
Demonstration of concavity compression, which stabilizes the shoulder joint against sideways forces. Part of an article on the Bankart method for repairing unstable dislocating shoulders.
Article can be found at: http://www.orthop.washington.edu/Pati...
Article: Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals
Article can be found at: http://www.orthop.washington.edu/Pati...
Article: Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals
Tuesday, 2 April 2013
"Managing Distal Clavicle Osteolysis without Surgery?" - CrossFit Discussion Board
Any luck healing Distal Clavicle Osteolysis without Surgery - CrossFit Discussion Board
12-22-2012, 09:03 AM | #1 |
Member | Any luck healing Distal Clavicle Osteolysis without Surgery I know there are several threads about Distal Clavicle, but I'd like to start this one for anyone who can share about any recovery they've had WITHOUT SURGERY. I'd like to heal my shoulder without going under the knife. About 9 months ago I started getting slight pain in my shoulder. I think it might have been from hand-release-pushups, which I was doing a lot of at the time. Unfortunately, the pain at the start wasnt enough to bother me, so I trained through the pain (and probably made it worse). Eventually it became a bit more painful, and I could feel the separation between my clavicle and scapula. At the worst point, I could not do dips or do anything that required reaching back (wrapping a town around was the worst). An orthopedic surgeon diagnosed me as having Discal Clavicle Osteolysis. After this I avoided the painful exercises... dips, muscleups, bench, and to be safe shoulder press(although wasnt painful)... for a month or two, and the pain went away. My physical therapist suggested rotary cuff strengthening exercises, which I did, starting with a rubber band, and now I use resistance via a cable machine. Now, the pain in my shoulder is virtually gone, but there is still significant separation. Also, my good shoulder is now separated (but no pain)! Dips, pushups, and benching feel very strange on both of my shoulders and they click and grinds a lot... so I still avoid them. I also don't do any kipping, the swinging feels like it puts too much strain on my shoulders. This is unfortunate for me because in the past I was very strong with the gymnastic side of crossfit. I've been doing a lot of kettlebell work lately... swings and turkish gettups have been my friends. Light weight overhead squatting with barbells seem to feel good on my shoulder, so I do that. So I do that exercise a bit too. Other then that I squat, dealfit (seems to not put any strain on my joint), jump rope, and run. I miss jumping up on the rings or doing massive sets up kips Anyone out there recovered from this without surgery? Any tips? |
12-23-2012, 08:06 PM | #2 |
Member | Re: Any luck healing Distal Clavicle Osteolysis without Surgery If it is true osteolysis of the distal clavicle, then it is either wait and see and modify, PT or have surgery |
Anti-cortisone (& no-dips), views - Weightlifter's Forum (Distal Clavicular Osteolysis)
Weightlifter's Shoulder (Distal Clavicular Osteolysis)
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Weightlifter's Shoulder (Distal Clavicular Osteolysis)
It's been since June... I used to do parallel bar dips with 90lb dumbbell and I weigh 200. Now I can barely do 150 on the machine (not body weight), on a good day, I can flat bench 330x4 but incline bench and body weight dips are too painful. After any chest work including cable flys, my shoulder hurts for days. Advil takes the pain from 10--->7. But I can't even sleep on my left side now because it hurts.
I'm finally scheduling an xray this week because its not getting any better. I can barely pick up my kids. And I did zero chest work from June-December to see if it would heal.
Anybody else gone through this?
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Subd for more info.
I've had some shoulder issues off and on. Ive been focusing on some lighter weight, more rehab type stuff lately to make sure i fix it before it progresseshttp://anabolicminds.com/forum/supplement-reviews-logs/224226-lizking-logs-d.html -
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I'm hoping cortisone will help but never had cortisone and also don't know if it is a cure or a band aid
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Cortisone is a bad Band aid. It helps for the moment only. Cortisone eats away your tendons over time. Once you start getting them you will want to continue because it does work for relieving pain temporarily. Just my opinion I'm no professional just someone who used to receive cortisone injections in my knee when active in sports.
http://anabolicminds.com/forum/supplement-reviews-logs/225489-rush954-goes-1-a.html
If hard work were really a virtue, then mules would be saints.
~ James Dee Richardson - 03-01-2013 08:15 PMRegistered User
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xray showed deterioration of meniscus at the clavicle humurol joint. Cortisone shot today and surgery if not better in 2 weeks. G A Y
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I recently got over a bad rotator cuff impingement.
I had pain for about 6 months before I finally went to go see the Doc.
A cortisone shot really sped the healing along, before then I did a bout 10,000,000 external rotations, changed my push pull ratio, layed off bench for a month, and laid off overhead press for 6 months, and so on.
But I only got better to a point.
It wasn't until the cortisone knocked out the inflammation that the rehab work really began to heal it.
So cortisone can aid healing, but like other's have said, too many will weaken tendons and it's pain re-leaving properties may allow you to keep doing what injured it in the first place so be careful with it.
My original rotator cuff injury never came back. Sidenote though, I did get an overuse injury to my bicep tendon and needed another one, but as painful as it was, I was thankful it was a new injury and that I didn't re injure the old one. - 03-05-2013 08:21 PMRegistered User
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I've been laying off presses and dips and the pain is virtually gone! That cortisone is impressive. And though I want to bench more and get back to dips again, I know I should wait...
Shoveling snow tonight wasn't the best for the shoulder but now I can at least sleep on that side.
I hope this nonsense heals up because I'm just starting to get into my groove with chest work. But I understand holding off on the short term for benefit of long term. - 03-06-2013 11:36 AMRegistered User
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I've had to accept the fact that my days of doing dips are gone.
Too late I realized my mobility just wasn't built for it.
Now I can never reenact that Dr Dre video : (. - 03-06-2013 12:14 PMRegistered User
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I've been laying off presses and dips and the pain is virtually gone! That cortisone is impressive. And though I want to bench more and get back to dips again, I know I should wait...
Shoveling snow tonight wasn't the best for the shoulder but now I can at least sleep on that side.
I hope this nonsense heals up because I'm just starting to get into my groove with chest work. But I understand holding off on the short term for benefit of long term.
Similar issues with this thread I started
Rotator Cuff Injury? Stay Away Lifts - 03-17-2013 01:28 AMRegistered User
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I hate to tell you this, and your physician should have but cortisone shots deteriorate tendon and bone over time. You are allowed to receive a cortisone injection every 3 months, cortisone is a corticosteroid, used to reduce inflammation. It is a temporary fix. My advice is that you should seek physical therapy or consider surgery as an option. They will probably start you off with conservative treatment first:exercises, stretches, range of motion, ice, pulse US, etc Also, in the future you will need to be careful with or avoid overhead movements, you will have to be careful of, military press, heavy bench presses, dips, flys, etc.
It sucks but it would be helpful to change the way you train, shoulder scaption, flexion, internal and external rotation, and shoulder extension exercises. You might also want to work on some scapular stabilization exercises. If you have surgery you will not be able to actively move your arm fro 2-3 months or more. Just some things to think about.. - 03-25-2013 02:27 PMRegistered User
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I've been reading about nandrolone to help this. Anybody have experience with this?
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I hate to tell you this, and your physician should have but cortisone shots deteriorate tendon and bone over time. You are allowed to receive a cortisone injection every 3 months, cortisone is a corticosteroid, used to reduce inflammation. It is a temporary fix. My advice is that you should seek physical therapy or consider surgery as an option. They will probably start you off with conservative treatment first:exercises, stretches, range of motion, ice, pulse US, etc Also, in the future you will need to be careful with or avoid overhead movements, you will have to be careful of, military press, heavy bench presses, dips, flys, etc.
It sucks but it would be helpful to change the way you train, shoulder scaption, flexion, internal and external rotation, and shoulder extension exercises. You might also want to work on some scapular stabilization exercises. If you have surgery you will not be able to actively move your arm fro 2-3 months or more. Just some things to think about.. - 03-31-2013 04:08 AMRegistered User
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Hey, I have had my share of shoulder injuries and also see a bunch working at a PT clinic. Everything said about cortisone is true, and its good you have came to terms with saying good bye to dips, also shy away from flat bench. The external rotation that happens is so stressful on your shoulder and flys as well. Basically any lift where you can not see your hands are going to be tough to do correctly with out possibly eventually reaggravating the injury. And I just realized I'm repeating what KimChee has said, take what he says and do it. After recovering from two right shoulder surgeries and one left surgery it is better to just rest and try and avoid surgery, because if you get surgery you will be relatively pain free but your range of motion will suffer and all these exercises that aggravate it will be tough to do well anyways. Good luck and exercise all the assist or muscles around the shoulder too.
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Hey, I have had my share of shoulder injuries and also see a bunch working at a PT clinic. Everything said about cortisone is true, and its good you have came to terms with saying good bye to dips, also shy away from flat bench. The external rotation that happens is so stressful on your shoulder and flys as well. Basically any lift where you can not see your hands are going to be tough to do correctly with out possibly eventually reaggravating the injury. And I just realized I'm repeating what KimChee has said, take what he says and do it. After recovering from two right shoulder surgeries and one left surgery it is better to just rest and try and avoid surgery, because if you get surgery you will be relatively pain free but your range of motion will suffer and all these exercises that aggravate it will be tough to do well anyways. Good luck and exercise all the assist or muscles around the shoulder too. - Yesterday 07:31 PMRegistered User
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You have a lot of variations of the deltoid muscle you have anterior, lateral, and posterior. The anterior is the front and a lot of people work that muscle more than the lateral/posterior. And it causes a pulling effect from the front of the deltoid( in laymans word the front gets too big and rips the deltoid) maybe this is not your problem but it's very common with weight lifters
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You have a lot of variations of the deltoid muscle you have anterior, lateral, and posterior. The anterior is the front and a lot of people work that muscle more than the lateral/posterior. And it causes a pulling effect from the front of the deltoid( in laymans word the front gets too big and rips the deltoid) maybe this is not your problem but it's very common with weight lifters
Osteolysis of the acromioclavicular joint - review by Dr. Mazzara, Orthopedic Surgeon: Sports Medicine CT
Osteolysis of the acromioclavicular joint - review by Dr. Mazzara, Orthopedic Surgeon: Sports Medicine CT
Osteolysis of the acromioclavicular joint is a process involving the resorption of the distal clavicle. It is usually posttraumatic or may be due to repetitive microtrauma as seen in weight lifting. Pain is localized to the acromioclavicular joint. Radiographs, bone scans or MRIs, in addition to history and physical examination are diagnostic. Plain x-rays alone are usually enough to confirm the diagnosis of osteolysis. Activity modification often helps relieve symptoms but surgery is usually necessary when the symptoms do no improve with conservative treatment.
Disorders of the AC joint are a common cause of shoulder pain and often involve the ligaments, bones, or articular surfaces. Osteolysis of the distal clavicle presents as AC joint pain associated with a loss of subchondral bone detail, AC separation, and cysts adjacent to the articular surface.
Osteolysis has been seen in weight lifters and body builders, those involved in martial arts, and following acute trauma of the AC joint.
Anatomy of the AC Joint
The Ac joint is a diarthrodial joint connecting the convex distal clavicle with the flat of slightly concave acromion. The degree of congruence between these two surfaces is variable. A fibrocartilaginous meniscal disk separates the two articular surfaces in the adolescent. In the adult, the disks are small or poorly defined. The joint is stabilized by the coracoclavicular ligaments (conoid and trapezoid), the AC ligament, and the AC capsule. These ligaments limit the amount of motion allowed at the AC joint to about 10 degrees of rotation as the arm reaches into full elevation.
Etiology of Osteolysis
The mechanical cause of atraumatic osteolysis appears to be repetitive microtrauma to the shoulder. This is frequently seen in weight lifters and athletes. It is now seen more frequently as due to this increased popularity of weight training as a part of fitness programs. Traumatic osteolysis can be seen as a result of a single blunt trauma to the shoulder. The precise cause of the osteolysis is unclear but it is thought to be due to vascular compromise, nervous system dysfunction, microfracture, and stress-induced osteoclastic resorption. The histologic features of microscopic fractures, demineralization, subchondral cysts, and distal clavicle erosion have been described.
Clinical Presentation
In both atraumatic and traumatic osteolysis, the patient usually reports a dull ache that is localized over the AC joint. It may radiate to the anterior deltoid or trapezius. With posttraumatic osteolysis, the patient will sometimes relate the onset of pain to a direct blow to the shoulder. Since the traumatic episode may have occurred between 4 weeks to several years prior to the onset of symptoms, specific questions about previous trauma should be asked. These patients may or may not be involved in repetitive physical activity with he affected shoulder.
With atraumatic osteolysis, the patient has an insidious onset of pain in the region of the AC joint. These patients are usually weight lifters or heavy laborers who do not recall a specific injury that may have precipitated their pain. Weight lifters may have more pain while performing bench presses, push-ups, and dips. Patients may note pain at night, with nocturnal awakening when rolling onto the affected shoulder. There may be associated symptoms of popping, catching or grinding. Activities of daily living may become painful as the patient’s symptoms progress.
Physical Examination
Inspection of the affected shoulder may reveal joint prominence or asymmetry. Palpation over the AC joint will reveal tenderness. Provocative tests, such as reaching across to touch the opposite shoulder or placing the hand behind the back, may cause localized pain. Active motion of the shoulder may cause crepitus which must be differentiated from subacromial crepitus.
Motion is rarely restricted, although in long-standing cases mild restrictions of internal rotation and / or cross-body adduction may develop. Restricted motion should be documented by comparing both shoulder. More significant restricted motion in the painful shoulder suggests adhesive capsulitis or glenohumeral arthritis.
The most reliable physical examination test is the cross-body adduction test, in which the arm on the affected side is elevated to 90 degrees and the examiner grabs the elbow and adducts the arm across the body. This will cause pain at the AC joint if there is true pathology in the AC joint. This test may cause pain in posteriorly in patients with subacromial impingement if they have posterior capsular tightness.
In patients with isolated AC joint pathology, an injection of 1ml of 1% lidocaine directly into the AC joint will experience pain relief while patients with subacromial pain or other pathology will still have pain on provocative testing.
Radiographic Evaluation
Standard AP views of the shoulder are usually inadequate to visualize the AC joint. The Zanca view is obtained by angling the x-ray beam 10-15 degrees superiorly and decreasing the voltage to about 50% of that used for a standard glenohumeral exposure.
X-rays taken soon after the onset of symptoms may appear normal. Months or years later, the x-rays may reveal loss of subchondral bone detail in the distal clavicle, cystic changes in the subchondral bone, widening of the AC joint, tapering or enlargement of the distal clavicle. The acromion in osteolysis reveals no pathologic changes, differentiating it from AC arthritis.
A bone scan with cone down views of the AC joint will demonstrate increased uptake in the distal clavicle. Scanning is most commonly indicated for the your to middle-aged patient whose symptoms and physical examination are not consistent with plain x-rays.
MRI is rarely indicated for isolated osteolysis. If performed it will show a bright signal in the distal clavicle on T-2 weighted images, signifying edema. Atraumatic and traumatic osteolysis will have similar MRI findings.
Joint Injection
Diagnostic uncertainty can be resolved through direct injection of local anesthetic into the AC joint. Elimination of pain within a few minutes of the injection confirms the AC joint as the source of the patients symptoms. This injection test is the most valuable and simplest diagnostic tool.
Relief after the injection is also a good prognostic indicator of the success with distal clavicle resection. Persistence of pain after AC joint injection suggests an additional of a completely different diagnosis depending on the degree of pain relief. The most common alternative diagnosis includes rotator cuff impingement. A second injection into the subacromial space may help clarify the degree to which the patients symptoms are due to impingement as opposed to osteolysis.
Injections into the AC joint can be difficult due to the variable obliquity of the joint surface, sometimes combined with osteophytes and joint narrowing. Reviewing the x-rays and experience in such joint injections are important in successful joint injections.
Differential Diagnosis
Treatment Options
Treatment options must be individualized to the patient. Factors to be considered include the patients age, activity level, shoulder dominance, occupation, degree of activity restriction and / or athletic limitation, and goals.
Nonoperative Treatment
Initial treatment should be nonoperative and includes activity modification, ice or moist heat (whichever the patient prefers), nonsteroidal anti-inflammatory medications, corticosteroid injections.
Weight lifters should avoid bench presses, dips, flies, push-ups and any other lifts that elicit pain.
Steroid injections provide short-term relief but do not appear to have any long-term benefits. If administered, patients should avoid provocative activity for one week after the injection. General recommendations include no more than 3 corticosteroid injections in a 3 - 6 month period.
Physical therapy is generally not effective unless patients also have some other concurrent shoulder pathology.
Surgical Options
Patient’s who do not respond to nonoperative treatment or who cannot limit their activities may benefit from surgery.
Open and arthroscopic distal clavicle resection have been successful in relieving pain and allowing patients to return to their prior activity level. Open distal clavicle resection, is simple but requires a 4-5 cm incision. It also requires the partial detachment of the deltoid muscle and therefore patients must avoid strenuous for 4 weeks following the surgery.
An arthroscopic distal clavicle resection may be more a difficult procedure to perform but its limited deltoid release allows patients to resume activity when comfortable and requires 3 small 1/4 inch incisions that heal with a more cosmetically acceptable result. Approximately 15 millimeters of distal clavicle is resected.
In our practice, all distal clavicle resections are performed arthroscopically for osteolysis.
Following the surgery, patents are encouraged to use the arm as tolerated. Home exercises are initiated within 1 - 2 days after surgery and physical therapy is started after the first post-operative visit.
Overhead activities are discouraged for 2 - 3 weeks. Most patients will be able to return to full activity at 2 - 3 months after surgery. Patients who also have concomitant tendon problems and require additional work for that problem may require longer to return to normal activities.
Outcomes after arthroscopic distal clavicle resection have generally been excellent. Most studies have reported good to excellent results in the range of 83% to 100%. Our own results have been at the upper end of this range.
Inadequate pain relief following an arthroscopic distal clavicle resection for osteolysis may be due to diagnostic inaccuracy, inadequate distal clavicle resection, AC joint instability or shoulder weakness due to subtle instability of the AC joint.
Summary
The patient with osteolysis of the distal clavicle usually reports a dull ache over the superior aspect of the shoulder which is aggravated by specific physical activities. History, physical examination and plain x-rays are usually sufficient to confirm the diagnosis. Initial treatment involves activity modification, NSAIDs and corticosteroid injections for temporary relief. If nonoperative treatment fails and patients are not willing to modify their activities or live with the pain, operative resection of the distal clavicle often provides good to excellent results with few complications.
References
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Introduction
Disorders of the AC joint are a common cause of shoulder pain and often involve the ligaments, bones, or articular surfaces. Osteolysis of the distal clavicle presents as AC joint pain associated with a loss of subchondral bone detail, AC separation, and cysts adjacent to the articular surface.
Osteolysis has been seen in weight lifters and body builders, those involved in martial arts, and following acute trauma of the AC joint.
Anatomy of the AC Joint
The Ac joint is a diarthrodial joint connecting the convex distal clavicle with the flat of slightly concave acromion. The degree of congruence between these two surfaces is variable. A fibrocartilaginous meniscal disk separates the two articular surfaces in the adolescent. In the adult, the disks are small or poorly defined. The joint is stabilized by the coracoclavicular ligaments (conoid and trapezoid), the AC ligament, and the AC capsule. These ligaments limit the amount of motion allowed at the AC joint to about 10 degrees of rotation as the arm reaches into full elevation.
Etiology of Osteolysis
The mechanical cause of atraumatic osteolysis appears to be repetitive microtrauma to the shoulder. This is frequently seen in weight lifters and athletes. It is now seen more frequently as due to this increased popularity of weight training as a part of fitness programs. Traumatic osteolysis can be seen as a result of a single blunt trauma to the shoulder. The precise cause of the osteolysis is unclear but it is thought to be due to vascular compromise, nervous system dysfunction, microfracture, and stress-induced osteoclastic resorption. The histologic features of microscopic fractures, demineralization, subchondral cysts, and distal clavicle erosion have been described.
Clinical Presentation
In both atraumatic and traumatic osteolysis, the patient usually reports a dull ache that is localized over the AC joint. It may radiate to the anterior deltoid or trapezius. With posttraumatic osteolysis, the patient will sometimes relate the onset of pain to a direct blow to the shoulder. Since the traumatic episode may have occurred between 4 weeks to several years prior to the onset of symptoms, specific questions about previous trauma should be asked. These patients may or may not be involved in repetitive physical activity with he affected shoulder.
With atraumatic osteolysis, the patient has an insidious onset of pain in the region of the AC joint. These patients are usually weight lifters or heavy laborers who do not recall a specific injury that may have precipitated their pain. Weight lifters may have more pain while performing bench presses, push-ups, and dips. Patients may note pain at night, with nocturnal awakening when rolling onto the affected shoulder. There may be associated symptoms of popping, catching or grinding. Activities of daily living may become painful as the patient’s symptoms progress.
Physical Examination
Inspection of the affected shoulder may reveal joint prominence or asymmetry. Palpation over the AC joint will reveal tenderness. Provocative tests, such as reaching across to touch the opposite shoulder or placing the hand behind the back, may cause localized pain. Active motion of the shoulder may cause crepitus which must be differentiated from subacromial crepitus.
Motion is rarely restricted, although in long-standing cases mild restrictions of internal rotation and / or cross-body adduction may develop. Restricted motion should be documented by comparing both shoulder. More significant restricted motion in the painful shoulder suggests adhesive capsulitis or glenohumeral arthritis.
The most reliable physical examination test is the cross-body adduction test, in which the arm on the affected side is elevated to 90 degrees and the examiner grabs the elbow and adducts the arm across the body. This will cause pain at the AC joint if there is true pathology in the AC joint. This test may cause pain in posteriorly in patients with subacromial impingement if they have posterior capsular tightness.
In patients with isolated AC joint pathology, an injection of 1ml of 1% lidocaine directly into the AC joint will experience pain relief while patients with subacromial pain or other pathology will still have pain on provocative testing.
Radiographic Evaluation
Normal AC joint on Zanca view |
X-rays taken soon after the onset of symptoms may appear normal. Months or years later, the x-rays may reveal loss of subchondral bone detail in the distal clavicle, cystic changes in the subchondral bone, widening of the AC joint, tapering or enlargement of the distal clavicle. The acromion in osteolysis reveals no pathologic changes, differentiating it from AC arthritis.
A bone scan with cone down views of the AC joint will demonstrate increased uptake in the distal clavicle. Scanning is most commonly indicated for the your to middle-aged patient whose symptoms and physical examination are not consistent with plain x-rays.
MRI is rarely indicated for isolated osteolysis. If performed it will show a bright signal in the distal clavicle on T-2 weighted images, signifying edema. Atraumatic and traumatic osteolysis will have similar MRI findings.
Joint Injection
Diagnostic uncertainty can be resolved through direct injection of local anesthetic into the AC joint. Elimination of pain within a few minutes of the injection confirms the AC joint as the source of the patients symptoms. This injection test is the most valuable and simplest diagnostic tool.
Relief after the injection is also a good prognostic indicator of the success with distal clavicle resection. Persistence of pain after AC joint injection suggests an additional of a completely different diagnosis depending on the degree of pain relief. The most common alternative diagnosis includes rotator cuff impingement. A second injection into the subacromial space may help clarify the degree to which the patients symptoms are due to impingement as opposed to osteolysis.
Injections into the AC joint can be difficult due to the variable obliquity of the joint surface, sometimes combined with osteophytes and joint narrowing. Reviewing the x-rays and experience in such joint injections are important in successful joint injections.
Differential Diagnosis
Rotator cuff impingement | Differentiate via physical exam, injection test, X-rays | |
Calcific Tendinitis Early adhesive capsulitis Glenohumeral arthritis | Differentiate via physical exam, injection test, x-ray. Evaluate presence of calcific deposits or DJD. Evaluate range of motion (active versus passive). | |
Rheumatoid arthritis Gout and pseudogout Septic arthritis Hyperparathyroidism | Evaluate with serologic studies when necessary. | |
Ganglia and cysts | Associated with large rotator cuff tears | |
Tumors | Ewing’s sarcoma in children. Myeloma and lymphoma in adults. | |
Referred pain | Consider cervical radiculopathy, cardiac, pulmonary, or gastrointestinal disorders. | |
Treatment options must be individualized to the patient. Factors to be considered include the patients age, activity level, shoulder dominance, occupation, degree of activity restriction and / or athletic limitation, and goals.
Nonoperative Treatment
Initial treatment should be nonoperative and includes activity modification, ice or moist heat (whichever the patient prefers), nonsteroidal anti-inflammatory medications, corticosteroid injections.
Weight lifters should avoid bench presses, dips, flies, push-ups and any other lifts that elicit pain.
Steroid injections provide short-term relief but do not appear to have any long-term benefits. If administered, patients should avoid provocative activity for one week after the injection. General recommendations include no more than 3 corticosteroid injections in a 3 - 6 month period.
Physical therapy is generally not effective unless patients also have some other concurrent shoulder pathology.
Surgical Options
Patient’s who do not respond to nonoperative treatment or who cannot limit their activities may benefit from surgery.
Open and arthroscopic distal clavicle resection have been successful in relieving pain and allowing patients to return to their prior activity level. Open distal clavicle resection, is simple but requires a 4-5 cm incision. It also requires the partial detachment of the deltoid muscle and therefore patients must avoid strenuous for 4 weeks following the surgery.
Post operative x-ray demonstrating distal clavicle resection |
In our practice, all distal clavicle resections are performed arthroscopically for osteolysis.
Following the surgery, patents are encouraged to use the arm as tolerated. Home exercises are initiated within 1 - 2 days after surgery and physical therapy is started after the first post-operative visit.
Overhead activities are discouraged for 2 - 3 weeks. Most patients will be able to return to full activity at 2 - 3 months after surgery. Patients who also have concomitant tendon problems and require additional work for that problem may require longer to return to normal activities.
Outcomes after arthroscopic distal clavicle resection have generally been excellent. Most studies have reported good to excellent results in the range of 83% to 100%. Our own results have been at the upper end of this range.
Inadequate pain relief following an arthroscopic distal clavicle resection for osteolysis may be due to diagnostic inaccuracy, inadequate distal clavicle resection, AC joint instability or shoulder weakness due to subtle instability of the AC joint.
Summary
The patient with osteolysis of the distal clavicle usually reports a dull ache over the superior aspect of the shoulder which is aggravated by specific physical activities. History, physical examination and plain x-rays are usually sufficient to confirm the diagnosis. Initial treatment involves activity modification, NSAIDs and corticosteroid injections for temporary relief. If nonoperative treatment fails and patients are not willing to modify their activities or live with the pain, operative resection of the distal clavicle often provides good to excellent results with few complications.
References
- Shaffer, BS: Painful Conditions of the Acromioclavicular Joint, JAAOS, 7(3), 176-188, 1999.
- Stephens, M; Wolin, PM; Tarbet, JA; Alkayarin, M: Osteolysis of the Distal Clavicle. The Physician and Sports Medicine. 28(12), 2000.
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Weightlifter's shoulder/Distal Clavicular Osteolysis - Bodybuilding.com Forums
Weightlifter's shoulder/Distal Clavicular Osteolysis - Bodybuilding.com Forums
"Doctor stated that I can't bench for a long long time and if I have to 'bench' I can do narrow grip incline and DB decline. "
- 07-24-2012, 10:45 AM #1
Weightlifter's shoulder/Distal Clavicular Osteolysis
Hey everyone...
I was recently diagnosed with distal clavicular osteolysis or Weightlifter's shoulder. It is a painful deterioration of the distal end of the clavicle (collar bone). It is an overuse phenomenon that causes tiny fractures along the end of the clavicle. A breakdown of the bone (osteolysis) occurs.
The doctor says mine looks minor and should be okay in 4-6 months, but it has already been about 3 months and it still doesn't feel, even a little, better.
The reason for this post is because I'd like to see if anyone else has had experience with this injury.
It would be great to hear how severe your injury was, how long it took to heal and weather or not you required the surgery (Mumford procedure or distal clavicular resection)
Thank you in advance! - 07-24-2012, 12:35 PM #2
- 07-25-2012, 09:45 AM #3Registered User
- Join Date: Apr 2007
- Age: 28
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Hey everyone...
I was recently diagnosed with distal clavicular osteolysis or Weightlifter's shoulder. It is a painful deterioration of the distal end of the clavicle (collar bone). It is an overuse phenomenon that causes tiny fractures along the end of the clavicle. A breakdown of the bone (osteolysis) occurs.
- 07-25-2012, 07:29 PM #4Registered User
- Join Date: Feb 2011
- Location: United States
- Age: 34
- Stats: 205 lbs
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I was just diagnosed with Rotator cuff tendonitis, labral tear, and distal clavicle edema. I have had these issues for 8 weeks now and it's just horrible. The dr also stated that my edema is minor but yet will take longer to heal than the other injuries. The Tendonitis can be taken care with a few more weeks of PT (already been 8 weeks), my labral tear is extremely minor/small (cartilage doesnt heal...so I will be ok if I stay away from certain activities), but the edema will take a minimum of 3-6 months.
She stated that I can't bench for a long long time and if I have to 'bench' I can do narrow grip incline and DB decline.
Xoticmike...the pain for me was a dull 'bruising' feeling at the shoulder joint (where the bicep tendon attaches) when not working out. When you are working out it feels like your shoulder is being stabbed with a knife that is on fire, coated in snake venom, and 100 wasps stinging the joint. This pain will last a few days after workout and then will gradually disappear until next workout. - 09-29-2012, 11:45 AM #5Registered User
- Join Date: Aug 2012
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I was just diagnosed with the same..
Hey everyone...
I was recently diagnosed with distal clavicular osteolysis or Weightlifter's shoulder. It is a painful deterioration of the distal end of the clavicle (collar bone). It is an overuse phenomenon that causes tiny fractures along the end of the clavicle. A breakdown of the bone (osteolysis) occurs.
The doctor says mine looks minor and should be okay in 4-6 months, but it has already been about 3 months and it still doesn't feel, even a little, better.
The reason for this post is because I'd like to see if anyone else has had experience with this injury.
It would be great to hear how severe your injury was, how long it took to heal and weather or not you required the surgery (Mumford procedure or distal clavicular resection)
Thank you in advance!
That being said, I still would prefer to avoid surgery at all costs, but when I cant even do a dip/pushup/bench press meaningful weight without significant pain, I'm not sure how long I'll be able to live with it. - 10-05-2012, 02:36 PM #6
Same Issue
I just got back from my sport doctor this Friday and he diagnosed me with the same problem. I hurt mine back in mid-May, kept working out with it despite the pain, but finally I just stopped all shoulder and chest work at the end of July. I havnt done any chest/shoulders since, but the doctor actually told me to get back in the gym and "stop babying it" (in the nicest way possible haha). Basically he explained that the problem will heal on its own but it could take 6 months to many years before I will no longer feel pain. He said that if after a month of hitting it back in the gym the pain is just too much to deal with, then I could come back in for surgery. He explained it as a 15 minute outpatient procedure and that he's had patients get back in the gym and work out full strength within 3 days.
That being said, I still would prefer to avoid surgery at all costs, but when I cant even do a dip/pushup/bench press meaningful weight without significant pain, I'm not sure how long I'll be able to live with it.
I hurt mine in May, and here we are into October. I went to my primary care doctor in June and he said it was an AC injury, which I had already self diagnosed through research (mostly on this site). He said rest it for 6 to 8 weeks. I did not do ANY upper body weightlifting for the next two months. It did gradually get better, but not to the point where i felt comfortable resuming lifting. I decided to go see a Orthopedic Doctor that specializes in shoulder injuries. After an x-ray he said it was DCO. He didn't feel like it was too serious because i have a good ROM, and my pain level has dropped to about a 3 on a scale of 1 - 10.
He said he would do surgery if that is what i wanted, but i should continue to rest it as our bodies have a way of healing themselves. That was two months ago, and I still feel the same. So now i don't know what to do. I am turning 50 next month and am in very good shape for my age, and it's killing me to go to the gym and only do cardio and leg workouts. I started doing very light weights for biceps and triceps, and it does give me a little pain, but I so want to get back to lifting. I am not one to jump into surgery, but i am beginning to believe that my recovery has gone as far as it is going to go.
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