synonyms: distal clavicle osteolysis, weight lifter's shoulder,
Distal Clavicle Osteolysis ICD-9
- 715.11 = osteoarthritis shoulder region
- 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.
- Diarthrodial joint which contains meniscus
- Mutiple anatomic variations
- See also Shoulder Anatomy.
- 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.
- 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.
- 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).
- SLAP Lesion:
- Posterior Capsular Contracture:
- RTC Tear:
- Anterior Shoulder Instability:
- Acromioclavicular Arthritis:
- Subacromial impingement
- Instability(excessive resection)
- Continued symptoms (inadequate resection)
- Ectopic calcification
- Reactive bursitis
- Clavicle/acromion fracture
- Infection
- 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).
