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Orthopaedic Services ShoulderWhat is distal clavicular osteolysis?
Distal clavicular osteolysis, or DCO, is an overuse injury that occurs at the distal (end) of the clavicle (collarbone), leading to slow dissolution and resorption. Although the cause is unclear, it appears to be consistent with a stress reaction or fracture at the site of considerable forces, and it is typically among weight-lifting athletes.
Non-operative treatment: Many patients can be treated by backing off on activities that provoke their symptoms. For example instead of lifting heavy weights, the bench press may be done with increasing repetitions and decreasing the amount of weight. Gripping the bar at a greater distance may decrease the symptoms. Pain medications, ice after activity and judicious use of cortisone injection are all important components of non-operative management.
Operative treatment: In the weight-lifting population, non-operative treatment is often ineffective; DCO requires surgical intervention. Persistent symptoms that have failed to respond to non-operative treatment, particularly among those who are unable or unwilling to alter their activities, may justify surgical intervention. Surgery involves removal of the end of the clavicle (collar bone), either via open technique or more commonly, via arthroscopy. The amount removed is usually no more than a centimeter, which prevents abutment of the bone surfaces and removes all inflammatory debris from within the joint. Surgery is very successful in resolving the pain, allowing the athlete to fully return to the activity without experiencing any weakness.
Possible complications of non-operative treatment include:
Possible complications of operative treatment include:
How our shoulder experts can help
Our shoulder experts will diagnose and treat your condition using the latest advances in orthopaedic technology. To request an appointment with our physicians, please call 202-787-5601.How does DCO occur?
DCO usually results from repeated trauma, such as with weightlifting. Less commonly, a traumatic event, such as falling on the shoulder, can precipitate its development.What increases risk?
- Contact sports, weightlifting or racket sports
- Possibly with previous shoulder separation, sprain or dislocation
What are the symptoms of DCO?
Diffuse discomfort or ache, tenderness and swelling at the end of the collarbone or the acromioclavicular (AC) joint (the top of the shoulder) are common. Symptoms are usually insidious, without a history of discrete trauma. Pain and aching are related directly to specific exercises, most commonly dips, flies, push-ups and bench press. Pain may be worse when crossing the arm towards the opposite body, such as when washing the opposite axilla (armpit).How is DCO diagnosed?
Typical symptoms of pain over the AC joint, focal tenderness, pain with forcing the arm across the body (cross-body adduction test) and X-rays showing dissolution of the clavicle with seeming joint space enlargement, is characteristic of this condition.Are there any special tests?
Imaging studies are rarely needed because of the straightforward presentation of this condition. However, there are two studies that may be helpful in confirming pathology of this joint:- A bone scan, in which a minimally radioactive dye is injected into the arm by IV. The dye is taken up at sites where there is significant metabolic activity. In the case of DCO, uptake at the AC joint would be expected to be rather dramatic, and clearly different from the opposite AC joint by comparison.
- Selective injection technique, in which local anesthetic is infiltrated into the AC joint, may be helpful if the symptoms are relived following the injection.
How is DCO treated?
Non-operative treatment: Many patients can be treated by backing off on activities that provoke their symptoms. For example instead of lifting heavy weights, the bench press may be done with increasing repetitions and decreasing the amount of weight. Gripping the bar at a greater distance may decrease the symptoms. Pain medications, ice after activity and judicious use of cortisone injection are all important components of non-operative management.
Operative treatment: In the weight-lifting population, non-operative treatment is often ineffective; DCO requires surgical intervention. Persistent symptoms that have failed to respond to non-operative treatment, particularly among those who are unable or unwilling to alter their activities, may justify surgical intervention. Surgery involves removal of the end of the clavicle (collar bone), either via open technique or more commonly, via arthroscopy. The amount removed is usually no more than a centimeter, which prevents abutment of the bone surfaces and removes all inflammatory debris from within the joint. Surgery is very successful in resolving the pain, allowing the athlete to fully return to the activity without experiencing any weakness.
What are the complications of treatment?
Possible complications of non-operative treatment include:
- Persistent symptoms
- Inability to participate in their sport or be competitive
Possible complications of operative treatment include:
- Surgical complications not specifically associated with AC joint resection, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.
- Complications specific to surgical treatment of DCO, which include persistent symptoms, inadequate resection or overly generous resection.
When can you return to your sport/activity?
You may consider returning as soon as you are comfortable. Most overhead athletes will require 4-6 weeks before they begin to throw. Weight-lifting may be started as soon as the pain permits, which may be in the first few weeks for some patients.How can DCO be prevented?
- Limit amount and frequency of weightlifting
- Vary weightlifting routine
- Avoid trauma to the shoulder, such as with tackling
- Maintain appropriate conditioning, including shoulder strength, endurance, flexibility and cardiovascular fitness
- Use proper techniques when falling, tackling, and weightlifting
- Ensure proper use and fit of protective equipment
