Well, gang, you can add this kid to the list of those with a shoulder injury. I hurt it back on 6/20/2005. I had been going to the gym 5 days a week for months and had on that very day set a new personal best on the bench press of 320 pounds. My shoulder started to hurt immediately after. I’ve gone to the doctor a few times and X-rays and an MRI were done. I met with an orthopaedic Doctor yesterday who diagnosed me with ‘osteolysis of the distal clavicle’. This is also called ‘weightlifter’s shoulder’. I pasted some information about my plague below so you could better understand what I’m dealing with. It doesn’t feel good.

I started a 6 day packet of Methylprednisolone today in hopes that it will help reduce pain and swelling issues. I have a follow-up appointment with the doctor in 3 weeks. If I’m not better by then I will most likely get the injection. Surgery will be the last option.

I am to limit much of the weightlifting exercise I had been doing and may never be able to do some things again. I need to be very careful in Jiu-Jitsu class as a good slam onto the AC joint of my shoulder could really do some damage and force me into surgery. From what I’m being told this injury is going to be an annoyance for quite some time. Drugs and injections don’t offer much in the way of a cure and surgery involves a removal of some small part of the end of your collar bone. Ouch.

I’ve been given the green light by the doctor to continue lifting with my lower body and certain things with my upper body. I was also told that Judo is a cause of many shoulder issues so I’ll need to be careful and let pain be my guide there. I could be dealing with pain for months to years.

I was thinking just how I'm going to alter my lifting plan now that I'm hosed with this condition. I can't do bench (DB or BB), dips, pulldowns, shoulder presses, pull-ups, upright rows, or flys.

I was thinking I could do deads, all the various legs crap, various curls and tris, and bent over rows or seated rows. I'm not coming up with any ideas on how I can keep my chest involved. Maybe cable cross-overs? Any other ideas?

I'm really bummed as just when I get to benching some good numbers I may never be able to bench again and my shoulders, one of my better features, are hosed.

Here's some more informatin about Osteolysis of the distal clavicle:

What is osteolysis of the distal clavicle?

Osteolysis of the distal clavicle is a degenerative process (softening, absorption, and dissolution of bone or the removal or loss of calcium in bone) that results in chronic pain, particularly with adduction movements of the shoulder. Osteolysis of the distal clavicle is typically seen secondary to traumatic injury or in persons who perform repetitive weight training involving the shoulder.

What can cause AC joint osteolysis?

No one knows for sure what causes osteolysis of the distal clavicle but some risk factors include:

- A single injury to the AC joint or to the end of the clavicle
- Repetitive minor injuries to the AC joint or to the end of the clavicle
- Repetitive heavy weight lifting such as overhead shoulder press and bench press
- Pre-existing disease states such as rheumatoid arthritis, hyperparathyroidism, infection, multiple myeloma, and scleroderma.

What does osteolysis of the distal clavicle feel like?

Osteolysis of the distal clavicle usually comes on slowly and results in shoulder pain, stiffness and/or swelling. The pain may is felt in the area of the AC joint or the end of the clavicle. 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 incident that precipitated their symptoms. Weight lifters often have the most pain while performing bench presses, push-ups, and dips. Night pain is not often a complaint, but the patient will have difficulty sleeping on the affected side. Activities of daily living may become painful as the patient's symptoms progress.

On physical examination, patients consistently exhibit point tenderness over the AC joint and pain with cross-body adduction. Patients generally have well-developed shoulder musculature and full range of motion, but they can have pain with the impingement test, making diagnosis difficult. In this situation, 1 mL of 1% lidocaine hydrochloride can be injected directly into the AC joint. Patients with isolated distal clavicle osteolysis will have a temporary resolution of their symptoms after injection, whereas patients with other shoulder pathology will continue to have pain with provocative testing.

Can osteolysis of the distal clavicle be detected on X-rays?

X-rays can be an effective tool for identifying osteolysis of the distal clavicle but the bony changes may take weeks or months before they can be seen on an X-ray. A bone scan is an effective tool to help identify early osteolysis. A bone scan will show increased uptake over the distal clavicle and, occasionally, increased uptake in the acromion process. Magnetic resonance imaging exhibits altered signal intensity in the distal clavicle but is not necessary to make a definitive diagnosis.

What is the treatment for osteolysis of the distal clavicle?

The goal of treatment of osteolysis of the distal clavicle is to reduce pain while the clavicle "remineralizes". Rest or activity modification, anti-inflammatory medications and ice are usually prescribed to reduce pain. If these measures are not effective an injection of cortisone into the AC joint may be necessary. In most cases, the clavicle slowly remineralizes (over 4 to 6 months), but may take on a tapered appearance. In some cases, the bones do not remineralize and a surgical consult may be required. The surgeon may consider resecting (removing) part of the affected clavicle to reduce symptoms.

**Nonoperative treatment. Patients are initially started on a nonsteroidal anti-inflammatory drug (NSAID) and instructed in activity modification. Specifically, weight lifters should avoid bench presses, dips, flies, push-ups, and other lifts that elicit pain. Most patients will respond to activity modification; however, symptoms often recur if the previous weight-training schedule is reinstituted. Intra-articular corticosteroids can be considered for short-term symptom relief, but studies to date have not shown any long-term benefits. Because patients generally retain normal shoulder function, formal physical therapy is generally not initiated unless there is concomitant shoulder pathology. Patients whose condition does not respond to conservative management or who cannot limit their activities require surgery.

**Operative management. Both open and arthroscopic distal clavicle resection have been successful in alleviating pain and returning patients to previous activity levels. Open resection is a relatively simple procedure, but a 4- to 5-cm incision is required. It also entails at least partial detachment of the deltoid; therefore, patients must avoid strenuous use of the arm for 3 to 4 weeks. The arthroscopic technique is technically more demanding, but it is more cosmetically appealing, and patients return to activities as soon as they are comfortable.

Can osteolysis of the distal clavicle be prevented?

When symptoms of AC joint pain first develop, avoiding pain provoking activities is recommended. Additional padding for contact sports can also be effective. Finally, weight lifters should avoid locking their elbows during the bench press, use a narrower grip on the bar, and avoid bending their elbows past horizontal.

Overview

The natural history of the disease is that of a self-limiting disorder with resolution within 1-2 years with activity modification.

-Conservative management consists of rest and avoidance of symptomatic activity.

-Nonsteroidal anti-inflammatory drugs can also help alleviate symptoms.

-Corticosteroid injections are often given; however, they provide little long-term relief.

-While most patients respond to conservative management, symptoms often return with resumption of previous activity.