Distal Clavicle Osteolysis - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of distal clavicle osteolysis.

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Osteolysis means bone erosion. The bone is dissolving or the bone is lost! There is a localized area of inflammation, hyperemia, microfracture, bone resorption and eventually arthritis of the AC joint. It is a micro stress fracture or it is a stress reaction in the distal clavicle with subsequent bone resorption. It typically affects younger male patients. It occurs from activities that require overhead heavy lifting, repetitive motion, and the use of a jack hammer. The condition is also common in weight lifters, laborers, and it occurs in younger people than patients with primary AC joint arthritis. There is a hyperemic response in the distal clavicle with localized bone resorption and cyst formation. Secondary AC joint arthritic changes may occur later during the disease process.
EXAMINATION
The weight lifter will complain that they are no longer able to lift their usual amount of weight. There will be localized pain, swelling and tenderness over the AC joint area. The patient will have pain with terminal shoulder elevation and cross body motion.
Cross Body Adduction Test
90° flexed arm is adducted across the chest to the opposite side.
IMAGING
X - ray shows erosion of the distal end of the clavicle. The acromion is OK. You may see Osteopenia, Osteolysis, tapering and cystic changes of the clavicle. An MRI may be obtained to rule out additional shoulder pathology. Acromioclavicular Joint Radiography - Zanca View Direction of the X - Ray Beam:
The beam is directed with cephalad angle of 10 degrees. 50% penetration. Clavicular osteolysis can be assessed using the Zanca view. The Zanca view can be helpful for AC joint pathology. The acromion will be normal with the abnormality isolated to the distal clavicle. Zanca view is also used for diagnosis of arthritis of the AC joint. The findings of the x - rays may not represent the patients real symptoms.
Differential Diagnosis
Bilateral Erosions
Hyperparathyroidism
Rheumatoid arthritis
Scleroderma
Unilateral Erosion
Post - traumatic Osteolysis
Myeloma
Metastases
Osteomyelitis
TREATMENT
Rest
Ice
Activity modification
Anti-inflammatory medication
Injection
Blind injection or ultrasound guided injection.
Surgery
If pain persists despite conservative treatment.
Arthroscopic or open resection of the distal clavicle. Arthroscopy will allow for evaluation of the shoulder joint and for any other shoulder pathology. If you do open resection, then repair the trapezius and deltoid fascia adequately. Surgery is successful in about 90% of cases (Distal clavicle resection surgery most likely will lead to a long term successful outcome).
Resect 5 - 10 mm of bone.
Keep the posterior - superior ligament intact because it maintains horizontal stability of the clavicle.