Distal Clavicle Osteolysis
What is Distal Clavicle Osteolysis?
Acromioclavicular joint, or distal clavicle, osteolysis is an unusual condition in which the outer end of the clavicle (distal clavicle) undergoes multiple minor stress fractures secondary to repetitive injuries. As a consequence of these injuries, the bone is eroded at a faster rate than it can be repaired and as a result, bone erosion or ‘osteolysis’ occurs. This results in the loss of bone form the distal clavicle.
What Causes it?
The Acromioclavicular joint undergoes significant loading when undertaking lifting activities at or above, shoulder height. Distal clavicle osteolysis usually affects patients under the age of 40 years old, with those undertaking overhead sporting activities on a repeated basis especially prone to this type of condition. In particular, weightlifters, avid gym goers, rugby payers and overhead workers such as builders and plasters are particularly prone to developing this condition.
What are the symptoms?
This similar to ACJ arthropathy, with pain and tenderness in the front / top of the shoulder around the joint. The pain is often worse when the arm is brought across the chest, since this motion compresses the joint. The joint may also click or snap as it moves. Pain is worse with overhead activities and stretching. It may be difficult to sleep on the side
How is it diagnosed?
The diagnosis is usually based on a good clinical history and physical examination. Diagnosis of AC joint osteoarthritis is usually made by physical examination. The AC joint is usually tender. A key finding is pain as the joint is compressed. To test for this, your arm is pulled gently across your chest.
Investigations:
X-Ray is used to demonstrate the loss of distal clavicle with cyst formation and erosions. MRI may be used to look at further bony changes which include oedema and erosion.
Treatment:
- Conservative treatment comprising of rest, activity modification and non steroidal anti-inflammatory may be helpful in the early stages and when symptoms are mild
- Physiotherapy: A rehabilitation programme may be directed by a physical or occupational therapist may be helpful in stretching the joint and preventing the loss of movements. The success depends on the level of pain and expectations.
- Injections: An ultrasound or fluoroscopy guided injection in the AC joint provides a decrease in inflammation and reduces pain.Cortisone’s effects are often temporary, but it can give very effective relief in the short term. It also aids in confirming the diagnosis.
- Arthroscopic Technique
If the non-operative treatment fails, then the commonest form of surgical intervention is called –Resection or Excision Arthroplasty which means excision of 8 –10 mm of lateral end of the collar bone. A fibre-optic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon can perform the repair under video control.
After surgery, the arm will be placed in a sling for a short period of time. This allows for early healing. As soon as comfort allows, the sling may be removed to begin exercise and use of the arm.
- Open Technique: