Distal clavicle osteolysis, or weightlifter’s shoulder, is a shoulder injury that affects the AC joint and is commonly associated with contact sports and weightlifting. Symptoms include pain, reduced range of motion, stiffness, and swelling. Treatment involves avoiding symptomatic activity, anti-inflammatory drugs, and ice. Surgery may be required if the bone does not remineralize. Prevention includes avoiding exacerbating activities and using extra padding for contact sports.
Distal clavicle osteolysis, also known as weightlifter’s shoulder, is a shoulder injury that affects the acromioclavicular (AC) joint. It is most commonly associated with contact sports in which the clavicle or collar bone is placed under heavy strain. The exact cause, however, is not known. Symptoms may come on slowly and include a dull ache in the AC joint, reduced range of motion, stiffness and swelling in the shoulder, and reduced strength. Symptoms may worsen with continued activity.
Osteolysis refers to the loss of minerals, such as calcium, into the bone, causing the bone to soften or dissolve. In distal clavicle osteolysis, the end, or distal part, of the clavicle begins to slowly break down and dissolve. This can be caused by a single AC joint injury, smaller repetitive injuries, repetitive stress on the AC joint such as in weight lifting, or a pre-existing disease that could affect the mineralization of the bone structure, such as rheumatoid arthritis.
Changes in bone structure occur over time but can usually be diagnosed with the help of x-rays and a patient history. Treatment depends on the amount of bone loss. In most cases, the avoidance of symptomatic activity or modification of activities, combined with anti-inflammatory drugs and ice can allow the clavicle to remineralize. This process can take up to two years to fully resolve. Symptoms often return if previous activities are resumed.
Surgery may be required if the bone does not remineralize or if a patient is unable or unwilling to limit their activity. The most common form of surgery for distal clavicle osteolysis is a distal clavicle resection, or arthroscopic distal clavicle resection, in which the affected portion of the bone is removed. Postoperative healing times vary, but limited range of motion may return within a week or two after surgery.
The condition can be prevented in some cases. Experts recommend the cessation of all exacerbating activities as soon as AC joint pain presents. Extra padding is recommended for contact sports. Weight lifters can avoid injury by taking a tighter grip on the bar and avoid locking or overextending the elbows.
The first recorded distal clavicle osteolysis injury was in 1936. In this case, a jackhammer operator presented with a painful shoulder and no obvious trauma. The occurrence of these injuries has increased with the increase in both awareness and popularity of competitive sports.
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