From the Guidelines
Distal clavicle osteolysis should be initially managed with conservative treatment, including rest, activity modification, and anti-inflammatory medications, with surgical intervention considered only for patients with persistent symptoms despite 6+ months of conservative treatment. The condition is characterized by bone resorption at the outer end of the collarbone, typically caused by repetitive microtrauma 1. Initial treatment involves rest, activity modification, and anti-inflammatory medications like ibuprofen or naproxen for 2-4 weeks. Some key points to consider in the management of distal clavicle osteolysis include:
- Physical therapy focusing on rotator cuff strengthening and scapular stabilization exercises should be pursued for 6-12 weeks
- Corticosteroid injections may provide temporary relief for persistent pain
- Most cases resolve with conservative management within 3-6 months
- For patients with persistent symptoms despite 6+ months of conservative treatment, surgical intervention may be necessary, typically involving distal clavicle resection (Mumford procedure) 1. This condition is most common in weightlifters, particularly those performing bench press and other pushing exercises, as the repetitive compression between the acromion and clavicle leads to microfractures and subsequent osteolysis 1. Modifying workout routines to reduce stress on the acromioclavicular joint is essential for both treatment and prevention of recurrence. It is crucial to follow the American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures, which provides evidence-based recommendations for the management of clavicle fractures, including distal clavicle osteolysis 1.
From the Research
Definition and Causes of Distal Clavicle Osteolysis
- Distal clavicle osteolysis (DCO) is a condition characterized by the erosion and resorption of the distal clavicle, often caused by repetitive microtrauma or acute trauma 2, 3.
- The condition is commonly associated with weightlifting and activities that involve repetitive pressing and overhead lifting 2, 4, 5.
- DCO can be separated into traumatic and atraumatic pathogeneses, with the most widely accepted etiology involving a connection between microfractures of the subchondral bone and subsequent attempts at repair 2.
Symptoms and Diagnosis
- Symptoms of DCO typically begin with an insidious aching pain in the acromioclavicular (AC) joint region, exacerbated by weight training or other provocative maneuvers 2, 4.
- Patients often present with point tenderness over the affected AC joint and pain with cross-body adduction maneuvers 2.
- Diagnosis may involve radiographic examinations, such as AC joint scintigraphy and radiographs, to rule out other possibilities and confirm the presence of DCO 2, 3.
Treatment Options
- Initial treatment for DCO typically involves avoidance of provocative maneuvers, modification of weight training techniques, ice massage, and nonsteroidal anti-inflammatory drugs (NSAIDs) 2.
- Conservative management may also include activity modification, oral analgesics, physical therapy, and corticosteroid injection 4, 5.
- In refractory cases, adjuvant treatments such as platelet-rich plasma (PRP) injections or surgery may be considered 4, 5, 6.
- Arthroscopic resection of the distal clavicle has been shown to be an effective treatment option, with results comparable to open excision and low morbidity 6.