From the Guidelines
Osteolytic lesions of the lateral end of the clavicle are most commonly caused by distal clavicular osteolysis (DCO), which is often a result of repetitive microtrauma, particularly in individuals who perform weight training exercises. The causes of osteolytic lesions of the lateral end of the clavicle can be multifactorial, including:
- Distal clavicular osteolysis (DCO), also known as weightlifter's shoulder, which typically results from repetitive microtrauma, particularly in individuals who perform weight training exercises like bench press or military press 1.
- Post-traumatic osteolysis following acromioclavicular joint injuries, which can lead to malunions and have adverse effects on strength and function of the shoulder, as well as being cosmetically unacceptable 1.
- Rheumatoid arthritis, which can cause inflammatory erosion of the bone.
- Primary bone tumors such as osteochondroma or enchondroma.
- Metastatic cancer, particularly from lung, breast, kidney, or prostate primaries.
- Multiple myeloma.
- Infections like osteomyelitis.
- Metabolic disorders such as hyperparathyroidism, which can lead to bone resorption in this area. It is essential to note that the treatment of clavicle fractures, including those that may lead to osteolytic lesions, has evolved in recent years, with increasing evidence supporting surgical treatment of widely displaced fractures to reduce rates of nonunion and symptomatic malunion, and improve patient-reported outcomes 1. Diagnosis typically requires radiographic imaging, including X-rays, CT scans, or MRI to visualize the bone destruction, and may necessitate biopsy in cases where malignancy is suspected. Treatment depends on the underlying cause, ranging from activity modification and anti-inflammatory medications for DCO to surgical intervention for tumors or severe cases, and appropriate antimicrobial therapy for infections.
From the Research
Causes of Osteolytic Lesion of Lateral End of Clavicle
- Traumatic osteolysis: repeated microfractures due to stresses imposed by activities such as weightlifting and benchpressing can cause osteolytic lesions of the lateral end of the clavicle, as seen in young male athletes 2.
- Infections: tuberculosis can present as an expansile osteolytic lesion in the lateral end of the clavicle, and should be included in the differential diagnosis, especially at unusual sites 3.
- Hematological malignancies: multiple myeloma can cause local osteolytic lesions and skeletal-related events, which can induce severe pain and immobility, and increase the risk of fractures and osteomyelitis 4.
- Post-traumatic osteomyelitis: osteomyelitis can arise following operative treatment of bone, and requires a long-term treatment, with symptoms appearing 1 week to 3 months after operation 5.
Differential Diagnosis
- Osteomyelitis: differentiating osteolysis and osteomyelitis is a challenge, as they may have a similar presentation, but the treatment regimen, morbidity, and long term prognosis for the patient are vastly dissimilar 6.