Treatment of Distal Clavicular Osteolysis
Conservative management with activity modification, rest from provocative exercises, NSAIDs, and physical therapy should be the initial treatment for distal clavicular osteolysis, with surgical distal clavicle resection reserved for patients who fail conservative therapy after 3-6 months. 1, 2
Initial Conservative Management
Start with a structured non-operative approach for all patients:
Activity modification is the cornerstone: immediately cease weightlifting (especially bench press and overhead pressing movements), manual labor involving repetitive shoulder stress, and any activities that reproduce AC joint pain 1, 2
NSAIDs and ice massage applied to the AC joint region for symptomatic relief 1
Physical therapy focusing on range-of-motion exercises once acute pain subsides, avoiding provocative maneuvers 1, 2
Duration of conservative trial: Most patients show clinical improvement within 3 months if compliant with activity restrictions 2
Important Clinical Caveat
Patient compliance is fundamental to conservative treatment success—athletes unwilling to modify or cease weightlifting/manual labor have poor outcomes with non-operative management and should be counseled early about surgical options 1. The literature consistently shows that continued provocative activities during conservative treatment leads to treatment failure 1, 2.
Advanced Conservative Options for Refractory Cases
If symptoms persist beyond 6-8 weeks of strict activity modification:
Corticosteroid injection into the AC joint can be considered, though evidence is limited 3
Platelet-rich plasma (PRP) injection under ultrasound guidance has shown promise in case reports for refractory DCO, though this remains investigational 4
Surgical Indications
Proceed to distal clavicle resection (Mumford procedure) when:
Point tenderness persists over the AC joint after 3-6 months of conservative treatment 1
Radiographic evidence of osteolysis on plain films or MRI is confirmed 3, 1
Patient is unwilling or unable to permanently modify weightlifting or manual labor activities 1
Conservative measures including activity modification, NSAIDs, and physical therapy have failed 1, 2
Surgical Approach and Outcomes
Arthroscopic distal clavicle resection is the preferred surgical technique:
Performed via direct superior approach with low morbidity 5
Long-term results show 93% good-to-excellent outcomes (38 of 41 shoulders) at average 6.2-year follow-up 5
Critical distinction: Patients with atraumatic/microtraumatic etiology (weightlifting-related) have better surgical outcomes than those with acute traumatic etiology—all 3 failures in one series occurred in trauma patients 5
Arthroscopic resection provides comparable results to open excision with faster recovery 5
Prognosis and Follow-up
Clinical improvement typically precedes radiographic reconstitution—patients may feel better while X-rays still show osteolytic changes 2. Radiographic healing lags behind clinical recovery by several months, so do not be discouraged by persistent imaging abnormalities if the patient is functionally improving 2.
The key pitfall to avoid: Allowing athletes to return to weightlifting too early during conservative management invariably leads to symptom recurrence and treatment failure 1, 2.