Table of ContentsView AllTable of ContentsCausesWhen to See a Healthcare ProviderDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Causes
When to See a Healthcare Provider
Diagnosis
Treatment
Prevention
Distal clavicle osteolysis is shoulder jointpain at the end of the collarbonethat is the result of bone disintegration and damage. The most common symptom is a sharp or aching pain at the junction of theacromioclavicular joint (AC joint)and collarbone. While the pain is usually felt during activity, there may also be a persistent tenderness around the joint during non-activity. Inflammation and swelling are also common manifestations.
Common Causes
Distal clavicle osteolysis is seen most commonly in weightlifters or other athletes who perform heavy bench presses for a long period of time. Besides weightlifters, anyone who repeatedly lifts objects overhead (tennis players, swimmers) and/or carries heavy objects (construction workers, military workers) can develop distal clavicle osteolysis.
Rarer Causes
Much less commonly, distal clavicle osteolysis arises from direct trauma to the collarbone, like from a fall or direct blow.
If you experience pain around the AC joint from an acute trauma or you develop tenderness and swelling around the AC joint, especially if you are a weightlifter or have a history of repetitive movements of the shoulder, be sure to see your healthcare provider for a proper diagnosis and treatment plan. In many cases, AC joint disorders, like distal clavicle osteolysis, respond to conservative therapies like ice and an anti-inflammatory medication. However, if pain persists, be sure to see anorthopedist, as surgery may be required.
Physical Examination
The shoulder joint may also be evaluated, as people with distal clavicle osteolysis generally retain a full range of motion of their shoulder.
Labs and Tests
With a suspected AC joint problem, your healthcare provider may order an AC injection test, often performed under the guidance of an X-ray or ultrasound.If a person experiences temporary pain relief after the steroid is injected, the test confirms a diagnosis of AC joint pain.
Your healthcare provider may also order blood tests, especially if he suspects a potential infection or that an inflammatory process is going on.
While an infected AC joint is not common, it may be suspected in a person with a weak immune system who has a fever and a tender, hot joint. In this case, a complete blood count will likely be ordered to see if there is an elevated number ofwhite blood cells(your infection-fighting cells). In addition, a sample of the joint fluid (collected through joint aspiration) will need to be examined under a microscope to look for bacteria.
Other blood tests may be ordered to rule out other inflammatory processes. For example, tests forrheumatoid factorand antibodies to citrullinated peptides/proteins (anti-CCP antibodies) can evaluate forrheumatoid arthritis; a uric acid level test can check for gout. Since primary hyperparathyroidism can cause bone resorption of the collarbone, your healthcare provider may check a parathyroid hormone level and calcium blood level as well.
Imaging
Alternately, amagnetic resonance imagining (MRI)scan may be ordered if a healthcare provider suspects othercauses of shoulder pain, either in addition to or separate from the suspected distal clavicle osteolysis.
Differential Diagnoses
As mentioned above, there are several health conditions that may cause pain at the AC joint and/or bone resorption at the distal end of the collarbone. Besides primary hyperparathyroidism, infection, or an inflammatory process like gout or rheumatoid arthritis, your healthcare provider may also need to perform imaging tests, such as an X-ray or MRI of the cervical spine (neck). This is because neck problems, like arthritis, can refer pain to the collarbone.
Distal clavicle osteolysis is initially treated conservatively with rest, restriction of movement, andice applicationover the AC joint. Any activity associated with the injury should be stopped. If there is severe pain, the shoulder may need to be held in a fixed position with an orthopedic sling.
Medications
In addition to rest and ice, medications to reduce inflammation and relieve pain are also essential to the healing process. Often times, a healthcare provider will recommend anonsteroidal anti-inflammatory (NSAID).A steroid injection into the AC joint may also be performed to temporarily ease pain.
Physical Therapy
When the shoulder is reasonably healed and the inflammation has ceased, physical therapy would be started to safely restore range of motion and strength to the affected shoulder. The recommended exercises and reps will vary depending on your specific case; follow your therapist’s instructions.
Surgery
In some cases, surgery may be needed if more conservative measures fail to provide relief. The surgery would involve the removal of the end of the collarbone, a technique healthcare providers refer to as theMumford procedure.It is a common surgery used to correct other conditions affecting the AC joint, including severe osteoarthritis. It can be performed either through a small incision orarthroscopically.
With time, most people who undergo surgery can resume normal activities, including weight training and sports activities, with no loss of function. Recovery usually takes around three months, although some can return to activity faster with a structured course of physical therapy and rehabilitation.
Due to the fact that most athletes find it difficult to completely eliminate bench pressing from their weightlifting routine, modifications can be made to ease the stress on the joint and collarbone. A few examples of modifications include:
If you have recovered from distal clavicle osteolysis and your healthcare provider has given you the “OK” to continue working out, be sure you are clear on exactly what exercises you can and cannot do in order to avoid any further trauma to the AC joint.
A Word From Verywell
Being diagnosed with distal clavicle osteolysis can be a disheartening experience, especially if you are an active weightlifter or athlete. The good news is that many people get better with proper rest, ice, and pain control. Worst case scenario, surgery is needed, which is nearly always successful.
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ha AS, Petscavage-Thomas JM, Tagoylo GH.Acromioclavicular Joint: The Other Joint in the Shoulder.AJR Am J Roentgen. 2014; Feb;202:375-85. doi:10.2214/AJR.13.11460
DeFroda SF, Nacca C, Waryasz GR, Owens BD.Diagnosis and Management of Distal Clavicle Osteolysis.Orthopedics. 2017;40(2):119‐124. doi:10.3928/01477447-20161128-03
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