This 42-year-old former professional goalkeeper presented with a six month history of right shoulder pain. While there was no obvious precipitant the player described an injury to his shoulder about five years previously. On examination he was found to have localised tenderness over his right acromioclavicular joint (that was different to the contralateral side), pain with end range abduction and pain with cross body adduction. His examination was otherwise unremarkable with no rotator cuff signs, evidence of instability or restricted movement.
The original x-ray shows evidence of a grade 2 injury to the acromioclavicular ligament (ACL) (with disruption of the ACJ but a normal coracoclavicular interval). Since the original x-ray there has been resorption of bone at the lateral end of the clavicle with corticated margins to the clavicle. There are also 15 x 10 mm and 7 x 3 mm diameter ossicles in the gap. The cortex of the acromion is slightly irregular and the joint is generally wide. These findings are entirely in keeping with post-traumatic osteolysis.
This patient was successfully treated with a short period of rest from gym based training. No further treatment was needed. Twelve months after his presentation he remains pain-free and is able to complete all normal activities – including playing recreational football and training in the gym. In some cases, a corticosteroid injection can be helpful as can excision of the distal clavicle.
Post-traumatic osteolysis is common following injuries to the ACJ. While this can be quite impressive on x-rays it is often entirely asymptomatic. Patients may however present with localised pain and tenderness. Osteolysis of the distal clavicle can also occur without trauma. This is generally seen in players who do a lot of gym training – especially large numbers of bench press, dips and push-ups. Symptoms are bilateral in 20% of cases. As with this case x-rays usually show some degree of osteoporosis, demineralisation and loss of the sub-articular cortex in the lateral clavicle. The injection of local anaesthetic into the ACJ can be a useful diagnostic test (this should remove the pain and help distinguish from other causes of shoulder pain).
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.