Distal clavicle osteolysis

Case
This 19-year-old male player presented with pain in his dominant right shoulder. This was well localised to the acromioclavicular (ACJ) region and was associated with localised tenderness. He gave a history of an ACJ ‘sprain’ one year previously. He reported that the pain seemed to resolve after the initial trauma, however it recurred. The onset of further pain coincided with him starting a gym-based programme with his club’s fitness trainer.

Findings
An x-ray series from the time of the player’s initial presentation was unremarkable (a normal Zanca view is shown here). A repeat x-ray series, taken almost exactly one year later, shows that there has been interval change. There is irregularity of the distal end of the right clavicle consistent with healed bone resorption. The acromion is also slightly irregular at the acromioclavicular joint and this joint is wide. The coraco-clavicular interval remains normal.

Discussion
This player was managed with a short period of oral NSAID, physiotherapy and relative rest. His symptoms slowly settled over a three month period. During this time, he was able to continue to train and play football but altered his upper body weight training to avoid press activity (bench press, military press and push ups).

Distal clavicle osteolysis should be considered as a possible cause of shoulder pain among football players. In this group the most common causes are likely to be post-trauma or be associated with repetitive microtrauma caused by weight training. As a result this condition should be considered in any patients who have ongoing pain following an ACJ injury. In general, treatment options include activity modification and time, corticosteroid injections or excision of the distal clavicle.

As in this case, x-rays can be very helpful for establishing a diagnosis (and may be the only imaging that is required). The most common finding is of osteopenia affecting the distal end of the clavicle (usually in the distal 2cm) with loss of the articular cortical margin. When further investigations are required, MRI is generally the modality of choice. Increased signal on T2 sequences about the distal clavicle and ACJ is the most common single finding. A diagnostic local anaesthetic injection can be a useful investigation technique when the diagnosis is in doubt.

Important notice
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.

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Rodrigo PeixotoDr Shahram MohagheghBangouraVladimir1991Ivan andres Recent comment authors
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Asaad huseen asaad
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Asaad huseen asaad

Thank you very much Gold and very nice information Thank you to everyone who worked with it

Ameur Aref
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Ameur Aref

Good job

dr.mohamed@1944
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نسأل الله لكم التوفيق والسداد

Ahmed abdin seyam hassan
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Ahmed abdin seyam hassan

I was learned it ..thank you for this information

Abood 77
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Abood 77

جهودكم مشكورة

Ivan andres
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Ivan andres

Muchas gracias por los aportes, que buena información

Vladimir1991
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Vladimir1991

Thanks for the Article. I have had a patient with exact problem. It is a Goalkeeper, about 25 years of age. At the first time it was difficult to find out what is the problem, but then it comes as a pretty obvious. Therapy was at the beginning rest, than low intensity trainings, no “press” exercises, for about 3-4 weeks. After that came up with regular training, with slightly painfull shoulder. But now without any problems.

Bangoura
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Bangoura

L OSTEOLYSE DISTALE DE LA CLAVICULE EST UNE EXCISION DE LA CLAVICULE DISTALE PERMET DE BIEN TRAITER LES PATIENTS SOUFFRANTS D UNE OSTEOLYSE DELA CLAVICULE DISTALE OU DE DOULEURS CHRONIQUES.
CETTE INTERVENTION EST POSSIBLE TANT QUE LA STABILITE DE LA CLAVICULE ASSUREE PAR LES LIGAMENTS CORACO.CLAVICULAIRES.

Dr Shahram Mohaghegh
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Dr Shahram Mohaghegh

Thank you .Has anyone had experience with Regenerative-type injections (such as platelet-rich plasma [PRP] or stem cell injections) for treatment of DCO yet?

Rodrigo Peixoto dos Santos
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Rodrigo Peixoto dos Santos

Highly affected region, a lot of trauma due to falls and contracts