Introduction
Distal clavicle osteolysis is an uncommon condition induced most likely by overuse. Chronic repetitive stress and a single acromioclavicular trauma can both cause distal clavicle osteolysis. Although the exact origin of the condition is not known, acromioclavicular joint tension and subchondral microfractures appear to be involved. Symptoms typically begin with an insidious throbbing aching in the acromioclavicular joint region, which is exacerbated by lifting weights and primarily affects individuals in their twenties. Clinical symptoms are usually nonspecific and overlap with labral or rotator cuff injuries.
What Is Osteolysis of the Distal Clavicle?
Osteolysis of the distal clavicle is the painful process of osseous resorption. Osteolysis is the term used to describe the softening, absorption, and breakdown of bone as well as the removal or loss of calcium from bone. The end of the clavicle may experience osteolysis at the acromioclavicular joint. The end of the clavicle may lose up to 0.5 to 3 centimeters of bone over time due to osteolysis.
What Causes Osteolysis of the Distal Clavicle?
The following are the etiological factors that may lead to osteolysis of the distal clavicle:
1. Bench pressing, overhead lifting, and overhead sports motions like those in volleyball, basketball, tennis, and swimming are the most often reported aggravating activities in distal clavicular osteolysis. These motions regularly load the acromioclavicular joint with traction and compression, which results in the repeated microtrauma pattern linked to distal clavicle osteolysis.
2. Single damage to the acromioclavicular joint or the clavicle's end.
3. The repetitive mild clavicle or acromioclavicular joint injuries.
4. Hard lifting that is repeated, such as bench pressing and overhead shoulder presses.
5. Existing illness conditions such as scleroderma, hyperparathyroidism, infection, multiple myeloma, and rheumatoid arthritis may lead to osteolysis of the distal clavicle.
What Are the Symptoms Associated with Distal Clavicle of the Osteolysis?
Osteolysis of the distal clavicle typically develops gradually and causes shoulder discomfort, stiffness, and edema. The acromioclavicular joint location or the end of the clavicle may both experience pain. Activities like bench presses, shoulder presses, push-ups, and throwing frequently make the pain worse. This swelling of the acromioclavicular joint may also put a strain on the shoulder's rotator cuff below, which could result in pain for the rotator cuff tendons.
How to Diagnose Distal Clavicle Osteolysis?
Distal clavicle osteolysis can be diagnosed by various methods:
1. X-Ray - To assess for distal clavicular osteolysis, a plain film of the acromioclavicular joint is often used. Imaging of distal clavicular osteolysis frequently reveals microcysts, loss of subchondral bone detail, and osteolysis of the distal clavicle.
2. Ultrasonography - Consideration should be given to alternative imaging modalities such as MRI, bone scan, or ultrasound if radiograph findings are early, mild, or unclear. A developing method for diagnosing distal clavicular osteolysis is diagnostic musculoskeletal ultrasonography. An experienced doctor may use ultrasound during an evaluation, and it is much less expensive than magnetic resonance imaging (MRI) and bone scan. Additionally, it might be more sensitive than X-ray on plain film.
3. MRI - Concomitant pain generators or differential diagnosis should be taken into account when choosing an imaging modality. For instance, magnetic resonance is necessary for an accurate evaluation when there is a high suspicion of the superior labrum, anterior to posterior tears lesion in addition to SCO. The following
4. The differential diagnosis or concurrent pain generators should be taken into account when choosing an imaging modality. For instance, magnetic resonance is necessary for an accurate evaluation when there is a high suspicion of SLAP (superior labrum, anterior to posterior tears) lesion in addition to SCO. Although no laboratory tests are required for the diagnosis, they should be taken into account depending on other potential medical explanations in the differential.
How to Treat Distal Clavicle Osteolysis?
First-line treatment for distal clavicular osteolysis continues to be conservative, involving activity restriction or avoidance, the use of NSAID (nonsteroidal anti-inflammatory drugs), and physical therapy. Although there are currently no studies or position statements that support a particular physical therapy plan for distal clavicular osteolysis, it is generally advised for those with further shoulder disease to restore flexibility and rotator cuff strength.
Injections of corticosteroids are a crucial supplement to conservative management. Injections into the intra-articular acromioclavicular joints may be helpful for both therapeutic and diagnostic purposes. By reducing pain and enhancing function, it can assist in correctly identifying the main source of the discomfort. Other targeted injections may be used to test for alternative shoulder pathologies if the pain is not alleviated after the initial injection.
Botulinum toxin injection is a new method for treating unremitting distal clavicular osteolysis-related pain. If nonoperative treatment fails or an athlete is unable to adjust a particular athletic task or activity, surgical intervention can be quite successful. To prevent iatrogenic acromioclavicular joint instability, the majority of surgical management is resectioning the distal clavicle with no more than eight millimeters of excision. This is accomplished using either an open or arthroscopic procedure.
Conclusion
A pathological condition known as distal clavicle osteolysis (DCO) involves the resorption of subchondral bone in the distal clavicle. Acromioclavicular (AC) joint pain is the most common symptom of the illness. Although symptoms frequently return with resumed former activities, conservative therapy is effective for the majority of people with distal clavicle osteolysis. Surgery is a therapy option for patients in whom non-surgical options have failed or who will not restrict their activities (distal clavicle resection).
Distal clavicle osteolysis might not be properly diagnosed and remain undiagnosed for years. With the rise in popularity of weight training over the past few decades, its prevalence has increased. Magnetic resonance imaging is far more capable of early distal clavicle osteolysis detection. For athletes, limiting time away from action requires early detection and intervention. Distal clavicle osteolysis has a favorable prognosis in general. To know more about this condition consult the doctor online.