Clavicular Osteolysis

Clavicular osteolysis, sometimes known as weightlifter's shoulder, is an overuse injury of the joint between the collarbone (clavicle) and the shoulder bone (acromion). The overuse of the joint results in the end of the clavicle slowly dissolving. The cause of clavicular osteolysis is unknown, but it is generally a secondary condition that occurs after an episode of trauma to the shoulder.

SYMPTOMS

  • Diffuse pain and/or inflammation at the shoulder end of the clavicle or the acromioclavicular (AC) joint (the joint between the clavicle and the shoulder).

  • Symptoms after a workout that overtime begin to occur during one's workout. Pain on the top of the shoulder worsens when reaching across the body.

CAUSES

  • Repeated trauma, such as with weightlifting.

  • A traumatic event, such as falling on the shoulder (less common).

RISK INCREASES WITH:

  • Contact sports, weightlifting, and racket sports.

  • Poor strength and flexibility.

  • Previous shoulder injury (separation, sprain, or dislocation).

  • Inadequate or poorly fitting protective equipment.

  • Incorrect weight lifting technique.

PREVENTION

  • Limit amount and frequency of weightlifting.

  • Vary weightlifting routine both in intensity and duration.

  • Avoid trauma to the shoulder, such as with tackling.

  • Learn and use proper techniques when falling, tackling, and weightlifting.

  • Ensure proper use and fit of protective equipment.

  • To prevent re-injury, tape or pad vulnerable joints before practice or competition

  • Maintain physical fitness:

  • Shoulder strength

  • Shoulder endurance

  • Flexibility

  • Cardiovascular fitness

PROGNOSIS

Clavicular osteolysis is curable by avoiding activities that increase the severity of symptoms. Surgery may be necessary if the symptoms do not resolve or activity is continued.

RELATED COMPLICATIONS

  • Recurrent and persistent pain, especially activities that cause symptoms are resumed within 1 year of the initial treatment.

  • Increased susceptibility to recurrent injury.

  • Prolonged healing time, if exacerbating activities are resumed too early.

  • Inflammation of the AC joint.

TREATMENT

Treatment initially involves the use of medication and ice to reduce the pain and inflammation. Patients are asked to cease any activities that cause the symptoms to worsen. In some cases corticosteroid injections may be given to reduce the pain and inflammation. If symptoms do not subside with conservative treatment or the patient is or unwilling to alter activity, surgery to remove the end of the collarbone is recommended. Clavicular osteolysis surgery involves removing (resecting) up to 1 inch of the end of the clavicle near the shoulder. The surgery may be conducted either through an open incision or with the use of an arthroscope. In most cases, surgery is resolves all pain, allowing the athlete to fully return to activity without experiencing shoulder weakness.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers are usually only prescribed after surgery. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling worsens or does not improve despite 2 to 6 weeks of treatment.

  • You experience pain, numbness, or coldness in the arm.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).