Distal Clavicle Osteolysis

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Distal Clavicle Osteolysis

Authors, Editors, Case Information Author: Karson Mostert, MD Affiliation: Mayo Clinic Co Author(s): Benjamin Kopecky, MD Cara Prideaux, MD Senior Editor: Wesley Troyer, DO Clinical Vignette: A physically active 30-year-old male presented to sports medicine clinic for left anterior shoulder pain that was worse during and after performing push-ups. A positive Scarf test was noted. Type of Probe Used: Linear LA4-18B transducer Unlabeled Short Axis View of the AC Joint Unlabeled Short Axis View of the AC Joint Labeled Short Axis View of the AC Joint Labeled Short Axis View of the AC Joint with increased distance is noted between the acromion and the clavicle, irregularity of the bony contour of the distal clavicle with evidence of degradation. The acromion remains intact. #3 - Video View Video Short Axis Cine of the left AC Joint from anterior to posterior with distal clavicle osteolysis visualized on the left side of the screen and then acromion on the right side of the screen. Interpretation Image Interpretation: Increased distance between the left acromion and the clavicle, with cortical irregularity of the distal clavicle consistent with distal clavicle osteolysis. Teaching Pearl: Distal clavicle osteolysis is an overuse injury most often seen in weightlifters and athletes performing repetitive overhead or pressing-related activities. Ultrasound can show distal clavicle cortical irregularities, AC joint widening, capsular hypertrophy, effusion, and focal tenderness to sonopalpation that helps localize pain to the AC joint. One can pair ultrasound imaging with provocative testing, such as the scarf test, and a cervical and neurologic exam to rule out alternative sources of shoulder pain. Radiographs are often used to confirm distal clavicle resorption. References: 1. Singh M, Soo Hoo J. A sports medicine clinician’s guide to the diagnosis and management of distal clavicular osteolysis. Curr Sports Med Rep. 2023;22(6):230-237. doi:10.1249/JSR.0000000000001078 2. Nevalainen MT, Ciccotti MG, Morrison WB, Zoga AC, Roedl JB. Distal clavicular osteolysis in adults: association with bench pressing intensity. Skeletal Radiol. 2016;45(11):1473-1479. doi:10.1007/s00256-016-2446-z 3. Blankstein A, Ganel A, Givon U, Dudkiewicz I, Perry M, Diamant L, Chechik A. Ultrasonography as a diagnostic modality in acromioclavicular joint pathologies. Isr Med Assoc J. 2005;7(1):28-30.
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Authors, Editors, Case Information

Unlabeled Short Axis View of the AC Joint

Labeled Short Axis View of the AC Joint

#3 - Video

Interpretation

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