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Distal Clavicle Osteolysis

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Topic updated on 01/20/16 1:14am
Introduction
  • Pathophysiology
    • pathoanatomy
      • caused by repetitive micro-fracture in distal clavicle which leads to osteopenia
  • Epidemiology
    • demographics
      • commonly seen in weight lifters
    • risk factors
      • history of traumatic injuries
Anatomy
  • Osteology
    • clavicle is
      • S-shaped bone
      • last bone to fuse
    • medial growth plate fuses early 20s
Presentation
  • Symptoms
    • pain at distal clavicle
  • Physical exam
    • tenderness at distal end of clavicle
Imaging
  • Radiographs
    • recommended views
      • AP clavicle
    • findings 
      • cysts at distal end of clavicle
      • osteopenia
      • resorption and erosion
      • tapering of distal clavicle
Treatment
  • Nonoperative
    • activity modification, corticosteroid injections, NSAIDS
      • indications
        • first line of treatment
      • technique
        • (quit weight lifting or modify technique by moving arms farther apart)
  • Operative
    • open or arthroscopic distal clavicle excision
      • indications
        • severe symptoms that have failed nonoperative treatment
      • outcomes
        • open vs. arthroscopic based on surgeon preference and comfort
          • arthroscopic resection has the advantage of allowing evaluation of the glenohumeral joint
            • good results shown with arthroscopic treatment 
          • open procedures require meticulous repair of deltoid-trapezial fascia
Techniques
  • Arthroscopic distal clavicle resection 
    • should resect only 0.5-1cm of distal clavicle

 

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Qbank (1 Questions)

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(OBQ08.250) A 31-year-old professional bodybuilder reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint. Based on the radiograph shown in Figure A, which treatment is likely to provide the most successful result? Topic Review Topic
FIGURES: A          

1. Glenohumeral joint injection
2. Periscapular muscle strengthening
3. Labral repair
4. Arthroscopic resection of the distal clavicle
5. Capsular release

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