Distal Clavicle Osteolysis - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of distal clavicle osteolysis.
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Osteolysis means bone erosion. The bone is dissolving or the bone is lost! There is a localized area of inflammation, hyperemia, microfracture, bone resorption and eventually arthritis of the AC joint. It is a micro stress fracture or it is a stress reaction in the distal clavicle with subsequent bone resorption. It typically affects younger male patients. It occurs from activities that require overhead heavy lifting, repetitive motion, and the use of a jack hammer. The condition is also common in weight lifters, laborers, and it occurs in younger people than patients with primary AC joint arthritis. There is a hyperemic response in the distal clavicle with localized bone resorption and cyst formation. Secondary AC joint arthritic changes may occur later during the disease process.
EXAMINATION
The weight lifter will complain that they are no longer able to lift their usual amount of weight. There will be localized pain, swelling and tenderness over the AC joint area. The patient will have pain with terminal shoulder elevation and cross body motion.
Cross Body Adduction Test
90° flexed arm is adducted across the chest to the opposite side.
IMAGING
X - ray shows erosion of the distal end of the clavicle. The acromion is OK. You may see Osteopenia, Osteolysis, tapering and cystic changes of the clavicle. An MRI may be obtained to rule out additional shoulder pathology. Acromioclavicular Joint Radiography - Zanca View Direction of the X - Ray Beam:
The beam is directed with cephalad angle of 10 degrees. 50% penetration. Clavicular osteolysis can be assessed using the Zanca view. The Zanca view can be helpful for AC joint pathology. The acromion will be normal with the abnormality isolated to the distal clavicle. Zanca view is also used for diagnosis of arthritis of the AC joint. The findings of the x - rays may not represent the patients real symptoms.
Differential Diagnosis
Bilateral Erosions
- Hyperparathyroidism
- Rheumatoid arthritis
- Scleroderma
Unilateral Erosion
- Post - traumatic Osteolysis
- Myeloma
- Metastases
- Osteomyelitis
TREATMENT
- Rest
- Ice
- Activity modification
- Anti-inflammatory medication
- Injection
Blind injection or ultrasound guided injection.
- Surgery
If pain persists despite conservative treatment.
Arthroscopic or open resection of the distal clavicle. Arthroscopy will allow for evaluation of the shoulder joint and for any other shoulder pathology. If you do open resection, then repair the trapezius and deltoid fascia adequately. Surgery is successful in about 90% of cases (Distal clavicle resection surgery most likely will lead to a long term successful outcome).
Resect 5 - 10 mm of bone.
Keep the posterior - superior ligament intact because it maintains horizontal stability of the clavicle.

[@mr.physio]

Thank you Doc! You are a legend!

[@Greysonbird]

This was extremely helpful! Very informative and clearly explained, yet concise and to the point. Thank you!

[@jonstark3034]

Just had distal clavicle exision surgery Tuesday the 26th of April, your video made it easy to understand what i will be going through.

[@Bthast62]

How did the surgery and recovery go?

[@DG-wu7ke]

I had this surgery in the late 90's. The pain prior to surgery was unbelievable. I had already worked the autoglass industry 15yrs and had easily installed 20k windshields by this time. My surgeon used the weight lifter analogy and the repetitive motion example. Post surgery was difficult. The first week was sleepless as there is now way to lay flat that doesn't cause pain and getting up is agony when you do try. You end up seated with pillows stacked in your lap to try to sleep. It doesn't work until you're so exhausted you get 20 minutes. The first physical therapy session was a blast. They take the sling off and want to slowly let your arm down. I remember it was days later when I could actually bend over a`and get my arm away from my torso. That tiny amount of motion hurt so good. Next was crawling your hand up the wall. That took a week. Just to get my arm straight up above my head. One their last tortures was to see how far you can touch up your back. That is still challenging but I've gotten into a habit of stretching those muscles that way. There were lots of weight lifting exercises. They were designed to pull those muscles and tendons in every direction they could come up with. It was two years later before I broke to cycle and had regained my original strength and 90% of the motion in my shoulder. It is a tough haul but when it feels like a 300lb pound woman is grinding her hooker-heels into the top of your shoulder you'll do almost anything to make it stop. Everyday post surgery is healing pain which is totally different than the screaming pre-surgery kind. Good luck with yoursa

[@Bthast62]

Two years? 😭 Im having this surgery bc weightlifting progress has stopped and causes bad inflammation.

[@DanesinTexas]

Thanks so much for the info. Well made video. Having surgery soon, so this helps

[@melanievoltz4453]

Incredibly helpful! Thank you Doctor.

[@zikaj]

Very helpful and informative video. Excellent graphics.

[@alexroyer8683]

Can someone explain their experience with treatment and how the injury is doing in current day after treatment?

[@ahmedsrssamir8192]

thanks

[@leighphillips1793]

Amazing video, everything I was looking for. Thanks 🙏 I need to go back to my doctor and discuss my X-ray results now.

[@STC987]

Great video. Very informative.

[@jannikthomason5414]

Good video. Will have MRI on my AC joint soon...pain for 6 months and none of the "conservative" treatments have worked...keeping my fingers crossed that a likely surgery will help or else I will have to find a new career path :(

[@sanimarathwal1328]

Did you get surgery done?

[@希慢活冀]

真是增長醫學知識

[@laurence2421]

I used a C-arm to take X-ray selfies at work 😅 I found distal clavicle osteolysis. I had my suspicions because I started getting lots of pain in the gym. Sure enough, I found it on X-ray. This video is very informative. I’m going straight to an arthroscopic surgeon.

[@danielmaldonado1959]

Ever get the surgery

[@m7md00009]

Soo helpful thank you so much

[@beachfiredude]

Thank you Great up

[@physiojobayer1789]

thanks sir

[@VixxyMcN]

I have this apparently I have an old clavicle fracture and small lucencies on either side of the AC what does that mean?

[@nuwankumara2269]

Ac joint update

[@mikethaison432]

I just gave it like a year or so and then just went back and slowly increased weight. Surgeon said I basically did the surgery to myself. A lot of heavy weightlifters get this problem, it's almost like a right to passage at this point. Honestly don't get the surgery it's not worth it. Just wait it out.

[@Oicad]

Did you do any lifting within that year or just no chest and shoulders

[@mikethaison432]

@@Oicad For about 8 months I did no lifting just physical therapy and taking Joint supplements, fish oil, Tumeric, and UC II collagen. Before you begin treatment the inflammation needs to be dealt with so I took Celebrex for about 2-3 weeks before starting the PT. Worked my internal external rotations to 150 lb resistance bands for sets of 25 over that span of a year. Did it every 3 days

[@Oicad]

I appreciate the prompt response! Do I need to take celebrex to get rid of the inflammation or will it eventually go away.

[@mikethaison432]

@@Oicad So some people get cortisone shots, those are better. I just did Celebrex because it is easier to get a prescription for.

[@mikethaison432]

@@Oicad I will say this, just give it 2-3 weeks without inflammation before starting PT

[@AmorFati777X]

I had a distal clavicle resection due to osteoarthritis and now after feeling perfect that old familiar pain is back... How is this even anatomically possible??

[@antonioyanakiev267]

Old movement patterns could still possible aggravate the AC joint, There is also the possibility that it is alright as pain can be as a result of neuropathy not necessarily tissue damage or issues, A good movement to help with AC mobility and pain is a butterfly raise / Lu raise, Good luck to you brother

[@AmorFati777X]

@@antonioyanakiev267 simmered down after several weeks. Things never quite get back to the way they were. Overall good outcome though

[@abusufyan9624]

Help me

[@drha6646]

thanks sir