Fact-sheet: Post-traumatic osteolysis of the distal clavicle
Updated on 09/10/2019 at 2:07 PM
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Definition
Osteolysis of debated etiopathogenesis: likely due to repeated microtrauma causing stress fracture with secondary osteolysis, rather than true osteonecrosis.
It typically occurs in athletes (gymnasts, weightlifters, judokas).
A history of trauma weeks earlier is sometimes found; in other cases no clear cause for the osteolysis is identified.
Clinical features
Pain with an inflammatory pattern;
a history of trauma may be found in the preceding weeks
Radiography
Pseudo-widening of the acromioclavicular joint space due to osteolysis of the distal clavicle with irregular margins; comparative views are helpful
Ultrasound
Widening of the acromioclavicular joint space, sometimes with a cortical step-off
MRI
STIR hyperintensity of the distal clavicle
Subchondral fracture line of low signal intensity to be sought within the edema
Gadolinium-enhanced sequences can help detect the fracture line early on, and a true avascular area at a later stage
Management
Medical management: immobilization, analgesics, NSAIDs.
Movements using the pectoralis major should be avoided.
Ultrasound-guided corticosteroid injection, serving both as a diagnostic test and as treatment.
Remineralization occurs over 4 to 6 months, with possible residual deformity.
Surgical treatment is less common (resection of the distal clavicle).