The Shoulder

Skeletal Radiol 1999 Apr;28(4):202-8
PMID: 10384990 [PubMed - indexed for MEDLINE]

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients.

de la Puente R, Boutin RD, Theodorou DJ, Hooper A, Schweitzer M, Resnick D.

Department of Radiology, University of California San Diego and Veterans Affairs Medical Center, 92161, USA.

OBJECTIVE: To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress. DESIGN AND PATIENTS: MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients. RESULTS: MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed. CONCLUSION: Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle.

Am J Sports Med 1992 Jul-Aug;20(4):463-7
PMID: 1415892 [PubMed - indexed for MEDLINE]

Nontraumatic clavicular osteolysis in weight lifters.

Scavenius M, Iversen BF.

Department of Orthopaedic Surgery, Frederiksberg University Hospital, Copenhagen, Denmark.

In a previous study, we found an overrepresentation of weight lifters in patients who had a resection of the lateral end of the clavicle. To further investigate a possible association between competitive weight lifting and the development of nontraumatic osteolysis of the lateral end of the clavicle, we studied a group of 25 Danish weight lifters. This group was compared to an age-matched control group of 25 men who had never engaged in weight training procedures. None of the subjects had any history of trauma to the shoulder girdle. All 50 subjects underwent radiographic examination of both shoulder joints. In the weight lifter group, seven cases (28%) demonstrated classical radiographic findings of clavicular osteolysis, with loss of subchondral bone detail, translucency, and cystic changes, while four subjects (16%) had subjective symptoms but no radiographic changes. None of the individuals from the control group revealed similar symptoms or radiographic signs. Thus, based on this limited material, the prevalence of the disorder is about 27%.

Acta Orthop Belg 1992;58(2):176-82

Surgical treatment of acute type V acromioclavicular injuries. A prospective study.

Verhaven E, Casteleyn PP, De Boeck H, Handelberg F, Haentjens P, Opdecam P.

Department of Orthopaedics and Traumatology, Vrije Universiteit Brussels, Belgium.

In a prospective study, 28 consecutive patients with an acute Type V acromioclavicular sprain were treated with a coraco-clavicular repair using a double velour Dacron graft. All patients were reviewed after a mean follow-up period of 5.1 years (range: 1 to 9 years). At follow-up, 20 patients (71.4%) showed good or excellent results, according to the Imatani evaluation system, and 8 patients (28.6%) demonstrated a fair or poor result according to the same system. Loss of reduction was encountered in 11 shoulders (40%), despite an initial anatomical reduction. No correlation was seen between the overall scores at follow-up and the degree of residual dislocation, between the overall scores and the presence of coraco-clavicular calcifications or ossifications, between the overall scores and the development of posttraumatic arthritic changes, or between the overall scores and the presence of osteolysis of the distal clavicle.

Skeletal Radiol 1983;10(1):34-6

Lytic clavicular lesions in fibromatosis colli.

Sartoris DJ, Mochizuki RM, Parker BR.

Two patients with fibromatosis colli (congenital torticollis) presented with lytic lesions in the clavicle at the insertion of the fibrosed clavicular head of the sternocleidomastoid muscle. Biopsy of one lesion showed intraosseous fibrosis. These lesions are probably not uncommon but radiographs are rarely performed in uncomplicated cases.

Radiology 1977 Apr;123(1):56

Osteolysis of the clavicular tip associated with repeated minor trauma to the shoulder.

Seymour EQ.

Osteolysis of the acromial end of the clavicle was seen in a 30-year-old man who had played a great deal of handball and softball, apparently as the result of repeated stress to the acromioclavicular articulation. Such osteolysis appears to be self-limited and requires no specific therapy other than rest of the affected area.

Am J Roentgenol 1976 Nov;127(5):781-4

Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes.

Levine AH, Pais MJ, Schwartz EE.

Erosion of progressive resorption of the distal clavicle following trauma has been described but merits greater attention due to its frequency. Six cases of posttraumatic osteolysis of the distal clavicle are reported with emphasis on early radiographic detection. Soft tissue swelling, deminerlization, and loss of the subarticular cortex at the injured clavicular tip antecede the more commonly recognized gross erosion. Recognition of this early stage, with consequent immobilization, may shorten the course of this process and decrease the prolonged disability. The pathogenesis of the process is discussed and illustrated.

Clin Orthop 1975;(109):108-14

Post-traumatic osteolysis of the distal clavicle.

Murphy OB, Bellamy R, Wheeler W, Brower TD.

Five cases of painful bone resorption from the distal clavicle following shoulder trauma are reported to demonstrate that the lesion is generally benign. Surgical excision is curative. The multiplicity of circumstances leading to clavicular osteolysis suggest that the balance between bone accretion and resorption is precarious in this region of the skeleton.