Distal clavicle osteolysis

Last revised by Samin Khoei on 28 Jul 2023

Distal clavicle osteolysis is the painful osseous resorption of the distal clavicle

Distal clavicle osteolysis most commonly affects young males. It is bilateral in ~20% 1

There are two distinct forms of distal clavicle osteolysis although these have identical histopathologic and imaging findings 1,2:

  • post-traumatic: weeks to more commonly months after injury
  • atraumatic: stress-induced overuse, seen in laborers and overhead athletes, especially in weight-lifters

May be normal early in the disease course. Progressive disease can manifest with cortical irregularity, subchondral cysts and erosion/tapering of the distal clavicle 1,3

Bone marrow edema of the distal clavicle more than the acromion with subchondral cystic change +/- subchondral fracture, and distal clavicle periostitis 1,2. Acromioclavicular joint effusion and capsular edema may be present 1

Most patients respond to conservative treatment (exercise modification, NSAIDs, ice cooling). On follow-up MRI 2:

  • acromioclavicular joint osteoarthritis is common (~70%)
  • flattening of the distal clavicle
  • acromioclavicular joint widening

See article: distal clavicular erosion (differential).

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