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Distal clavicular osteolysis

Case contributed by Orlando M Martinez
Diagnosis certain

Presentation

The patient reported persistent shoulder pain that worsened during overhead movements, accompanied by tenderness and restricted shoulder mobility. Physical examination revealed localized tenderness and swelling over the distal clavicle, along with notably limited abduction and external rotation. The patient's history was remarkable for vigorous weight training of the upper extremities.

Patient Data

Age: 25 years
Gender: Female
x-ray

The frontal radiograph reveals irregularity and localized lucency at the distal aspect of the clavicle, particularly prominent at the acromioclavicular joint. There is evidence of erosive changes with partial resorption of the distal clavicular bone. Marginal sclerosis and cystic changes are observed, indicative of chronic remodeling.

mri

The T1-weighted coronal MRI demonstrates focal signal alterations within the distal clavicle, particularly notable at the acromioclavicular joint. Hypointense areas indicative of bone resorption and irregularity of the distal clavicle are evident. T2 correlates illustrate reciprocal findings.

Case Discussion

Key learning points:

A plain radiograph is commonly sufficient to diagnose distal clavicular osteolysis. Equivocal radiographic findings will require further evaluation with MRI, US, or a bone scan 1.

Consistent findings include the loss of subchondral bone detail and microcysts in the distal clavicle 2.

Patients with distal clavicular osteolysis will often have a history of weight-lifting, particularly persistently performing overhead exercises (e.g., bench press) 3.

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