Post-traumatic distal clavicular osteolysis

Case contributed by Henry Knipe
Diagnosis almost certain

Presentation

Elite athlete. Ongoing shoulder pain 2 weeks post-injury despite treatment.

Patient Data

Age: 30 years
Gender: Female
This study is a stack
Sagittal
T2 fat sat
This study is a stack
Sagittal
T1
This study is a stack
Axial PD
fat sat
This study is a stack
Coronal T2
fat sat
This study is a stack
Coronal
PD
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Info

Elevated distal clavicle but not beyond the superior acromion; no anteroposterior displacement. Acromioclavicular effusion with capsular oedema. Marked oedema on the distal clavicle with irregularity of distal articular surface and loss of normal low T1 signal. Mild oedema within the adjacent acromion. Coracoclavicular ligament is intact. 

Two weeks prior

x-ray
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Info

Similar alignment to the prior with mild elevation of the distal clavicle compared to the acromion. No articular erosion. 

Case Discussion

Distal clavicular osteolysis has a myriad of causes with trauma being one of them. While the acromioclavicular joint injury is a Rockwood type I/II, which typically heal well with conservative measures, in this case the clinical course has become complicated. 

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