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Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients

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Abstract

Objective

Atraumatic distal clavicular osteolysis (DCO) has been described in adult male weightlifters. Our purpose was to investigate the frequency, magnetic resonance imaging (MRI) characteristics, risk factors, and long-term sequelae of DCO in young patients.

Materials and methods

Individuals with atraumatic DCO were identified in a retrospective review of 1,432 consecutive MRI shoulder reports in patients between 13 and 19 years of age. MRI findings of DCO, association with athletic activity, short-term clinical outcome after 3–6 months, and long-term clinical and MRI outcome after 2 years were analyzed. A pre-MRI questionnaire assessed the patients’ athletic history including overhead activity and weightlifting.

Results

At a mean age of 15.9 years, 6.5 % (93/1432) of patients had atraumatic DCO, and 24 % were females. The combination of an overhead sport (basketball, volleyball, tennis, swimming) and supplemental weight training was a risk factor for DCO (odds ratio = 38, p = 0.01). Ninety-three percent of patients responded to conservative therapy. On follow-up imaging, 71 % of DCO patients had acromioclavicular (AC) joint osteoarthritis (vs. 35 % in controls, p = 0.006); 79 % had flattening of the distal clavicle and interval widening of the AC joint to a mean of 5.0 mm (compared to 2.4 mm in controls, p < 0.001). Severity of DCO edema was associated with pain (p < 0.02) at initial presentation and with AC joint osteoarthritis (p = 0.004) on follow-up.

Conclusion

In athletic teenagers, the combination of weightlifting and overhead activity is a risk factor for atraumatic DCO, and females are affected in 24 %. Long-term sequelae include widening of the AC joint and AC joint osteoarthritis.

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References

  1. Cahill BR. Osteolysis of the distal part of the clavicle in male athletes. J Bone Joint Surg Am. 1982;64:1053–8.

    CAS  PubMed  Google Scholar 

  2. Dupas J, Badilon P, Daydé G. Aspects radiologiques d’une ostéolyse essentielle progressive de la main gauche. J Radiol. 1936;20:383-7.

    Google Scholar 

  3. Ehricht HG. Osteolysis of the lateral clavicular end after compressed air damage. Arch Orthop Unfallchir. 1959;50:576–82.

    Article  CAS  PubMed  Google Scholar 

  4. Kaplan PA, Resnick D. Stress-induced osteolysis of the clavicle. Radiology. 1986;158:139–40.

    Article  CAS  PubMed  Google Scholar 

  5. de la Puente R, Boutin RD, Theodorou DJ, Hooper A, Schweitzer M, Resnick D. Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients. Skelet Radiol. 1999;28:202–8.

    Article  Google Scholar 

  6. Erickson SJ, Kneeland JB, Komorowski RA, Knudson GJ, Carrera GF. Post-traumatic osteolysis of the clavicle: MR features. J Comput Assist Tomogr. 1990;14:835–7.

    Article  CAS  PubMed  Google Scholar 

  7. Patten RM. Atraumatic osteolysis of the distal clavicle: MR findings. J Comput Assist Tomogr. 1995;19:92–5.

    Article  CAS  PubMed  Google Scholar 

  8. Kassarjian A, Llopis E, Palmer WE. Distal clavicular osteolysis: MR evidence for subchondral fracture. Skelet Radiol. 2007;36:17–22.

    Article  Google Scholar 

  9. Fiorella D, Helms CA, Speer KP. Increased T2 signal intensity in the distal clavicle: incidence and clinical implications. Skelet Radiol. 2000;29:697–702.

    Article  CAS  Google Scholar 

  10. Stein BE, Wiater JM, Pfaff HC, Bigliani LU, Levine WN. Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Should Elbow Surg. 2001;10:204–8.

    Article  CAS  Google Scholar 

  11. Havranek P. Injuries of distal clavicular physis in children. J Pediatr Orthop. 1989;9:213–5.

    Article  CAS  PubMed  Google Scholar 

  12. Ogden JA. Distal clavicular physeal injury. Clin Orthop Relat Res. 1984;188:68–73.

    PubMed  Google Scholar 

  13. Wolf BR, Ebinger AE, Lawler MP, Britton CL. Injury patterns in Division I collegiate swimming. Am J Sports Med. 2009;37:2037–42.

    Article  PubMed  Google Scholar 

  14. Bahr R, Reeser JC. Injuries among world-class professional beach volleyball players. The Federation Internationale de Volleyball beach volleyball injury study. Am J Sports Med. 2003;31:119–25.

    PubMed  Google Scholar 

  15. Sciascia A, Kibler WB. The pediatric overhead athlete: what is the real problem? Clin J Sport Med. 2006;16:471–7.

    Article  PubMed  Google Scholar 

  16. Haupt HA. Upper extremity injuries associated with strength training. Clin Sports Med. 2001;20:481–90.

    Article  CAS  PubMed  Google Scholar 

  17. Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology. 2014140587.

  18. Matthews LS, Simonson BG, Wolock BS. Osteolysis of the distal clavicle in a female body builder. A case report. Am J Sports Med. 1993;21:150–2.

    Article  CAS  PubMed  Google Scholar 

  19. Kay SP, Ellman H, Harris E. Arthroscopic distal clavicle excision. Technique and early results. Clin Orthop Relat Res. 1994;301:181–4.

    PubMed  Google Scholar 

  20. Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BRJ. Degenerative joint disease of the acromioclavicular joint: a review. Am J Sports Med. 2013;41:2684–92.

    Article  PubMed  Google Scholar 

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The authors of this manuscript have no disclosures, grants, or other assistance related to this study.

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Correspondence to Johannes B. Roedl.

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Roedl, J.B., Nevalainen, M., Gonzalez, F.M. et al. Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients. Skeletal Radiol 44, 659–666 (2015). https://doi.org/10.1007/s00256-014-2092-2

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  • DOI: https://doi.org/10.1007/s00256-014-2092-2

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