Distal Clavicular Osteolysis

Distal clavicular osteolysis is characterized by shoulder pain following relatively minor trauma or following chronic repetitive stress (most common in young weight lifters).

Radiographic findings include subarticular erosions, tapering, and widening of the acromioclavicular joint, and are seen weeks to months after the initial insult. Late findings may also be seen at the acromion, and include erosion and dystrophic calcification.

MRI shows bone marrow edema, abnormalities of the acromioclavicular joint, and subchondral cysts in the distal clavicle. Recently, subchondral fractures have been seen in a number of cases of Distal clavicular osteolysis.

The images above show bone marrow edema, a joint effusion, and a subchondral fracture. Radiographs obtained around the same time show lucencies in the distal clavivle with areas of sclerosis.

More broadly speaking, post-traumatic osteolysis occurs most frequently at the distal calvicle, followed by the pubuc and ischial rami, distal ulna, distal radius, the carpal bones, and the femoral neck.

References

• Kaplan PA, Resnick D. Stress-induced osteolysis of the clavicle. Radiology. 1986 Jan;158(1):139-40.
• Kassarjian A, Llopis E, Palmer WE. Distal clavicular osteolysis: MR evidence for subchondral fracture. Skeletal Radiol. 2007 Jan;36(1):17-22.
• Levine AH, Pais MJ, Schwartz EE. Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes. AJR Am J Roentgenol. 1976 Nov;127(5):781-4.