An uncommon condition that affects mostly athletes who perform repetitive overhead activity is distal clavicle osteolysis (DCO).
This is a condition that most commonly affects young active men, but nowadays, it has been increasingly found in women as a result of the rise of popularity of bodybuilding and extreme athletics.
For those with rigorous training regimens, distal clavicle osteolysis can be unbearable because of the pain.
Nonoperative therapy, which includes activity modification, nonsteroidal anti-inflammatory drugs, and cortisone injections, is the first-line management for this condition.
Arthroscopic techniques typically are the most beneficial when it comes to operative modalities for this type of injuries. They are favored because of improved cosmesis and the ability to assess the glenohumeral joint during surgery to rule out concomitant pathology.
Patients often do well after such procedures and are able to return to their preinjury level of participation within a relatively short period.
The AC joint, which is the articulation of the distal clavicle and the acromion, is stabilized by several ligamentous attachments. It is also stabilized both in the horizontal and vertical planes by several ligaments.
A great majority of the patients are young, athletic men who participate in activities such as weight training, but, as mentioned, women have also been diagnosed with DCO secondary to weight lifting or push-ups.
As a surgeon, you have to be on the lookout for complaints of vague anterior shoulder girdle pain without the sensation of subluxation. Patients might have some tenderness over the AC joint. Most of them will not be able to recall an isolated traumatic event. The range of motion is usually normal.
Before anything else, the radiographic evaluation of the AC joint should be the first step in the diagnosis. Pathological changes should be limited to the distal clavicle and spare the acromion.
In this case, surgical procedures will only be indicated when the patient continues to experience persistent pain.
Surgeons must consider concomitant shoulder pathology such as rotator cuff tears and biceps tendinopathy, which have been demonstrated to be present in up to 81% and 22% of patients, respectively.
In the literature, open and arthroscopic surgical approaches have been described with variable success. Due to the improved cosmesis, arthroscopic approaches have become more popular.
In case of distal clavicle resection alone, advanced imaging should be obtained, either through open Mumford-style procedures or a direct AC arthroscopy.
With the rise of popularity and familiarity of arthroscopy, along with the advantages earlier noted, both indirect and direct approaches have been described in the literature.
Criticism of the arthroscopic approach includes the high technical demand, operative time, destruction of the joint capsule and the risk of inadequate resection.