Anisau, Aliaksandr

Vanhoenacker, Filip

English

Ghent University Academic Bibliography

Case 15701 Distal clavicular osteolysis in a bodybuilderAliaksandr Anisau 1, 2Filip M. Vanhoenacker 1, 2, 31. General Hospital AZ Sint-Maarten Duffel-Mechelen, Leopoldstraat 2, B-2800 Mechelen,Belgium.2. University Ghent, Department of Medicine and Health Sciences.3. University Hospital Antwerp, University Antwerp, Department of Radiology, University HospitalAntwerp; Wilrijkstraat, 10, 2650 Antwerp, Belgium; Email:filip.vanhoenacker@telenet.beUniversity Hospital Antwerp, Department of Radiology, University Hospital Antwerp;Wilrijkstraat, 10 2650 Antwerp, Belgium; Email:filip.vanhoenacker@telenet.be University Hospital Antwerp  Musculoskeletal System Section: 2018, May. 2 Published: 33 year(s), malePatient:Clinical HistoryA 33-year-old amateur body-builder presents with left shoulder pain since about 5 months, withouta history of preceding acute trauma. Palpation of the acromioclavicular joint is painful.Mobilization of the left shoulder is normal and painless.Imaging FindingsStandard radiography showed cortical irregularity of the articular side of the distal clavicle (figure1a and 1b). The acromion appeared to be normal. The patient underwent an MR arthrography,because initially, rotator cuff pathology was suspected. The rotator cuff tendons and capsulolabralsystem were normal. There was marked bone marrow edema in the distal clavicle and whereas thesignal of the distal acromion was almost normal (figure 2a and 2b). The subchondral cortex of thedistal clavicle appeared thinned and was irregularly delineated (figure 2a). A mild AC-joint effusionand hypertrophy of the joint capsule was present (figure 2a and 2c). Follow-up radiographs 2months after they initial presentation showed a normal right AC joint (figure 3a), whereas residualosteolysis was seen at the superolateral aspect of the left clavicle (figure 3b).DiscussionDistal clavicular osteolysis (DCO) follows both chronic repetitive stress and singleacromioclavicular trauma [1]. The exact etiopathogenesis is unclear, but AC-joint trauma andsubchondral microfractures seem to be involved [1, 2]. Subsequent attempts at repair areinsufficient and the final result is osteolysis [1, 4]. It's unclear why changes predominate in thedistal clavicle while the acromion is relatively spared [1].DCO has been most frequently reported in weightlifters and bodybuilders [1, 2]. Overhead sports,especially when combined with supplemental weight training, are also at increased risk [4].Professional activities requiring similar movements or exposure to chronic repetitive stress (e.g.pneumatic drill operation) can also cause DCO [5].Clinical findings are often nonspecific and frequently overlap with those of labral or rotator cufftears [5]. Patients experience pain in the AC-joint region, exacerbated by weight training andrelieved by prolonged rest [2]. Targeted clinical examination reveals point tenderness over theAC-joint and painful cross-body adduction [2, 4].Conventional radiographs may remain normal during the first months or years after the onset oftraining [1, 3]. A 15° cephalad inclination avoids superposition of the scapular spine with theAC-joint [2]. Radiographic changes include cortical thinning, irregularity and microcysts in distalclavicle and mild AC-joint widening [1, 2]. A late finding is tapering of the distal clavicle [2]. MRIis far more sensitive to detect DCO in an early stage [1]. The most common MR-finding is bonemarrow oedema in the distal clavicle, sometimes also in the articular part of the acromion, but lessdistinct [1, 3]. Often, a hypo-intense line is seen in this area of clavicular bone marrow edema,representing a subchondral fracture [1, 4]. AC-joint abnormalities are common, and includeeffusion, mild widening, intra-articular bone fragments and capsule hypertrophy [2, 5]. OtherMR-findings are similar to those seen on radiographs, as described above.Treatment is essentially conservative, consisting of rest and nonsteroidal anti-inflammatory drugs(NSAID's), is usually successful [2, 4]. In severe cases, resection of the distal clavicle is indicated[1, 2]. If left untreated, the process may cause progressive resorption of lateral aspect of theclavicle, erosions and cupping of the acromion and dystrophic calcifications [3].DCO should be considered in the differential diagnosis of shoulder pain in the appropriatepopulation. Therefore, analysis of MR arthrographic studies of the shoulder should not be restrictedto evaluation of the rotator cuff and capsulolabral system, but the AC-joint should be scrutinized aswell.Final DiagnosisDistal clavicular osteolysis.Differential Diagnosis ListSeptic arthritis, Rheumatoid arthritis, Hyperparathyroidism, Gout, Corticosteroid inducedarthropathy, Sclerodermia, Primary or metastatic neoplasm (including multiple myeloma)FiguresFigure 1 Conventional radiograph of the left shoulderYellow arrows: irregular delineation of the of the articular cortex of the acromial end of theclavicle. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; Enlarged view of the AC-joint. Yellow arrows: irregular delineation of the of the articularcortex of the acromial end of the clavicle. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: Conventional radiography;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; Figure 2 arthro-MRI of the left shoulderMRI T2 fs, coronal image. Red arrow: bone marrow edema in distal clavicle. White arrow:very subtle bone marrow edema in acromion. Yellow arrow: subchondral cortical irregularityin the distal clavicle. Blue arrow: AC-joint effusion. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; MRI T2 fs, axial image. Red arrow: bone marrow edema in the distal clavicle. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; MRI T1 fs, coronal image. Green arrows: hypertrophy of the AC-joint capsule. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; Figure 3 Follow-up radiograph of both AC jointsRight AC joint with 15° cephalad inclination 2 months later. Normal delineation of the ACjoint. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; Left AC joint with 15° cephalad inclination 2 months later. Yellow arrow: there is stillirregular delineation and osteolysis of the superolateral aspect of the left clavicle. © Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium Area of Interest: Extremities; Musculoskeletal bone; Musculoskeletal joint;  Imaging Technique: MR;  Procedure: Diagnostic procedure;  Special Focus: Athletic injuries; References[1] Kassarjian A, Llopis E, Palmer WE (2007) Distal clavicular osteolysis: MR evidence forsubchondral fracture Skeletal radiol 36(1): 17-22[2] Schwarzkopf R, Ishak C, Elman M, Gelber J, Strauss DN, Jazrawi LM (2008) Distal clavicularosteolysis Bull NYU Hosp Jt Dis 66(2): 94-101[3] De La Puente R, Boutin RD, Theodorou DJ, Hooper A, Schweitzer M, Resnick D (1999)Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17patients Skeletal radiol 28(4): 202-208[4] Roedl JB, Nevalainen M, Gonzalez FM, Dodson CC, Morrison WB, Zoga AC (2015)Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis inyoung patients Skeletal radiol 44(5): 659-666[5] Patten RM (1995) Atraumatic osteolysis of the distal clavicle: MR findings J Comput AssistTomogr 19(1): 92-95CitationAliaksandr Anisau 1, 2Filip M. Vanhoenacker 1, 2, 31. General Hospital AZ Sint-Maarten Duffel-Mechelen, Leopoldstraat 2, B-2800 Mechelen,Belgium.2. University Ghent, Department of Medicine and Health Sciences.3. University Hospital Antwerp, University Antwerp, Department of Radiology, University HospitalAntwerp; Wilrijkstraat, 10, 2650 Antwerp, Belgium; Email:filip.vanhoenacker@telenet.beUniversity Hospital Antwerp, Department of Radiology, University Hospital Antwerp;Wilrijkstraat, 10 2650 Antwerp, Belgium; Email:filip.vanhoenacker@telenet.be (2018, May. 2)  Distal clavicular osteolysis in a bodybuilder {Online}URL: http://www.eurorad.org/case.php?id=15701

Distal clavicular osteolysis in a bodybuilder

https://biblio.ugent.be/publication/8560967/file/8560968.pdf

Distal clavicular osteolysis in a bodybuilder

Abstract

Similar works

Full text

Available Versions

Ghent University Academic Bibliography