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

Roedl, Johannes B.; Nevalainen, Mika; Gonzalez, Felix M.; Dodson, Christopher C.; Morrison, William B.; Zoga, Adam C.

doi:10.1007/s00256-014-2092-2

Cited by 47 publications

(32 citation statements)

References 19 publications

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“…Bone marrow edema and early osteoarthritis at the elbow, known as posteromedial impingement (6), and at the shoulder (26,27) are seen as sequelae of abnormal biomechanical stress in overhead athletes, even at a young age. For the diagnosis of posteromedial elbow impingement in baseball players, a smaller previous study by Cohen et al (6) showed good correlation between MR arthrography and arthroscopy.…”

Section: Myotendinous Injuriesmentioning

confidence: 99%

Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players

Roedl

Gonzalez

Zoga³

et al. 2016

Radiology

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Purpose To evaluate a combined imaging approach with both ultrasonography (US; conventional US and valgus stress US) and magnetic resonance (MR) arthrography in baseball players with medial elbow pain. Materials and Methods Institutional review board approval was obtained and the requirement for informed consent was waived. The study is compliant with HIPAA. Baseball players with medial elbow pain underwent US in addition to MR arthrography. Findings were assessed with each modality alone and both combined in this retrospective investigation. For the evaluation of ulnar collateral ligament (UCL) tears with stress US, the interval gapping of the medial elbow joint was measured between rest and valgus stress both at the injured and at the uninjured (contralateral) elbow. Surgical or arthroscopic correlation was available as the so-called gold standard. McNemar tests compared the accuracies of the imaging modalities. Results In this study, 144 baseball players had 191 findings of medial elbow pain, including 53 UCL tears. With stress US, joint gapping at the injured elbow greater than 1.0 mm compared with the contralateral elbow yielded a sensitivity, specificity, and accuracy of 96%, 81%, and 87%, respectively, for diagnosing UCL tears. With MR arthrography, the sensitivity, specificity, and accuracy for UCL tears were 81%, 91%, and 88%, respectively, and increased to 96% (P = .013, McNemar test), 99% (P = .023), and 98% (P < .001), respectively, when combined with US to a dual modality MR and US approach. For 31 patients with ulnar neuritis, the sensitivity, specificity, and accuracy increased from 74%, 92%, and 88%, respectively, with MR arthrography alone to 90% (P = .07, McNemar test), 100% (P < .001), and 98% (P < .001) combined with US. For the 59 myotendinous and the 48 osteochondral diagnoses, the sensitivity, specificity, and accuracy with MR arthrography alone were 93%, 93%, and 93%, and 94%, 98%, and 97%, respectively, with no additional diagnostic value from US. Conclusion The combined approach with both MR arthrography and US shows higher accuracy than each modality alone for the assessment of medial elbow pain. (©) RSNA, 2016.

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Section: Myotendinous Injuriesmentioning

confidence: 99%

Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players

Roedl

Gonzalez

Zoga³

et al. 2016

Radiology

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“…With very little mention in the pediatric literature, Roedl et al recently reported that atraumatic distal clavicular osteolysis occurs in 6.5% of adolescents between 13 and 19 years of age presenting with atraumatic shoulder pain. 70 The study found that overhead sports such as swimming, basketball, volleyball, and tennis, especially when combined with weight training, was the strongest risk factor in adolescents due to frequent tension and traction by the strong acromioclavicular and coracoclavicular ligaments on the relatively weak distal clavicle. Different than adults, where distal clavicular osteolysis is virtually seen exclusively in males, in adolescents, 24% of affected patients were female.…”

Section: Distal Clavicular Osteolysismentioning

confidence: 99%

Pediatric Musculoskeletal Trauma: Upper Limb

Restrepo

Cervantes

Zahrah

et al. 2021

Semin Musculoskelet Radiol

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Pediatric upper extremity injuries, acute and chronic due to overuse, are commonly encountered in the clinical setting. However, interpretation of imaging studies is often challenging in pediatric patients because of changing postnatal skeletal development and the broad spectrum of pathology that can potentially occur. This article discusses normal skeletal development and the pathomechanics of skeletal injuries in pediatric patients. It also outlines a framework for imaging as it pertains to the pediatric upper extremity, with specific emphasis on acute and chronic injuries to the shoulder, elbow, forearm, and wrist.

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“…AODC is characterized by chronic changes seen in the lateral end of the clavicle. It is seen most commonly in those engaged in body building and competitive weight lifting (21). Less commonly such lesions have been reported in athletes involved in basketball, volleyball, swimming, football, and baseball pitchers (21).…”

Section: Atraumatic Osteolysis Of the Distal Clavicle (Aodc)mentioning

confidence: 99%

“…Athletes participating in sports that require overhead activity as well as supplemental weight training are at a higher risk. AODC is believed to be due to repetitive excess load and associated microtrauma to the distal end of the clavicle (21).…”

Section: Atraumatic Osteolysis Of the Distal Clavicle (Aodc)mentioning

confidence: 99%

Evaluation and management of shoulder pain in skeletally immature athletes

Patel

Breisach

2017

Transl. Pediatr.

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Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies.

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

Abstract: 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.

Cited by 47 publications

References 19 publications

Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players

Potential Utility of a Combined Approach with US and MR Arthrography to Image Medial Elbow Pain in Baseball Players

Pediatric Musculoskeletal Trauma: Upper Limb

Evaluation and management of shoulder pain in skeletally immature athletes

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