Posttraumatic osteolysis of the distal clavicle with emphasis on early radiologic changes

Successful treatment of the post-traumatic osteolysis of distal clavicle with alendronate

“…7 Asano et al reported the presence of inflammatory cells in bone marrow of both clavicle and acromion, fibrous tissue with vascular proliferation covering the distal clavicle and the presence of multinuclear giant cells 5 months after the injury, 3 while Levine et al showed that after 18 months of the initial trauma there was evidence for vascular proliferation, periosteal hypertrophy, villous hyperplasia and tiny fragments of necrotic bone. 12 Others have suggested bone and articular cartilage destruction and replacement by fibrous tissue, detritus in marrow spaces, subchondral cyst formation and sclerotic bone generally viewed as indicative of avascular necrosis. 4,14,16 Osteoclasts are the only known cells capable of effective bone resorption.…”

“…Although usually self-limiting within 18 months, post-traumatic osteolysis may lead to irreversible vanishing of the distal 0.5-3 cm of the clavicle. 12 However, a recent case report suggested that conservative therapy may not only lead to healing of the distal clavicle, but also to normalization of joint space dimension. 9 The pathogenesis of the disease remains unknown.…”

“…Although immobilisation is generally accepted as the first line therapy and although it may decrease the duration of the lytic phase, it may not suppress the early manifestation of the disease. 12 However, reliable studies focusing on the effect of other current therapies such as anti-inflammatory agents, cryotherapy, intra-articular corticosteroid injections, short wave diathermy and operative resection of the distal clavicle are still missing.…”

Osteolysis of the Distal Clavicle: Serial Improvement and Normalization of Acromioclavicular Joint Space with Conservative Care

“…7 Other etiologic theories of both posttraumatic and stress-induced ODC include autonomic nerve dysfunction leading to abnormalities in blood supply, terminal nerve or vascular damage, hyperplastic synovial invasion, and ischemic necrosis. [8][9][10][11] The clinical and radiographic abnormalities are frequently identical in both varieties.…”

“…3,9,10 Focal pain and AC swelling with or without crepitus are common features in weight lifters and athletes afflicted with the stress-induced variety. [13][14][15] Exercises such as the bench press or push-ups frequently cause acute exacerbation, along with cross-body adduction and greater than 908 abduction of the arm.…”