Distal Clavicle Osteolysis in a 30-Year-Old Male: A Case Report

TL;DR

A 30-year-old man with shoulder pain was diagnosed with distal clavicle osteolysis after being initially misdiagnosed, emphasizing the need for early and accurate diagnosis.

Contribution

This case report highlights the diagnostic challenges and management of distal clavicle osteolysis in a young male with a history of repetitive shoulder trauma.

Findings

The patient was misdiagnosed with rotator cuff tendonitis before being correctly diagnosed with DCO.

Conservative treatment was initiated, but functional limitations persisted due to delayed diagnosis.

Timely imaging and clinical assessment are crucial for distinguishing DCO from other shoulder conditions.

Abstract

Distal clavicle osteolysis (DCO) is an overuse injury characterized by pain and bone resorption at the acromioclavicular (AC) joint due to repetitive microtrauma. Early diagnosis is critical to prevent prolonged symptoms and functional impairment, as conservative treatment is most effective when initiated promptly. We present the case of a 30-year-old male who initially injured his right shoulder during a fall in judo and reinjured it while lifting a patient. He reported persistent AC joint pain exacerbated by overhead activities and wearing a lead apron during surgery. Physical examination revealed localized AC joint tenderness with positive Jobe, Speed, and Cross Arm tests. Imaging studies included X-rays showing AC joint widening and MRI findings consistent with DCO. Conservative management - rest, activity modification, and range-of-motion exercises - was initiated, and pharmacological or surgical interventions were deferred. The patient experienced ongoing functional limitations due to delayed diagnosis, initially being misdiagnosed with rotator cuff tendonitis. With a formal diagnosis of DCO, conservative treatment was implemented. The patient opted to defer corticosteroid injections or the Mumford procedure but was counseled on these options should symptoms persist. This case highlights the importance of early and accurate diagnosis of DCO to prevent unnecessary suffering and optimize outcomes. Timely imaging and a thorough clinical assessment are essential for distinguishing DCO from other shoulder pathologies. Conservative management remains effective if initiated early, reducing the likelihood of surgical intervention and improved patient outcomes.

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