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  1. #1
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    distal clavicle osteolysis

    Everyone with this, please read this article that I attached. This article is a review of all the research on this topic and is very interesting for anyone suffering from this condition as I have over the last 10 years. One thing I find most interesting is that they suggest that working through the pain will cause the clavicle to wear away enough that it stops rubbing, a self surgery and cure, which is very interesting and I would love to hear of anyone who has actually done that. I myself have avoided the surgery by stopping bench/incline/decline press and dips. Sorry its in txt format, the pdf was too large.
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    opulence...i has it Sol Rosenberg's Avatar
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    Can you paste the article into a post or series of posts?

    While I have not read the article, I would caution that wearing away the only joint that technically keeps the humerus attached to the axial skeleton may present additional problems down the road potentially. I'd enjoy giving it a read as this is a fascinating subject to me.
    Big Jim, may you rest well and know that you will NEVER be forgotten my friend.
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    Sure....

    Bulletin of the NYU Hospital for Joint Diseases 2008;66(2):94-101

    Distal Clavicular Osteolysis

    A Review of the Literature

    Ran Schwarzkopf, M.D., M.Sc., Charbel Ishak, M.D., Michael Elman, M.D.,
    Jonathan Gelber, M.D., David N. Strauss, M.D., and Laith M. Jazrawi, M.D.

    Abstract

    Acute distal clavicular osteolysis was first described in 1936.
    Since then, distal clavicular osteolysis (DCO) has been separated
    into traumatic and atraumatic pathogeneses. In 1982 the
    first series of male weight trainers who developed ADCO was
    reported. The association of weightlifting and ADCO is especially
    important considering how routine a component weights
    are to the male athlete’s training.The pathogenesis of DCO has
    oftenbeendebated.The mostwidelyacceptedetiologyinvolvesa
    connection between microfracturesof thesubchondral bone and
    subsequent attempts at repair, which is consistent with repetitive
    microtrauma. Symptoms usually begin with an insidious aching
    pain in theAC region that is exacerbated by weight training. On
    examination,patients havepointtenderness overtheaffectedAC
    joint and pain with a cross-body adduction maneuver.Although
    DCO may seem like an easy and quick diagnosis, one must rule
    out other possibilities. Avoidance of provocative maneuvers,
    modification of weight training techniques, ice massage, and
    nonsteroidal anti-inflammatory drugs (NSAID) constitute the
    basis of initial treatment. Much of the literature supports the same general indications for surgery. These include point tenderness
    of the AC joint, evident abnormal signs with AC joint
    scintigraphy andAC radiographs, lack of response to conservative
    treatment, and an unwillingness to give up or modify weight
    training or manual labor. Distal clavicle resection has provided
    good results. Distal clavicle osteolysis is a unique disease most
    likely due to an overuse phenomenon.

    Ran Schwarzkopf, M.D., M.Sc., is a Resident in the Department
    of Orthopaedic Surgery, NYU Hospital for Joint Diseases. Charbel
    Ishak, M.D., is a Research Physician, Musculoskeletal Research
    Center, Department of Orthopaedic Surgery, NYU Hospital for Joint
    Diseases. Michael Elman, M.D., was a Resident from the Department
    of Orthopaedic Surgery, Downstate Medical Center, Brooklyn, New
    York. Jonathan Gelber, M.D., was a Research Physician, Department
    of Orthopaedic Surgery, NYU Hospital for Joint Diseases. David N.
    Strauss, M.D., was a Fellow in the Department of Radiology, NYU
    Hospital for Joint Diseases. Laith M. Jazrawi, M.D., is Assistant
    Professor, New York University School of Medicine, and from the
    Divisions of Shoulder and Elbow Surgery and Sports Medicine, Department
    of Orthopaedic Surgery, NYU Hospital for Joint Diseases,
    NYU Medical Center, New York, New York.
    Correspondence: Laith M. Jazrawi M.D., Hospital for Joint Diseases
    Department of Orthopaedic Surgery, Suite 1402, 301 East 17th Street,
    New York, New York 10003; laith.jazrawi@nyumc.org.



    Beginning of article:

    Many investigators have credited Dupas and colleagues
    as first describing, in 1936, osteolysis in
    the distal clavicle as a result of trauma.1-8 Since
    then, distal clavicular osteolysis (DCO) has been separated
    into traumatic and atraumatic pathogeneses. Ehrict was first
    credited with reporting that DCO could present without the
    “trigger” of acute trauma. In Ehrict’s report, an air-hammer
    operator began to suffer from osteolysis.5 Subsequently, the
    problem was also diagnosed in a judo player, a deliveryman,
    and a handball player.9,10 Atraumatic distal clavicular osteolysis
    (ADCO) in weight trainers is thought to arise from a
    stress failure syndrome that involves resorption of the distal
    clavicle. In 1982, Cahill3 described the first series of male
    weight trainers who developed ADCO. The association of
    weightlifting and ADCO, as revealed in Cahill’s report, is
    especially important considering how routine a component
    weights are to the male athlete’s training. Cahill looked at 46
    males, none of whom had a history of acute injury to the AC
    joint area; 45 of them lifted weights, usually at least three times
    a week, with emphasis on the upper extremities. The average
    age was 23.3 years.3 Since then, there have been more than
    100 cases reported in male weight trainers. In 2001, Sopov
    and coworkers published a case report also involving a 20year-
    old male. In this case, the upper extremity stress came
    from several months of intensive training and lifting, including
    carrying a heavy machine gun during soldier/parachutist training.
    8 Like Cahill’s patients, there was no history of accidental
    trauma.As more females are participating in competitive and
    recreational weight training,ADCO has been reported recently
    in a female bodybuilder.6

    Acromioclavicular Joint Anatomy

    The acromioclavicular joint (AC) is a diarthrodial joint,
    stabilized by the coracoclavicular ligaments (conoid and
    trapezoid), the superior and inferiorAC ligaments, and theAC
    capsule (Fig. 1).A fibrocartilaginous meniscal disc is present
    between the convex distal clavicle and the flat acromion. The
    coracoclavicular ligaments provide vertical stability to theAC
    joint, while theAC ligaments confer horizontal stability. Urist
    demonstrated the variability of the AC joint’s orientation.11

    Pathogenesis

    The pathogenesis of DCO has often been debated. The first etiology
    proposed involved a connection between microfractures
    of the subchondral bone and subsequent attempts at repair,
    which is consistent with repetitive microtrauma. Hyperextension
    of the shoulder during bench press or chest flies exercises
    (i.e., dropping the elbows below or behind the plane of the
    body during the eccentric phase of the press) places excessive
    traction on the AC joints and may contribute to ADCO
    pathogenesis. Cahill found microfractures in the subchondral
    bone in 50% of the surgical specimens in his series and proposed
    that repetitive microtrauma caused subchondral stress
    fractures and remodeling.2,3 Furthermore, intense osteoblastic
    activity of the subchondral bone was discovered in all of the
    surgical specimens of osteolytic patients. This appeared to be
    predominantly an active repair process. The articular cartilage
    of the lateral end of the clavicle exhibited fissuring, degeneration,
    and areas of complete absence. This is in contrast
    to the tissue of asymptomatic shoulders belonging to 20-to
    30-year-old males, in which osteoblastic activity, although
    possibly present, is not predominant.3 Brunet described synovial
    invasion of the subchondral bone as a possible cause of
    osteolysis,2 and MRI findings have been reported to be similar
    to synovial proliferation. In one of the few case reports of
    DCO occurring in a female patient, Matthews and associates.
    pointed out that microscopic examination of a distal clavicle
    resection specimen revealed subchondral microcysts, disruption
    of the articular cartilage, and metaplastic bone formation
    with increased osteoclastic activity,6 again consistent with a
    repetitive stress phenomenon. Of all the proposed etiologies,
    Cahill’s is the most accepted.

    Pathology

    Examination of resected sections may reveal fragments of
    weakly mineralized trabecular bone proximally, dense scar
    tissue distally, and a thin, unorganized hyperplastic fibrocartilaginous
    layer. The tissue is often morphologically villous
    and hypertrophic, with occasional multinuclear giant cells.
    Both active and inactive resorptive surfaces can be observed.
    Occasionally, active osteoblastic surfaces are seen with
    abnormally large osteoid seams. Where the bone has been
    resorbed, hypervascular connective tissue will be laid down.
    Overall, the specimens will consistently demonstrate articular
    degeneration, chronic inflammation, fibrosis, loss of trabecular
    structure, and osteoblastic activity. In addition, studies have
    shown contrasting evidence, demonstrating the presence of
    synovial hypertrophy and invasion of the underlying bone,
    resulting in a synovial pathogenesis.2,3,7 Proponents for a
    synovial pathogenesis have shown evidence of hypertrophic
    synovial tissue migrating across the cartilaginous surface,
    leaving chronic degeneration of the joint. Finally, it has been
    suggested that a direct communication between the lesion and
    the AC joint is a distinguishing pathological feature.2,12

    Symptoms

    Symptoms usually begin with an insidious aching pain in
    the AC region that is exacerbated by weight training (e.g.,
    bench presses, push-ups, dips on the parallel bars,3 overhead
    activities, and horizontal adduction). The power clean exercise,
    which demands controlled use of the elbows, back, and
    shoulders to heist a bar, can precipitate the pain as well, as it
    puts significant stress on the AC joint.13 In certain cases, as
    symptoms progress, any throwing motion may cause pain.
    The athlete’s muscle tone can remain developed. In addition,
    there is no sign of subluxation.3 Occasionally, the pain may
    radiate to the surrounding deltoid or trapezium and is relieved
    by prolonged rest. Frequently, patients report difficulty
    sleeping on the affected side. Haupt has referred to ADCO
    as “weightlifter’s shoulder.”13 In his experience, the pain and
    discomfort is often more severe the night after a weightlifting
    program. The history of these cases never includes a major
    injury to the AC joint.

    Physical Examination

    Patients have point tenderness over the affected AC joint and
    pain with a cross-body adduction maneuver.AC joint stability
    should be assessed by grasping the distal clavicle between
    the thumb and forefinger and stressing the clavicle in an anteroposterior
    and superoinferior direction, while stabilizing
    the acromion with the other hand.14 Patients generally have
    full range of motion (ROM) of the glenohumeral joint. An
    AC joint injection can be both a diagnostic and a treatment
    modality in the management of DCO.

    Differential Diagnosis

    Although DCO may seem like an easy and quick diagnosis,
    one must rule out other possibilities. Some of the more important
    etiologies that should be excluded from the differential
    include hyperparathyroidism, gout, scleroderma, rheumatoid
    arthritis, multiple myeloma, infection, and massive essential
    osteolysis (Gorham’s disease).6 Cervical spine and neurovascular
    evaluations are also important to rule out as potential
    sources of referred pain.
    Last edited by rspowers; 08-24-2010 at 08:42 AM.
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    Imaging

    Radiographs of both AC joints, using a 35° cephalad technique,
    will reveal radiographic changes of the AC joint although
    some will be more subtle than others. Zanca described
    anAP view with the beam tilted 15° cephalad to better visualize
    theAC joint without overlapping the spine of the scapula.15
    The early radiographic signs are seen months or years after
    weight training has begun. In patients who have had severe
    symptoms, a 10° to 15° cephalic tilt AP plain radiograph
    view of the shoulder may reveal loss of subchondral bone in
    the distal clavicle, microcystic changes in the subchondral
    area, and widening of the AC joint (Fig. 2).3 The acromion in
    ADCO is spared of lytic changes. The presence of panarticular
    disease should lead to the consideration of other diagnoses
    (e.g.,AC arthritis). However, previous investigators have noted
    that radiographic appearance of the distal clavicle may vary
    considerably with the age and activity of the individual, as
    well as with the radiographic technique applied.8

    Early in the course of symptoms, Tc-99 scintigraphy with
    marked uptake in the distal clavicle may help to confirm AC
    joint involvement before changes become apparent on plain
    radiographs; at times, there is also increased activity in the
    adjacent acromion.3 Some critics have pointed out that the
    metaphyseal end of all long bones demonstrates an increase
    in the uptake on scintiscan, and the clavicle is no exception.
    A further increase in the uptake of that area can represent a
    simple increase in bone turnover, due to the stress applied by
    young individuals, and is a normal phenomenon.16 It may be
    related to an increased blood flow and blood pooling. However,
    active male athletes do not normally have significantly
    increased activity in the clavicle or metaphyseal ends. In
    Cahill’s study, 31 patients of the same age group and activity
    level as a DCO group who had other causes of shoulder symptoms
    did not demonstrate increased scintigraphic activity.3

    Magnetic resonance imaging (MRI), which often
    focuses on the rotator cuff muscles and glenoid labrum,
    may overlook clavicular osteolysis if a suggestive history
    or radiograph is unavailable.4 MR imaging demonstrates
    increased signal intensity associated with T2-weighted
    images, most notably on the fluid-sensitive STIR and fat-
    suppressed spin echo on the T2-weighted sequences (Fig.
    3).4 Bone marrow edema may be found in all of the cases,
    but never solely in the acromion. Bone marrow edema in
    the distal clavicle is the most common manifestation of
    this disease.4,17 Edema in this area has a high correlation
    with the presence of symptoms. Overall, posttraumatic and
    stress-induced osteolysis of the distal clavicle have similar
    appearances, the most common being the increased T2
    signal intensity in the distal clavicle (Fig. 4). Additional
    findings of osseous fragments, osseous irregularity, and
    fluid in the AC joint have been deemed to be common, but
    not universal.4 Perhaps the simplest radiographic findings
    are distal clavicle osteopenia early in the disease and tapering
    of the distal clavicle late in the disease.6

    CT Guided Injection

    Some physicians have found it helpful to use corticosteroid
    injections as both a therapeutic and a diagnostic tool. If
    the patient is suffering from AC joint pain, an injection
    may temporarily relieve the pain. Intra-articular corticosteroids
    can be considered for short-term symptom relief;
    however, they provide little long-term relief. The greatest
    benefit may be that a positive temporary relief of pain can
    be seen as a diagnostic tool for confirming that the pain is
    indeed localized in the AC joint. Worcester and Green noted
    100% pain relief for patients who underwent surgery and
    who experienced temporary relief of symptoms with two
    or more injections.18 In his case report, Sopov8 presented
    evidence in support of a CT-guided injection as treatment
    for DCO. After 3 months of conservative therapy and oral
    NSAIDs, Sopov’s soldier did not improve. Local corticosteroids
    were deemed to be an appropriate response to
    patients that do not respond to conservative treatment.8,16
    Under CT guidance, 5 m/L of anesthetic (0.5% Marcaine®)
    and 40 mg of corticosteroid were injected into the AC
    joint. This procedure resulted in a relief of symptoms for
    6 months. It is important to note that, besides possibly
    relieving symptoms, a CT-guided injection allows location
    of the best point on the skin, appropriate depth and needle
    inclination, and correct positioning of the needle tip.8

    Nonsurgical Therapy

    Avoidance of provocative maneuvers, modification of
    weight training techniques, ice massage, and nonsteroidal
    antiinflammatory drugs (NSAID) constitute the basis of
    initial treatment. Haupt has suggested several modifications
    to the weightlifting routine, as it is often difficult to remove
    or alter the young athlete’s weight-training program.13

    Since most athletes find it difficult to eliminate the bench
    press from their routine, most of the specific modifications
    of weight training techniques involve narrowing the hand
    spacing on the barbell (less than 1.5 times the bi-acromial
    width) and controlling the descent phase of the bench
    press to end approximately 4 to 6 cm above the anterior
    chest.19 Some patients may find that placing towels on
    their chest as spacers may reinforce this restriction. The
    narrower handgrip allows the athlete to make adjustments
    to the component angles of the bench press by maintaining
    shoulder abduction at less than 45° and shoulder extension
    at less than 15°. This then decreases the compressive force
    on the distal clavicle.19

    The power clean, although a rather full-body functional
    exercise, does place significant stress on the AC joint during
    the “racking” phase. In this part of the exercise, the
    shoulders are shrugged, the elbows flexed, and then the
    shoulders are abducted to bring the bar up into a “racked”
    position. If the athlete is suffering from an AC joint injury,
    the power clean should be modified to allow only the pulling
    portion of the lift without racking the bar—an exercise
    termed a “power clean high pull” or “power pull.” The
    key to this motion is that the athlete still gains a lower
    extremity benefit but avoids additional AC trauma that can
    be associated with a mistimed lift.19 The preferred way to
    perform the exercise is to adjust the exercise machine or
    starting position so that the elbows are even with or above
    the frontal plane when beginning the lift and during repetitions
    (Honing technique). Haupt notes that his practice
    routine promotes a program in which the bench press, dips,
    and push-ups are eliminated. Alternative recommendations
    are the cable crossover, dumbbell decline press, and
    incline press with straight bar.13 All pressing motions are
    performed with a narrow grip, no greater than 1.5 times
    the bi-acromial width. Conservative physicians also stress
    the use of NSAID and ice massage of the AC joint after all
    workouts.13 Since many of these athletes will tend to work
    through pain, more conservative physicians may allow
    them to continue to workout. In a sense, continued physical
    activity and pathogenesis will result in a “self-surgery”;
    that is, the clavicle will be resected on its own. With such
    high association of DCO with power lifting, especially the
    bench press, one may be quick to avoid some of the aforementioned
    exercises. However, it is important to note that
    a questionnaire study of elite power lifters in 1995 and in
    2000 showed that no particular movement used in weekly
    training, including the bench press, led to an increased risk
    of shoulder injuries.20 A patient whose condition does not
    respond to conservative management or who is unwilling to
    alter his or her exercise training and performance regimen
    require surgery.

    Surgery

    Much of the literature supports the same general indications
    for surgery. These include point tenderness of the AC joint,
    evident abnormal signs with AC joint scintigraphy and AC
    radiographs, lack of response to conservative treatment, and an
    unwillingness to give up or modify weight training or manual
    labor.2,3,6 The most common type of surgery for DCO has been
    a distal clavicle resection. Both open and arthroscopic distal
    clavicle resection have been successful in alleviating pain
    and returning patients to previous activity levels.3,21 Once
    the indications are supportive of surgery, the decision must
    be made as to how much of the clavicle should be resected
    and whether to perform an open or arthroscopic procedure.
    While Cahill reported excellent results with an open approach
    resecting 1 to 2 cm of distal clavicle, a recent study reported
    that arthroscopic resection of only 4 mm was effective.22
    The distal clavicle should be resected enough to prevent AC
    impingement through a full range of shoulder motion. The
    arthroscopic technique is technically more demanding, but
    it is more cosmetically appealing, and patients can perform
    active range of motion within the first week to prevent loss of
    shoulder motion. Cahill reports that 37 of 40 patients who had
    surgical excisions returned to weight training or competitive
    weight lifting, or both.3

    Open Procedure

    The rationale of the open procedure is that the pathological
    articular surfaces can be resected under direct vision in order
    to create a wide enough margin to prevent further acromion
    abutment on the clavicle. Two skin incisions can be used,
    the strap and the horizontal.13 The junction of the deltoid
    and trapezius fascia must be split to provide proper exposure
    of the AC joint. Classically, the amount of distal clavicle
    and acromion resected combined has been 1 to 2 cm; this is
    most commonly referred to as the Mumford procedure.After
    excision of the clavicle, the inferior AC joint capsule can be
    incorporated into the repair of the deltoid and trapezius fascia
    in order to eliminate any potential dead space. Flatow and
    colleagues support the transferring of the coracoacromial ligament
    to cover the outer end of the clavicle in order to provide
    additional stability to the weightlifter.23 Cahill noted that the
    AC joint might play a role in impingement syndrome. Further,
    surgical removal of the lateral end of the clavicle may aid in
    decompressing the coracoacromial arch.3 Osteolysis may be

    differentiated from impingement syndrome by both history
    and examination.
    Last edited by rspowers; 08-24-2010 at 08:43 AM.
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    The majority of follow-up studies have reported positive
    results when considering pain as a major indicator of success.
    In 1994, Slawski and Cahill published a paper analyzing the
    efficacy of an open distal clavicle resection on patients suffering
    from distal clavicle osteolysis.7 At the time, it was the
    first known series evaluating the results of this procedure for
    DCO and using a standard shoulder rating scale, the UCLA
    Shoulder Rating Scale. The study group consisted of 12 active
    weight lifters and two manual laborers.All patients returned to
    full sports activity and employment by an average of 9 weeks
    postoperatively (range, 5 to 12 weeks). In addition, all patients
    reported returning to a level of competition or productivity
    as good as or better than when they had been symptomatic.
    Although some minimal residual pain was reported, all were
    satisfied with the results and no postoperative complications
    were reported. The UCLA Shoulder Rating Scale was then
    used to evaluate follow-up pain and function. The average
    score was 33.5 (range, 29 to 35). There were eight excellent
    and nine good results, with no fair or poor scores. There were
    no discernible measured losses of motion or strength in the
    operated shoulders. None of the patients were weaker on the
    operated side, compared to the nonoperated side.7 Worcester
    and Green noted pain relief within 4 to 8 weeks in most patients.
    Good to excellent results were noted in 53% to 100%
    of patients in follow-ups of 13 months to 9 years.18

    It is important to note that Cook and Tibone attempted to
    quantify weakness objectively in 23 athletes who reported
    painless full range of motion at an average of 3.7 years postoperatively.
    Their goal was to measure true weakness as opposed
    to pain-induced weakness. The findings included radiographic
    evidence of increased horizontal translation, decreased flexion
    and extension power when tested on a weight machine at 60°
    per second, and diminished strength in the bench press.24

    Although, the open procedure has been shown to produce
    good to excellent results clinically, the extensive tissue damage
    required to gain access to the AC joint may involve a hospital
    stay, requires more rehabilitation, and has been linked to
    resulting muscle weakness.24-27 Some open procedures have
    been considered failures due to limited range of motion. The
    abutment of the distal clavicle stump on the acromion with
    arm motion can be due to a result of disruption of the AC
    ligaments from an open resection.23

    Arthroscopic Technique

    The Arthroscopic technique, on the other hand, involves less
    tissue dissection, less rehabilitation time (patients can begin
    active and passive range of motion on day 1 postoperatively),
    can be performed on an outpatient basis, and avoids postoperative
    muscle weakness.28 Pain relief was achieved an average
    of 3.4 months earlier in arthroscopic patients who received a
    superior approach.23 Additionally, less bone can be removed
    than in the open procedure.23,26 Evidence has shown that 0.5
    to 1.0 cm arthroscopic resections are comparable to the 1.5 to

    2.0 cm resections performed during an open procedure.26,29

    Bulletin of the NYU Hospital for Joint Diseases 2008;66(2):94-101

    Subacromial (Indirect) Approach

    The subacromial approach, first described by Ellman and
    Esch, preserves the superior AC joint ligaments and provides
    less chance for postoperative instability (Fig. 5). The technique
    uses anterior instrumental, posterior scope, and lateral inflow
    portals. A shaver is used to debride initially any obscuring
    bursa. Electrocautery is used to clearly demarcate the distal
    clavicle and minimize bleeding. Great care should be used not
    to disrupt the supporting ligaments and capsule. Once good
    visualization is obtained, a burr (usually 5 to 6 mm) is used
    through the anterior portal to clear any remaining osteophytes
    and to resect the distal clavicle from anterior to posterior.
    Modifications of this technique include burring from both
    the posterior and the lateral portals, as well as visualization
    through the three standard portals. Bone depth can be gauged
    using the known diameter of a burr; however, Tolin and Snyder30
    recommend the routine use of two needles to demarcate
    the orientation of the joint, as well as to gauge the amount
    of bone resected, by measuring the distance between the two
    needles on the skin.Although some investigators recommend
    resecting a small portion of the medial acromion, most find
    it unnecessary. To aid in resection of the superior portion of
    the distal clavicle, manual pressure can be applied to bring
    the clavicle into the subacromial space. It has been suggested
    that failure of this technique is not due to the amount of bone
    removed, but rather the result of uneven resection or disruption
    of theAC ligaments. This would lead to translation of the
    clavicle, resulting in an abutment on the acromion and cause
    recurring symptoms.21,31-34 This problem often happens after
    aggressive arthroscopic resection when care is not taken to
    preserve the stabilizing ligamentous envelope. Morrison and
    colleagues recommend beveling the posterior edge of the
    distal clavicle if this instability is recognized intraoperatively
    to avoid the resultant painful impingement.35

    Kay and coworkers studied a lateral decubitus position
    in conjunction with subacromial decompression and distal
    clavicle resection via a bursal approach.36 The lateral position
    allows the patient’s arm to be suspended by a boom loaded
    with weights. If the lateral position is used, an inflatable “bean

    bag” can be positioned to support the patient. An axillary roll
    will protect the uninvolved arm, and pillows placed between
    the patient’s knees and under the bottom leg will protect the
    peroneal nerve.All 10 patients studied obtained a satisfactory
    outcome. The five recreational athletes, including the weight-
    lifters, returned to their sports at or above their preinjury level.
    All patients returned to their preinjury occupation, with half
    missing work only on the day of surgery. One patient was at
    a hockey camp participating in drills 5 days after the surgery.
    Postoperatively, the patients’ functionality was a 9.6 on the
    UCLA shoulder scale (range, 8 to 10), and their pain averaged
    a 9.4 (range, 8 to 10). Seven of the 10 patients were pain-free
    by 12 weeks postoperatively.36

    It has often been believed that the bursal approach may not
    allow easy access of the clavicle in a tight joint with medial
    inclination, especially in osteoarthritic joints, even with direct
    superior pressure on the clavicle.37 An open incision has been
    proposed for these cases by surgeons favoring the bursal approach.
    Tolin and Snyder believed they overcame this problem
    by using a lateral position with 10 to 15 pounds traction on a
    70° abducted arm.30

    First described by Lanny Johnson and later championed by
    Flatow and associates,23 the superior approach offers a direct
    approach to theAC joint, avoiding violation of the subacromial
    space, in which there may be no pathology.

    Superior (Direct) Approach

    While some investigators recommend routing arthroscopic
    examination of the subacromial space for potential pathology,
    others believe that there is no reason to violate the bursa
    in isolated AC problems.23 Therefore, their preferred method
    for surgically treating DCO is a superior direct approach. A
    superior approach also allows resection of the outer end of
    the clavicle under direct visualization, without the edema and
    bleeding of a bursal approach. Prior to the start of a superior
    approach, regional interscalene anesthesia may be used. The
    patient can be placed either in a beach chair position38 or the
    arm can be suspended by a boom, with less than 50°of abduction
    and less than 15° of forward flexion with 10 pounds of


    Figure 5 Intraoperative photos of the indirect subacromial approach; posterior-anterior (left) and lateral (right) views of the right AC joint,
    centered on the clavicle, with arrows indicating the acromion.


    100 Bulletin of the NYU Hospital for Joint Diseases 2008;66(2):94-101

    weight.14 Two small-bore needles (22 gauge, 1.5 inch) are used
    to determine the location and orientation of the joint so as to
    allow precise introduction of the instruments. This is critical,
    because otherwise variations in joint inclination may be hard
    to appreciate.A 4.0 mm 30° arthroscope and necessary instruments
    are placed into the AC joint via direct anterosuperior
    and posterosuperior portals. A 2.7 mm arthroscope may be
    placed initially if the joint space is narrow.23,38 The capsule
    and ligaments of the AC joint are subperiosteally elevated
    to expose the distal clavicle, allowing direct visualization of
    the clavicle. The meniscus and intra-articular soft tissues are
    resected with a 5.0 mm motorized full-radius resector.38 An
    electrocautery unit may be used to shell out the outer end of
    the clavicle in order to preserve the soft tissue containing the
    AC ligaments and capsule.23 After this, if the joint space is
    large enough, a 6.0 mm burr is introduced. If the space is too
    small, more room can be created using smaller burrs first until
    the 6.0 mm burr can be accommodated.Approximately 4 to 7
    mm of the distal clavicle is removed.38 After resection, the joint
    should be carefully examined arthroscopically from both the
    anterior and posterior portals to ensure adequate bone removal
    and to check for loose fragments. It is essential to probe the
    edges to be sure that no overhanging ridges remain.23 Flatow
    and associates reported a 91% success rate with the superior
    approach,23 while Zawadsky and colleagues determined that
    all results of superior arthroscopic distal clavicle resection of
    ADCO were either good or excellent.38

    Limited (less than 1 to 2 cm) arthroscopic distal clavicular
    resection (DCR), specifically in weightlifters, has shown
    promising results.22 The surgical approach consists of a
    superior arthroscopic approach to the AC joint with two portals.
    22,23,28 Standard arthroscopic instrumentation (30° camera
    and 4.0 mm arthroscope), an arthroscopic shaver, and a 4 mm
    motorized burr should be used. The AC joint is debrided of
    material such as meniscal remnants and cartilaginous debris.
    The distal 4 mm of the clavicle is resected with the burr, using
    the diameter of the burr as a guide. The outer cortical shell of
    the distal clavicle is addressed with the burr after elevating
    the capsule from the clavicle with electrocautery, sparing the
    superiorAC ligament.A rhinoplasty rasp can be used through
    the portals to complete the distal clavicle contouring.22

    Experienced weightlifters are accustomed to self-directed
    training and biofeedback. Follow-ups of limited DCR on
    weightlifters have shown that they can resume their training
    within the first week postoperatively (average, 3.2 days; range,
    1 to 6 days). Preoperative training levels can be reached by
    the second week postoperatively (average, 9.1 days; range 7
    to 12 days).Very few patients will lose strength in the military
    press or the incline press.22
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    Although distal clavicle resection has been shown to be a
    successful procedure, some failures have been reported. One
    of the least recognized reasons of failure may be heterotopic
    bone formation. Thus, most investigators recommend removal
    of all bone and fragments within the joint in order to avoid a
    nidus for new bone formation. Berg and Ciullo suggested that
    it might be a more common cause of failure of both acromio


    plasty and distal clavicle resection.39 They suggested the use of
    prophylactic measures with patients considered at risk. They
    found their at-risk group to include patients with hypertrophic
    AC joint osteoarthritis that either were long-standing smokers
    or had other chronic pulmonary diseases. However, since
    periosteal bone formation can be a component of pulmonary
    osteoarthropathy, the results could have been attributed to a
    low partial pressure of oxygen and tissue hypoxia in their patients.
    This is reinforced by the fact that 60% of their patients
    had an incidence of chronic pulmonary disease, which was
    significantly higher than the United States average.39

    Resection of the distal clavicle and disruption of the AC
    articulation creates the potential for another complication—
    abnormal postoperative motion. Blazar and colleagues studied
    17 isolated distal clavicle patients (open and arthroscopic)
    and discovered that the average anterior plus posterior
    translation was 8.7 mm (range, 3 to 21 mm), which was significantly
    greater than the contralateral shoulders (mean, 3.2
    mm; range, 1 to 6 mm). The amount of pain determined by a
    questionnaire, correlated with the amount of translation and
    showed that excessive anteroposterior instability of the distal
    clavicle can cause postoperative pain and lead to poor surgical
    outcomes.40 In a cadaveric study, Miller and coworkers
    determined that there was no statistically significant difference
    in the anteroposterior translation between direct or indirect
    arthroscopic distal clavicle resections.41 Other complications
    include underlying muscle injury, excessive bleeding, lateral
    clavicle fracture, and infection.

    Conclusions

    In summary, distal clavicle osteolysis is a unique disease most
    likely due to an overuse phenomenon.When activity modification
    and conservative treatment fails to provide relief in an active
    patient, distal clavicle resection has provided good results.
    In isolated DCO, there is scarcely any indication for an open
    procedure, while the superior and subacromial approaches
    have their pros and cons. The subacromial approach offers
    certain advantages, including: 1. assessing for other pathology
    or working through established portals if other pathology is
    already being addressed, 2. less injury to the capsule, and 3.
    no need for smaller instruments. Disadvantages include: 1.
    violating an area with potentially no pathology, 2. more portals,
    and 3. more bleeding and fluid extravasation. The merits
    of a direct approach should not be discounted.

    Disclosure Statement

    None of the authors have a financial or proprietary interest
    in the subject matter or materials discussed, including, but
    not limited to, employment, consultancies, stock ownership,
    honoraria, and paid expert testimony.

    Reference

    1.
    Dupas J, Badilon P, Daydé G. Aspects radiologiques d’une
    ostéolyse essentielle progressive de la main gauche. J Radiol.
    1936;20:383-7.
    2.
    Brunet ME, Reynolds MC, Cook SD, et al. Atraumatic osteolysis
    of the distal clavicle: histologic evidence of synovial

    Bulletin of the NYU Hospital for Joint Diseases 2008;66(2):94-101 101

    pathogenesis. A case report. Orthopedics. 1986 Apr;9(4):557


    9.
    3.
    Cahill BR. Osteolysis of the distal part of the clavicle in male
    athletes. J Bone Joint Surg Am. 1982 Sep;64(7):1053-8.
    4.
    de la Puente R, Boutin RD, Theodorou DJ, et al. Post-traumatic
    and stress-induced osteolysis of the distal clavicle: MR imaging
    findings in 17 patients. Skeletal Radiol. 1999 Apr;28(4):2028.
    5.
    Ehricht HG. [Osteolysis of the lateral clavicular end after
    compressed air damage.].Arch Orthop Unfallchir. 1959;50:57682.
    6.
    Matthews LS, Simonson BG, Wolock BS. Osteolysis of the
    distal clavicle in a female body builder. A case report. Am J
    Sports Med. 1993 Jan-Feb;21(1):150-2.
    7.
    Slawski DP, Cahill BR. Atraumatic osteolysis of the distal
    clavicle. Results of open surgical excision. Am J Sports Med.
    1994 Mar-Apr;22(2):267-71.
    8.
    Sopov V, Fuchs D, Bar-Meir E, et al. Stress-induced osteolysis
    of distal clavicle: imaging patterns and treatment using CT-
    guided injection. Eur Radiol. 2001;11(2):270-2.
    9.
    Murphy OB, Bellamy R, Wheeler W, et al. Post-traumatic
    osteolysis of the distal clavicle. Clin Orthop Relat Res.
    1975(109):108-14.
    10.
    Smart MJ. Traumatic osteolysis of the distal ends of the
    clavicles. J Can Assoc Radiol. 1972 Dec;23(4):264-6.
    11.
    Urist MR. Complete dislocation of the acromioclavicular joint.
    J Bone Joint Surg Am. 1963 Dec;45:1750-3.
    12.
    LevineWN,BarronOA,YamaguchiK,etal.Arthroscopicdist al
    clavicle resection from a bursal approach. Arthroscopy. 1998
    Jan-Feb;14(1):52-6.
    13.
    Haupt HA. Upper extremity injuries associated with strength
    training. Clin Sports Med. 2001 Jul;20(3):481-90.
    14.
    Nuber GW, Bowen MK. Arthroscopic treatment of acromioclavicular
    joint injuries and results. Clin Sports Med. 2003
    Apr;22(2):301-17.
    15.
    Zanca P. Shoulder pain: involvement of the acromiclavicular
    joint: analysis of 1,000 cases. Am J Roentgenol Radium Ther
    Nucl Med. 1971 Jul;112(3):493-506.
    16.
    Clancey GJ. Osteolysis in the distal part of the clavicle in male
    athletes. J Bone Joint Surg Am. 1983 Mar;65(3):421.
    17.
    Patten RM. Atraumatic osteolysis of the distal clavicle: MR
    findings. J Comput Assist Tomogr. 1995 Jan-Feb;19(1):92-5.
    18.
    Worcester JN Jr, Green DP. Osteoarthritis of the acromioclavicular
    joint. Clin Orthop Relat Res. 1968 May-Jun;58:69-73.
    19.
    Fees M, Decker T, Snyder-Mackler L, et al. Upper extremity
    weight-training modifications for the injured athlete.A clinical
    perspective. Am J Sports Med. 1998 Sep-Oct;26(5):732-42.
    20.
    Raske A, Norlin R. Injury incidence and prevalence among
    elite weight and power lifters. Am J Sports Med. 2002 MarApr;
    30(2):248-56.
    21.
    Flatow EL, Duralde XA, Nicholson GP, et al. Arthroscopic
    resection of the distal clavicle with a superior approach. J
    Shoulder Elbow Surg. 1995 Jan-Feb;4(1 Pt 1):41-50.
    22.
    AugeWK,2nd,FischerRA.Arthroscopicdistalclavicleres ection
    for isolated atraumatic osteolysis in weight lifters. Am J
    Sports Med. 1998 Mar-Apr;26(2):189-92.
    23.
    Flatow EL, Cordasco FA, Bigliani LU. Arthroscopic resection
    of the outer end of the clavicle from a superior approach: a
    critical, quantitative, radiographic assessment of bone removal.
    Arthroscopy. 1992;8(1):55-64.

    24.
    Cook FF, Tibone JE. The Mumford procedure in athletes. An
    objective analysis of function. Am J Sports Med. 1988 MarApr;
    16(2):97-100.
    25.
    Sachs RA, Stone ML, Devine S. Open vs. arthroscopic acromioplasty:
    a prospective, randomized study. Arthroscopy.
    1994 Jun;10(3):248-54.
    26.
    Matthews LS, Parks BG, Pavlovich LJ Jr, et al. Arthroscopic
    versus open distal clavicle resection: a biomechanical analysis
    on a cadaveric model. Arthroscopy. 1999 Apr;15(3):237-40.
    27.
    Petersson CJ. Resection of the lateral end of the clavicle. A 3
    to 30-year follow-up.Acta Orthop Scand. 1983 Dec;54(6):9047.
    28.
    Bigliani LU, Nicholson GP, Flatow EL. Arthroscopic resection
    of the distal clavicle. Orthop Clin North Am. 1993
    Jan;24(1):133-41.
    29.
    GartsmanGM.Arthroscopicresectionoftheacromioclavic ular
    joint. Am J Sports Med. 1993 Jan-Feb;21(1):71-7.
    30.
    Tolin BS, Snyder SJ. Our technique for the arthroscopic Mum-
    ford procedure. Orthop Clin North Am. 1993 Jan;24(1):14351.
    31.
    Flatow EL. The biomechanics of the acromioclavicular, sternoclavicular,
    and scapulothoracic joints. Instr Course Lect.
    1993;42:237-45.
    32.
    Fukuda K, Craig EV, An KN, et al. Biomechanical study of
    the ligamentous system of the acromioclavicular joint. J Bone
    Joint Surg Am. 1986 Mar;68(3):434-40.
    33.
    Salter EG Jr, Nasca RJ, Shelley BS. Anatomical observations
    on the acromioclavicular joint and supporting ligaments. Am
    J Sports Med. 1987 May-Jun;15(3):199-206.
    34.
    Weaver JK, Dunn HK. Treatment of acromioclavicular injuries,
    especially complete acromioclavicular separation. J Bone Joint
    Surg Am. 1972 Sep;54(6):1187-94.
    35.
    Morrision DS, Frogameni AD, Woodworth P. Non-operative
    treatment of subacromial impingement syndrome. J Bone Joint
    Surg AM. 1997 May;79(5):732-7.
    36.
    Kay SP, Ellman H, Harris E. Arthroscopic distal clavicle excision.
    Technique and early results. Clin Orthop Relat Res. 1994
    Apr;(301):181-4.
    37.
    Henry MH, Liu SH, Loffredo AJ. Arthroscopic management
    of the acromioclavicular joint disorder. A review. Clin Orthop
    Relat Res. 1995 Jul(316):276-83.
    38.
    Zawadsky M, Marra G, Wiater JM, et al. Osteolysis of the
    distal clavicle: long-term results of arthroscopic resection.
    Arthroscopy. 2000 Sep;16(6):600-5.
    39.
    Berg EE, Ciullo JV. Heterotopic ossification after acromioplasty
    and distal clavicle resection. J Shoulder Elbow Surg. 1995
    May-Jun;4(3):188-93.
    40.
    BlazarPE,IannottiJP,WilliamsGR.Anteroposteriorinst ability
    of the distal clavicle after distal clavicle resection. Clin Orthop
    Relat Res. 1998 Mar(348):114-20.
    41.
    Miller CA, Ong BC, Jazrawi LM, et al. Assessment of clavicular
    translation after arthroscopic Mumford procedure: direct
    versus indirect resection--a cadaveric study.Arthroscopy. 2005
    Jan;21(1):64-8.
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    Registered User Solidsison's Avatar
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    wow I'm a sufferer...
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    Originally Posted by Solidsison View Post
    wow I'm a sufferer...
    I need to read this very carefully again but I may be too...

    Old Bob... Sore shoulders be damned... Full steam ahead...
    Getting Old Ain't For Sissys... ;)

    Eat to Live... Don't Live to Eat!!!

    1951 Body by Gold's Gym and a LOT of Blood, Sweat, and Tears...
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    This is one of the things I have doing on with my shoulder right now. I'm now discouraged from doing any overhead exercises since I also have an impingement that will continue to damage my RC and Labrum.

    From what I've been told, if something hurts badly, stop doing it! The surgery I'm facing should fix it up and the scar tissue that forms at the AC joint repair serves as a cushion.

    BG
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    Surgery is better to return to proffesional weightlifting?

    Hey guys,

    this article is pretty good. i read it all. what i understood is that the distal resection surgery is better for those professional bodybuilders that want to return to heavy weightlifting and bodybuilding. true?

    I have had an AC separation for 7 months now and the pain has decreases but i still feel weird in the shoulder as i feel bones crushing each other and moving around. Any advice on whether to get the surgery or not to return to normal bench presses and weight lifting? I am currently benching 120 kgs with a type 2 separation with a spot. But i do get pain every once in a while. Any advice?
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    I had the subacromial approach done to my shoulder back in July of 2010, the doc's description was as follows.

    Surgeons description: The arthoscope was introduced after the joint was insufflated with 30ccs of saline in subacromial bursa space and insufflated with 20 ccs of .25 percent Marcaine with Epinephrine. The interarticular surfaces were visualized and biceps tendon was intact as was the labial anchor. Anterior and inferior labial showed a large flap tear that was sheared of the entire 50% inferior aspect of the glenoid and anterior aspect that was still attached at the inferior rim and the anterior inferior rim. It was creating a large flap and this was debrided as was the torn labrum. The humeral surface also had a large area of osteoarthritis with grade IV chondromalacia and extensive chondromalacia was noted throughout the glenoid. Once the chondroplasty was performed, and unstable articular cartilage debrided back. the cartilage and fragments were removed from the joint. There was a small partial thickness tear of the humeral surface of the supraspinatus. This was debrided with a shaver. The biceps tendon was stable and examined. There was no significant tendonosis. Subscapularis was intact. There was some intra-articular synovitis. There was some bursitis encountered and this was debided and a standard decompression was then affected with the arthowand, 4.5 shaver and the 4.5 burr. The distal clavicle was preserved by coplaning and the extensive bursectomy was performed. The bursal surface of the cuff was healthy and no sign of a complete tear was identified. The wound was then injected with 20 ccs of Neuropen and sterile dressing applied.

    After spending 6 weeks getting motion back this exercise has done wonders! http://www.youtube.com/watch?v=JY0TMsw7W74

    This one has helped also!

    http://ronjones.org/Coach&Train/Body...ScareCrow.html
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    Chasing the dragon JRT6's Avatar
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    I get grinding in my shoulders just moving my arms to take a piss but my range of motion is excellent and my workouts are pretty much unaffected so I agree with this article. My ortho does too as we have had this discussion in the past.
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