A Review of Weight-Lifter's Shoulder

Over 100 cases of acute distal clavicular osteolysis (ADCO) in weight lifters have been reported in the medical literature in the last 25 years. Sometimes this problem is referred to as weightlifter's shoulder. It is an overuse phenomenon that causes tiny fractures along the end of the clavicle (collar bone). A breakdown of bone (osteolysis) occurs.

In this report, the authors review and summarize what is known about this problem. Although male weight lifters are affected most often, there have been reports of ADCO in a judo player, deliveryman, handball player, and some soldiers. Female bodybuilders are also at increased risk for this ADCO.

There may be a history of an acute injury of the AC joint. But the condition can occur without any known trauma. In most cases, there is repetitive stress to the affected upper extremity. Weight training, intensive lifting, and operating an air hammer are examples of the activities leading to ADCO.

There is evidence that the body tries to heal itself but the bone dissolves or is resorbed by the body instead. A network of blood vessels form in the area during the attempted healing process. Chronic inflammation with scar tissue called fibrosis is commonly found when tissue from the area is examined under a microscope.

The synovial lining of the joint starts to overproduce itself. Invasion of the underlying bone begins. Degenerative joint disease occurs as an end-result of the pathologic process.

Aching pain along the front of the shoulder at the acromioclavicular (AC) joint is the first symptom. Moving the arm across the body hurts. It gets worse with weight training involving the upper extremities (arms). Activities such as push-ups, bench presses, dips on the parallel bars, and throwing motions make the symptoms worse.

The diagnosis is made using X-rays, scintigraphy (bone scan), and steroid injection. CT-guided injection is actually a diagnostic tool and a treatment. Pain relief with steroid injection into the AC joint confirms that the pain is coming from the AC joint.

Treatment begins with conservative (nonoperative) care. This may include rest and/or changes in weight-training activities and techniques. The authors provide specific and detailed advice about changes that can be made in training.

Ice massage and nonsteroidal antiinflammatory drugs (NSAIDs) are used after all exercise sessions. Athletes must be observed carefully as many of them will work through the pain and not really modify their program. Surgery may be needed for those athletes who do not improve with conservative care or who are unwilling to change the training or performance routine.

The surgeon removes the end of the clavicle. This is called a distal clavicle resection. The procedure can be done with an open incision or through tiny puncture holes with an arthroscope.

Repair of any torn soft tissue in the area is done at the same time. Some surgeons transfer the coracoacromial ligament over the end of the bone that has been cut. This helps stabilize the joint. Other surgical techniques (both open and arthroscopic, direct and indirect) are discussed in detail.

Training can begin the first week after surgery (sometimes in the first few days). Pain is relieved in a majority of patients. It can take about four to eight weeks for the pain to subside completely. It is possible to return to competitive lifting sports at a preinjury level or better within a week or two. Likewise, there are reports of manual laborers returning to full work duties. The turn around time is very short.

Patients should be warned that there can be some problems. Abnormal motion of the AC joint can lead to a poor result. In such cases, pain is not relieved. There can be muscle injury, prolonged bleeding, infection, and fracture of the clavicle during the procedure. Smokers are at greater risk of poor wound healing and failed surgery.

Reference: 

Ran Schwarzkopf, MD, MSc, et al. Distal Clavicular Osteolysis. A Review of the Literature. In Bulletin of the NYU Hospital for Joint Diseases. Vol. 66. No. 2. Pp. 94-101.

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