Hi everybody! Dr. Lawless back here again to discuss one of the most common conditions of active gym goers and the apparent dreaded “shoulder pain” that comes along with lifting weights.
Do you have shoulder pain? It could be distal clavicle osteolysis (DCO).
Distal clavicle osteolysis, also known as weightlifter’s shoulder, is an overuse injury that is more commonly found in athletes or (you guessed it) weight lifters. It happens when the end of the collar bone (clavicle) is affected and starts to break down and weaken, instead of the bone staying healthy and strong.
What are the symptoms of distal clavicle osteolysis?
Pain located at the top of the shoulder near the acromioclavicular (AC) joint or at the end of the clavicle, are common symptoms of DCO. The AC joint is where the acromion – a part of the scapula (shoulder blade) meets the clavicle at its distal (outer) end. They are connected by the acromioclavicular ligament, which enables you to raise your arm above your head and make overhead movements.
This condition tends to progress slowly and starts with dull pain, stiffness, or tenderness that worsens over time. Pain from this condition improves with rest from pushing exercises and worsens when performing pushing exercises (bench press, shoulder press, dips, etc.).
What causes distal clavicle osteolysis?
Repetitive stress, microtrauma, and overload to the AC joint can cause this condition. These types of stresses on the shoulder are typically seen through movements that involve horizontal adduction, adduction, internal rotation, and forward/lateral flexion of the shoulder. All of which are commonly done by athletes who perform pressing exercises like a barbell bench press or shoulder press.
People who frequently lift heavy objects overhead (such as construction workers) or athletes that exert force on the shoulder through repetitive overhead movements (like tennis players, swimmers, volleyball players, basketball players, etc.) can also develop distal clavicle osteolysis.
How is distal clavicle osteolysis diagnosed?
Obtaining the patient’s history is usually enough to diagnose this condition, but imaging techniques, like x-rays, ultrasound, and even MRI can be used to further investigate.
How do you treat distal clavicle osteolysis?
Shoulder pain caused by distal clavicle osteolysis can be treated nonsurgically and can include applying ice to the area, taking anti-inflammatory medications, and undergoing physical therapy. Various injections, including cortisone, may also be helpful if symptoms persist.
Additionally, DCO is best treated with rest for about 1-2 months from the exercise or activity that caused it (i.e. bench pressing) and a gradual return to that activity with modifications as necessary. Modifications may include:
- Dumbbell bench press instead of barbell bench press
- Cable flys instead of dumbbell flys
- Avoiding overhead shoulder press until symptoms are alleviated
Treatment focuses on reducing pain and minimizing activities that exacerbate the condition while allowing time for the bone to rebuild.