611 - The Unseen Stressors: A Case Series on Distal Clavicle Osteolysis in Unlikely Patients

Case Diagnosis: This case series presents three patients diagnosed with distal clavicle osteolysis (DCO), an overuse injury seen in athletes with repetitive overhead lifting. Diagnoses were supported via exam showing tenderness over the acromioclavicular (AC) joint and imaging revealing osteolysis. While both patients had superior shoulder pain, their different primary activities—weightlifter, e-gamer, and student—underscore the varied etiology and complex nature of this condition.

Case Description:

A 26-year-old male wrestler and weightlifter had pain localized to the distal clavicle. An MRI showed DCO, labral tear and paralabral cyst, and AC joint arthropathy. EMG ruled out thoracic outlet syndrome. The second patient, a 33-year-old male e-gamer, presented with left shoulder pain and scapular dyskinesia. X-rays revealed DCO. The third patient, a 35-year-old female whose only risk factor was wearing a shoulder strap backpack, had x-rays revealing extensive DCO.

Discussions:

These varied presentations highlight the diagnostic and therapeutic complexity of DCO. The weightlifter’s pain stemmed from both DCO and mass effect of a paralabral cyst, complicating treatment and highlighting the need to address multiple pain generators. The e-gamer's and female’s case illustrates that DCO can occur in non-traditional athletes and non-athletes; chronic repetitive activities, even without heavy lifting, can lead to significant bony stress. All patients benefited from targeted physical therapy, but their unique circumstances required different injections, demonstrating that DCO pathophysiology is not singular and involves concurrent processes.

Conclusions:

These cases show that DCO has complex causes beyond simple overuse. A paralabral cyst complicated one patient’s diagnosis, while another patient’s sedentary but repetitive gaming activity led to a similar outcome. The third patient had no risk factors but displayed extensive disease. Managing DCO is not a one-size-fits-all approach and requires a careful, individualized strategy considering all contributing factors. These findings emphasize that effective treatment of DCO involves a thorough workup and addressing coexisting pathologies especially for non-traditional athletes.