Case 3
History:
27 year old lacrosse player male with chronic right shoulder pain
Findings:
Radiograph of the right shoulder show osteolysis of the distal clavicle. An MR arthrogram show an area of increase T2 signal in the region of osteolysis. The T1 WI show more of the erosion.
Diagnosis:
Post-traumatic osteolysis of the distal clavicle
Discussion:
Often missed initially or misdiagnosed as a Type I strain/sprain of the acromioclavicular joint. The osteolytic process which occurs is associated with mild to moderate pain in the shoulder, usually being within two months following initial injury. Usually not visualized on plain X-rays until 3 to 4 weeks following the onset of symptoms, although months and years may pass until osteolysis becomes manifest. These patients are typically between the ages of 20 and 40. The disease is typically self-limited and usually does not leave sequela.
MRI manifestations included soft tissue swelling, bone marrow edema in the distal clavicle, and cortical irregularity associated with periarticular cyst-like erosions, joint space widening, clavicular periostitis, and marrow edema in the acromion.
References:
- Zdichavsky M, Hufner T, Pape HC, Rosenthal H, Tscherne H. Post-traumatic osteolysis of the distal clavicle. A case report and review of the literature. Unfallchirurg. 2000 Dec;103(12):1121-3.
- Yu, Joseph S.; Dardani, Marcella; Fischer, Richard A. MR Observations of Posttraumatic Osteolysis of the Distal Clavicle After Traumatic Separation of the Acromioclavicular Joint. Journal of Computer Assisted Tomography. 24(1):159-164, January/February 2000.
