Steroid injections for Distal clavicle osteolysis
Distal clavicle osteolysis affects the lateral end of the collar bone (clavicle) where it connects to the acromioclavicular joint (ACJ). It is an overuse injury caused by microfractures that the body tries to repair.
Repetitive overloading of the clavicle from exercises such as bench presses, pushups and chest flies cause micro-trauma to the end of the clavicle resulting in pain and inflammation of the bone.
Research has found that if you bench press 1.5 x your body weight (1 rep max) more than once a week for over 5 years, this increases your risk of distal clavicle osteolysis (Nevalainen et al, 2016).
Symptoms of AC joint pain
- Pain and tenderness at the collarbone and ACJ.
- Painful when moving your arm across your body or overhead.
- Pain is worse when lying on the injured shoulder.
- Painful with bench press or pushups.
The acromioclavicular joint (also known as the ACJ) is the junction between the collarbone (clavicle) and the acromion (top of the shoulder blade). It is held together by strong ligaments and a joint capsule. The trapezius and anterior deltoid muscle also dynamically stabilise the ACJ throughout movement.
The ACJ allows for extra range of movement in the shoulder blade and assists with raising your arms up. It also helps with transmission of force from the upper limb to collar bone.
How to diagnose
One of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis. Here at Oxford Circus physiotherapy we can also use diagnostic ultrasound to confirm the diagnosis. Using the diagnostic ultrasound also allows the clinician to assess the AC joint dynamically throughout painful arm movements.
Distal clavicle osteolysis Treatment
Distal clavicle osteolysis will usually resolve with rest, activity modification, over the counter anti-inflammatories and a course of physiotherapy.
Modifying your bench press technique can reduce the stress on the AC joint.
A few examples of modifications include:
- Narrowing the hand spacing on the barbell
- Placing towels on the chest so that the descent phase of the bench press ends 4-6cm above the front of the chest.
Distal clavicle osteolysis Ultrasound-guided corticosteroid injection
If symptoms persist with physiotherapy or the pain is stopping you from sleeping or performing your day to day activities, an ultrasound-guided corticosteroid injection could be appropriate for you. A small dose of corticosteroid is injected under ultrasound guidance to ensure accuracy. The corticosteroid works by reducing inflammation and pain in the area.
Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications.
Mall, N.A., Foley, E., Chalmers, P.N., Cole, B.J., Romeo, A.A. and Bach Jr, B.R., 2013. Degenerative joint disease of the acromioclavicular joint: a review. The American journal of sports medicine, 41(11), pp.2684-2692.
Mazzocca, A.D., Arciero, R.A. and Bicos, J., 2007. Evaluation and treatment of acromioclavicular joint injuries. The American journal of sports medicine, 35(2), pp.316-329.
Nevalainen, M.T., Ciccotti, M.G., Morrison, W.B., Zoga, A.C. and Roedl, J., 2016. Distal clavicular osteolysis in adults: association with bench pressing intensity. Skeletal radiology. 45(11), pp.1473-1479.