Many injuries can cause shoulder pain in athletic people, including rotator cuff tears, labral tears, instability and more. In this Ask Dr. Geier column, I answer the question of a reader who already knows his diagnosis – distal clavicle osteolysis – but wonders if it explains the shoulder pain with movement of his arm.

Frank asks:
Hello Doc,
I am just curious if it’s common to experience pain when raising the arm vertically and/or horizontally, or if its likely I am experiencing some other condition if the pain increases when I perform these movements?
Thanks!

Thanks for the question, Frank! Yes those movements can cause pain in someone with distal clavicle osteolysis. Before I discuss its symptoms and treatment more specifically, let me explain the problem more broadly.

Risk factors for distal clavicle osteolysis

Distal clavicle osteolysis is a shoulder condition that usually affects weightlifters and bodybuilders. Manual laborers and athletes who do repetitive activities and lifting overhead can develop it as well. Generally the patient develops pain that increases gradually over time rather than after one specific event.

Signs and symptoms

The pain is located at the acromioclavicular (AC) joint between the end of the clavicle (collarbone) and the acromion (tip of the shoulder). Weightlifters and bodybuilders often notice pain with exercises that compress the joint, like bench press or military press. They might especially notice pain when they reach across the body. In fact, a physical examination test where the orthopedic surgeon pushes the affected arm across the body is a common provocative maneuver we use to help make the diagnosis.

Also read:
Ask Dr. Geier – Preventing youth pitching injuries
Ask Dr. Geier – Shoulder Labral Tears

Location of pain with distal clavicle osteolysis

Tests for distal clavicle osteolysis

X-rays often show resorption of the bone at the end of the clavicle at the AC joint. Occasionally the orthopedic surgeon will order an MRI to confirm the diagnosis and rule out other shoulder injuries. Often rest, activity modification, and anti-inflammatory medications are the first treatments, especially if the patient has only recently developed symptoms. Physical therapy or an injection of cortisone into the AC joint can help. For a patient whose symptoms persist despite nonoperative treatment, surgery to cut off a small amount of the clavicle at the AC joint – distal clavicle excision – can be performed.

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