Appendix
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Orthopedics

Distal Clavicular Osteolysis

Distal clavicular osteolysis (DCO) is an overuse injury most often seen in athletes and weight lifters that causes pain in the AC joint. This is an atypical injury with multiple effective treatment modalities. Distal clavicular osteolysis results from repetitive excess load to the AC joint, typically through horizontal adduction, adduction, internal rotation, and forward/lateral flexion of the shoulder, such as bench pressing or overhead lifting. This activity reviews the evaluation and treatmen

v1 · Reviewed Nov 8, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Early identification and intervention are imperative to limit time away from activity for athletes.
  • Plain film radiology of the AC joint is typically sufficient to evaluate for distal clavicular osteolysis.
  • Imaging of DCO often demonstrates microcysts, loss of subchondral bone detail, and osteolysis of the distal clavicle.
  • Early, mild, or unclear radiograph findings warrant considering other imaging modalities such as MRI, bone scan, or ultrasound.
  • Diagnostic musculoskeletal ultrasound is an emerging option for diagnosing DCO.
  • Ultrasound may be performed during evaluation by a trained clinician and is significantly less expensive than MRI and bone scan.
  • It may also be more sensitive than plain film x-ray.
  • No laboratory tests are necessary for the diagnosis but should be considered based on other medical causes in the differential.
  • Complete cervical spine and neurovascular evaluations are essential if referred pain is suspected.
  • The first-line therapy for distal clavicular osteolysis remains conservative with activity modification/avoidance, nonsteroidal anti-inflammatory medication use, and physical therapy.
  • Modification of bench press motion modification is widely recommended.
  • Narrowing barbell hand placement to less than 1.5 times the bi-acromial width and controlling the descent phase of the bench press to end 4 to 6 cm over the anterior chest, often aided by a towel or spacer use, can help decrease the stress placed on the distal clavicle.
  • An essential adjunct to conservative management is corticosteroid injection.
  • Intra-articular AC joint injection may be beneficial therapeutically and diagnostically.
  • An emerging option for treating intractable DCO-associated pain is botulinum toxin injection.
  • Surgical management can be highly effective for those who fail nonoperative management or athletes unable to modify specific athletic tasks and activities.
  • The mainstay of surgical intervention is resectioning the distal clavicle with no more than 8 mm of excision to avoid iatrogenic AC joint instability.
  • This is performed through an open or arthroscopic technique.
  • The open procedure offers the surgeon direct visualization and the ability to adjust the resection margin with a broader frame of reference.
  • The two arthroscopic approaches are direct and indirect.
  • Both procedures involve a cutting burr to remove no more than 8 mm of the distal end of the clavicle to preserve the anterior and posterior AC ligaments.
  • Resorption of the distal clavicle is a notable mark of pathology progression in patients who do not restrict painful movements and, in a sense, cause a "self-surgery."
  • One long-term study of the sequelae of DCO using MRI imaging found that the most common long-term complications of DCO are AC joint widening and AC joint osteoarthritis.
  • However, the significance of the MRI findings is not known, as not all patients with the finding were symptomatic.
  • review
    Distal Clavicular Osteolysis. StatPearls [Internet] — David C. Evans, Jeremy D. Schroeder — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov