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Many experienced weightlifters are able to continue training carefully. They can resume their program as early as three days after surgery. Most are back in full swing by the end of a week.
Pain is relieved in a majority of patients. Weightlifters are pleased that without the pain, they can quickly get back to their pre-operative level of lifting within a week or two. In fact, some even report exceeding their training weight once the pain is gone.
Patients should be warned that there could be some problems. Abnormal motion of the AC joint can lead to a poor result. In such cases, pain is not relieved. There can be muscle injury, prolonged bleeding, infection, and fracture of the clavicle during the procedure. Smokers are at greater risk of poor wound healing and failed surgery.
What parts of the shoulder are affected?
The shoulder is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone).
The acromioclavicular (AC) joint is affected most often. This is where the end of the collarbone (closest to the shoulder) attaches to the acromion. The acromion is a curved piece of bone that comes from the shoulder blade across the top of the shoulder. The clavicle and acromion meet to form the AC joint in front of the shoulder.
Ligaments and soft tissues hold the AC joint together and provide stability. These include the coracoclavicular ligament, superior and inferior AC ligaments, and the AC joint capsule.
Related Document: A Patient’s Guide to Shoulder Anatomy
Treatment for AC Joint Damage
AC Joint Osteolysis (Acromioclavicular) Joint Osteolysis or Distal Clavicular Osteolysis is often referred to as “weightlifter’s shoulder. “
The term Osteolysis means bone erosion. It occurs when the bone is eroded faster than it can be repaired or replaced.
AC Joint Osteolysis is an orthopedic condition that involves microtrauma and characterized by a series of small fractures along the end of the collarbone.
Injuries to the AC Joint account for approximately 10% of acute injuries to the shoulder girdle, with separations of the AC Joint accounting for 40% of shoulder girdle injuries in athletes.
As in other conditions, history and physical examination are the primary tools that healthcare professionals use to diagnose AC Joint Osteolysis. Other ways healthcare professionals diagnose the condition:
- The healthcare professional may move and feel the sore joint
- AC Joint Osteolysis radiology or X-ray of the affected joint
- AC Joint Osteolysis MRI or Bone scan
- Scarf test
- The patient is asked to perform with the elbow flexed to 90 degrees, placing the patient’s hand on his/her opposite shoulder and pushing back (pictured, right).
The acromioclavicular joint or the AC Joint is a diarthrodial joint with an interposed fibrocartilaginous meniscal disc connecting the clavicle with the acromion. It has an intra-articular synovium and an articular cartilage interface and is characterized by the various angles of inclination in the sagittal and coronal planes and by a disc.
The AC joint is surrounded by a capsule and reinforced by the superior/inferior capsular ligaments with the coracoclavicular ligaments (trapezoid and conoid) also important structures for the stability of the joint.
If the correct advice is followed, especially that of physical therapists particularly for weightlifters, there are no long-term effects of AC Joint Osteolysis. However, if the PT’s advice is not be heeded, the problem can re-occur.
To ensure that you receive proper treatment and advice for AC Joint Osteolysis from a licensed Physical Therapist, Contact us today to book an appointment.
Most people with AC joint osteolysis notice pain when lifting items overhead, especially if those items are heavy. However, as the damage progresses, other symptoms develop. These include:
- Pain at the site (at the end of the collarbone, top of the shoulder)
- Shoulder sore to the touch even after rest
- Weakness when moving the shoulder or lifting above the head
- Swelling at the end of the shoulder joint
- Severe pain while working out or performing heavy labor
Seeing your doctor as soon as you notice difficulty lifting can help prevent extensive damage to the collarbone and AC joint. However, treatment is not always as easy as rest.
The treatment for Weight Lifter’s Shoulder depends on the severity of the damage. For early stages of osteolysis, rest is often the first step. RICE – or rest, ice, compression, and elevation – helps to relieve pain and let the joint repair itself.
Anti-inflammatory medications like ibuprofen and corticosteroid injections may be recommended, as well as physical therapy. Within 6 to 8 weeks of this conservative treatment plan, most people feel much better.
However, if the damage to the AC joint is extensive, patients may need surgery. Most only require a minimally invasive arthroscopy, which is a small scope used to remove about 1cm of collarbone and then smooth out the AC joint. This prevents friction that causes pain.
Recovery from this surgery involves a sling to stabilize the arm while it heals, as well as sleeping on your back. After the first week, physical therapy is recommended to help rebuild muscle strength.
What causes this condition?
Repetitive trauma or stress from training and lifting causes tiny fractures of the distal end of the clavicular bone. Excessive traction on the AC joint from bench presses or chest fly exercises occurs when the elbows drop below or behind the body.
There may be a history of an acute injury of the AC joint. But the condition can occur without any known trauma. In most cases, there is repetitive stress to the affected upper extremity. Weight training, intensive lifting, and operating an air hammer are examples of the activities leading to acute distal clavicular osteolysis.
There is evidence that the body tries to heal itself but the bone dissolves or is resorbed by the body instead. A network of blood vessels forms in the area during the attempted healing process. Chronic inflammation with scar tissue called fibrosis is commonly found when tissue from the area is examined under a microscope.
The synovial lining of the joint starts to overproduce itself. Invasion of the underlying bone begins. Degenerative joint disease occurs as an end-result of the pathologic process.
How Do We Diagnose Distal Clavicle Osteolysis
The AC Joint is formed where the clavicle or collarbone contacts or forms a joint with the acromion. The AC Joint is a very small joint, and in weight lifters a ton of stress goes through the AC joint each time you work out.
Many people have small bumps on top of their shoulder. That is usually due to bone spurs around the AC joint. Because the surface area of the AC Joint is so small it is easy for the AC joint to become painful over time due to certain sports and certainly due to weight lifting and body building.
Osteolysis literally means dissolving (or erosion) of the bone. Because the AC Joint is so small, in certain overuse situations the end of the clavicle deteriorates and starts to breakdown. It is easier sometimes to think of it as a chronic stress fracture of the end of the clavicle.
In weightlifters the breakdown of the end of the clavicle occurs faster than the body can repair it. On x ray we will see little cysts in your clavicle in the early stages of clavicle osteolysis. As the process progresses we will see the AC Joint become wider because the distal clavicle (end of the clavicle) is dissolving.
The diagnosis of distal clavicle osteolysis is usually made by listening to your story and then finding tenderness or pain when we touch your AC Joint. The pain is frequently isolated to your AC Joint.
Tests for the rotator cuff or ligaments around the shoulder are often normal. An x ray will show that the AC Joint is starting to break down. We might see cysts or little fluid pockets in the bone. We might see erosion of the end of the clavicle.
No, osteolysis of the distal clavicle is not dangerous. If you stop weight lifting or the painful activity the pain will usually subside. Just because you are having pain does not mean that you are causing yourself further harm.
The recovery time from distal clavicle surgery is usually fairly quick. Many active weight lifters will be back in the gym within a few weeks. Some sooner and some later. As long as no other problems were found that needed to be repaired we allow you to start moving your shoulder as soon as you are comfortable.