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Right shoulder pain in a body builder

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Q1: Identify the pertinent findings on radiography

The radiograph (see p 514) of the right shoulder joint shows bone resorption and subchondral cysts on either side of the acromioclavicular joint.

Q2: What is the clinical diagnosis? What could be the cause?

The clinical diagnosis is atraumatic osteolysis of the distal end of the clavicle. Though the exact aetiology is unknown, it is likely to be a repetitive stress loading induced osteolysis of the distal clavicle, and typically occurs in body builders, weight lifters, and rugby players.1 2

Q3: What would be your line of management for this patient? Rationalise your answer

The condition is generally self limiting and responds to rest and analgesics with the majority showing osseous restoration of the clavicle in six to 12 months.3 Local steroid injections have not proved beneficial unlike in other shoulder pathologies.4 Cases not responding conservative measures benefit from surgical excision of the distal end of the clavicle.5

Final diagnosis

Stress induced osteolysis of the right distal clavicle.

References

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