Osteolysis of the Distal Clavicle: Serial Improvement and Normalization of Acromioclavicular Joint Space with Conservative Care

Objective

To discuss a case of osteolysis of the distal clavicle (ODC) in a 29-year-old male chiropractic student who showed interval radiographic and clinical evidence of healing.

Clinical Features

The patient complained of intermittent left-sided shoulder pain of 8 months' duration that was exacerbated while performing spinal-manipulative procedures. A radiographic examination showed changes consistent with osteolysis involving the distal clavicle.

Intervention and Outcome

A conservative treatment regimen of physiotherapy, nutritional supplementation, and activity modification resulted in an interval reduction in symptomatology and radiographic findings on serial examinations, ultimately resolving both abnormal clinical and radiographic findings after approximately 14 months of treatment. We specifically observed normalization of the acromioclavicular (AC) joint dimension.

Conclusions

In contrast to the posttreatment radiographic outcome seen in our patient, ODC classically does not result in complete resolution of radiographic findings or normalization of AC joint dimension, and such radiographic normalization of joint space is currently not reported in the literature. This case report serves to document and to show this unique occurrence.