AC Joint Osteolysis (Weightlifter’s Shoulder): Treatment & Recovery

Weightlifter's Shoulder (AC Joint Osteolysis) - Olympic Clean and Jerk

Today we’re going to talk about a specialized form of shoulder injury called AC Joint Osteolysis. Here’s a basic way to tell if you are suffering from it: Do you have pain at the top of your shoulder? Does it feel worse when you reach above your head or across your body? You may have AC Joint Osteolysis. If you’re also a weightlifter, boxer, or martial arts expert, it is highly likely that you are suffering from AC Joint Osteolysis. In this article, we will explain AC Joint Osteolysis, identify its causes and symptoms and find out how it is diagnosed and treated.

What is AC Joint Osteolysis?

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.

What Causes Weightlifter’s Shoulder?

As its name suggests, it most commonly occurs in weightlifters and powerlifters. Other people who may suffer from this condition are boxers, martial artists, rugby players, handball players, racquetball players, golfers, soldiers, and those who frequently engage in manual labor.

These individuals typically perform movements that chronically compress or stress the AC joint with heavy overhead activities.

The repetitive damage exceeds the ability of the bone to heal after loading.

What are the Symptoms of Weightlifter’s Shoulder?

The most common symptoms of Weightlifter’s Shoulder/AC Joint Osteolysis are:

  • Dull ache over the AC joint
  • Pain and tenderness when pressure is applied on top of the shoulder
  • Pain with upper extremity exercise and overhead activities
  • Pain felt radiating to the neck and deltoid
  • Swelling at the end of the collarbone or in the AC joint
  • A general  sense of weakness in the shoulderScarf Test - Model Demonstration

How is Weightlifter’s Shoulder/AC Joint Osteolysis Diagnosed?

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).

What Treatments are Available for Weightlifter’s Shoulder/AC Joint Osteolysis?

Non-Surgical Treatment:

1. Rest/modification of activities

For mild cases, altering your exercise may be all that you need. Over-training should be avoided as this adds too much stress to the bone and this can contribute to rapid bone breakdown.

For serious cases, six weeks of rest from overhead weightlifting is required to allow the bone to heal.

2. Stop smoking

Smoking decreases the amount of oxygen available to the bones and tissues thus creating less resilient tissue.

3. Ice

Apply ice massage after workouts.

4. Anti-inflammatory (NSAIDs) medication and pain-killers

These may be effective in reducing the pain and inflammation of the joint. However, NSAIDs can sometimes reduce bone healing.

5. AC Joint injection

A steroid injection with local anesthetic can help reduce pain. These injections usually last for a few months and can provide relief while the bone recovers.

6. Physical Therapy

Physical therapists can help you with:

  • Advice for activity modification and specific training tips. For example, they will advise you to move handgrip closer together on the barbells and to stop your bench press two inches above the chest also decreases the stress on the distal clavicle. Some weightlifters place a two-inch folded towel on the chest as a reminder of when to stop.
  • PTs also advise weightlifters to modify the power clean or power jerk. Do not rack the bar (lift the bar and let it rest on the clavicles or deltoids). Start with elbows even with, or above your shoulders, and lift. This eliminates the power pull.
  • Stretches for weightlifter’s shoulder: Your Physical Therapist will assess which muscles you should be stretching in your particular case to address any imbalances. Most weightlifters have a tendency to be tight around the chest and anterior shoulder. Your PT will decide whether this is the case for you.
  • Weightlifter’s shoulder rehab exercises: Rehabilitating your shoulder from AC Joint Osteolysis requires addressing strength and range of motion imbalances around your shoulder. It also requires exercises that address your shoulder proprioception or the unconscious ability for you to know where your shoulder is in space during every day and sporting activities.

If the aforementioned treatments will not work, you need:

Surgical Treatment

AC Joint Osteolysis surgery

Orthopedic Diagram of the Anatomy of the Acromioclavicular Joint

Surgery is usually not necessary for AC Joint Osteolysis but some patients may need to treat their conditions with a minimally invasive arthroscopic surgery. In most cases, this can be easily resolved with a distal clavicle resection, a procedure known as AC joint arthroplasty or the Mumford procedure.

This is a minimally invasive arthroscopic procedure that entails the removal of less than one centimeter of the end of the clavicle bone and some contouring of the AC joint. Thus, the bones in the AC joint will not grind against each other, eliminating shoulder pain while restoring complete range in motion.

Recovery time for this procedure is much shorter compared to open surgery, with most patients returning home on the same day.

The Anatomy of the Acromioclavicular (AC) Joint

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.

Are There any Long-Term Effects From AC Joint Osteolysis?

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.