Friday, October 30, 2009

Weightlifting and the Distal Clavicle

Photo by greg westfall

Weightlifting is an ancient sport, dating back to ancient China, Egypt, and Greece. I'm sure that even before these recorded competitions, there were plenty of contests of brute strength, including lifting heavy rocks:

The original Olympics did not include weightlifting as an event, but it was still a popular pastime in ancient Greece. Weightlifting continues to this day, and one popular exercise is the bench press:

Photo by Justin Berndt

This exercise places a great deal of strain on the glenohumeral (shoulder) joint and the adjacent acromioclavicular (AC) joint. One consequence of repeated increase strain on the AC joint can be osteolysis of the distal clavicle.

In this case a 36 year-old female felt the gradual increase of shoulder pain while increasing the number of pushups she was doing daily. She then experienced an abrupt increase in her pain after moving luggage from overhead compartment in a plane. Her orthopedic surgeon sent her for an MRI:

Sagittal T2 fatsat image reveals striking bone marrow edema (yellow arrow) within the distal clavicle.

On an axial T2 fatsat image, there is a linear, hypointense fracture line (yellow arrows) within the subchondral bone:

A coronal intermediate-weighted image confirms the presence of the subchondral fracture:

Repetitive stress can lead to bone marrow edema and a subchondral fracture line within the distal clavicle. Demineralization and bone resorption may follow. (Textbook of Arthroscopy; Miller, M. and Cole, B.; 178-179, 2004 and Kassarjian et al.; Skel. Rad. 36:17-22, 2007)

On physical examination, patients have point tenderness over the affected AC joint. The range of motion of the glenohumeral joint is typically not affected.

Thus, a subchondral stress fracture may be the earliest MRI manifestation of distal clavicular osteolysis.

Vic David MD


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MuchKneadedNYC said...

Great photo of the female weight lifter. I used to do some weight lifting myself. Unfortunately injuries in this sport are a mater of "when" not "if".

Your blog always offers excellent information and an engaging writing style.
Denise W. at Much Kneaded Massage