Shoulder Pain in a Power Lifter

Radiology Corner

Shoulder Pain in a Power Lifter

Alicia M. Yochum RN, DC, DACBR, RMSK

Published: March 2018

Journal of the Academy of Chiropractic Orthopedists

March 2018, Volume 15, Issue 1

This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The article copyright belongs to the author and the Academy of Chiropractic Orthopedists and is available at: http://www.dcorthoacademy.com. © 2018 Yochum and the Academy of Chiropractic Orthopedists.

A 45 year old female competitive power lifter presented for chiropractic care of her left shoulder pain. The pain was at the anterior superior shoulder and the patient did report the occasional sensation of grinding.

Diagnostic ultrasonography was performed and demonstrated that the pain localized to the acromioclavicular joint which was mildly narrowed with a joint effusion. No abnormal motion was visualized when the joint was stressed utilizing arm flexion and adduction. The right shoulder was also evaluated for comparison (Fig 2) which also showed mild narrowing with a joint effusion. These findings are consistent with mild osteoarthritis of the acromioclavicular joint. No rotator cuff tear or other pathology was present on ultrasound examination.

Fig1 and 2: Long axis views of the acromioclavicular joint using diagnostic ultrasound demonstrating a mildly narrowed joint with a joint effusion bilaterally.

Since the patient frequently competes/participates in power lifting the diagnosis of distal clavicular osteolysis was discussed as a possible differential. Due to the limitations of ultrasound, the internal osseous structure and marrow cannot be evaluated therefore plain film radiography was performed (Fig 3). This demonstrated a mildly narrowed acromioclavicular joint without resorption (lucency) of the distal clavicle.

Fig 3: AP external rotation view of the left shoulder demonstrating mild acromioclavicular osteoarthritis without osteolysis.

Distal clavicular osteolysis is associated with weightlifting and the first reported cases were in weightlifters. It occurs from repetitive microtrauma resulting in microfractures of the distal clavicular subchondral bone with attempts at repair. Symptoms include pain at the joint that is exacerbated with lifting which was present in the current case. There is no evidence of osteolysis in this patient on the current imaging, however if the patient continues to lift heavy weight they are at risk for developing osteolysis and this differential should always be investigated in this clinical setting.

Magnetic resonance imaging (MRI) would also be an imaging tool that could be utilized and would show resorption of the clavicle cortex with bone marrow edema. Treatment includes avoidance of provocative maneuvers, modification of weight training techniques such as a deep bench press, ice, rest and rehab to improve joint stability.

References:

  1. Schwartzkopf R. et. al. Distal clavicular osteolysis: a review of the literature. Bull of the NYU hospital for Joint Diseases 2008; 66 (2): 94-101