The shoulder is made up of three bones, the clavicle, scapula, and the humerus, that work together to provide the greatest range of motion of any joint in the body.

Weight lifters shoulder, sometimes called distal clavicle (DC) osteolysis or acromioclavicular (AC) joint osteolysis, is a painful overuse injury that causes tiny fractures along the clavicle bone (commonly known as the collarbone). Over time, the fractures start to deteriorate and erode the bone, causing inflammation and pain.

CAUSES:

Despite the name, weight lifters aren’t the only ones affected by this injury. Anyone who undergoes repetitive trauma or stress on the AC joint is at an increased risk. This may include those who do a great deal of manual labor or those who play contact or racquet sports.

In weight lifters specifically, the injury is often caused by a workout program heavily comprised of bench presses, overhead presses and chest fly exercises. These motions cause the elbows to drop below or behind the body, and place the shoulders in a position of excess extension, increasing the stress on the joint. Because weight lifters are often on a regimented schedule, the joint doesn’t have a chance to heal before the next training session and it starts to break down and deteriorate.

While less common, AC joint osteolysis can be caused by a trauma such as falling and landing on the shoulder, which can precipitate the development of the injury. Previous shoulder separation, sprain or dislocation can also increase the risk of the injury. The trauma may occur several weeks or even years before the onset of injury symptoms.

SYMPTOMS:

Weight lifters shoulder can cause a wide variety of symptoms including:

  • A dull ache in the front of the shoulder over the AC joint
  • Pain and tenderness when pressing on the AC joint
  • Swelling of the collarbone and/or AC joint
  • Shoulder pain after weightlifting
  • Pain brought on by reaching across the chest
  • Weakness in the shoulder

DIAGNOSING WEIGHT LIFTERS SHOULDER:

To diagnose weight lifters shoulder, your doctor will ask you questions about your medical history, lifestyle and previous injuries. He or she will then complete a physical examination. Your doctor will touch and feel your AC joint and the surrounding area to get a better understanding of what types of movements are painful, and then examine your range of motion.

While a physical exam will provide your doctor with valuable information, a final diagnosis may not be made until you’ve undergone a series imaging studies. You may get an X-ray, a bone scan, and/or an MRI. You may also receive a steroid injection. The steroid injection acts as both a diagnostic tool and a treatment. If your pain is relieved after receiving a steroid injection, it confirms that the pain is indeed coming from the AC joint.

TREATMENT OPTIONS:

Oftentimes, distal clavicular osteolysis can be remedied with rest, ice, activity modifications and anti-inflammatory medication (such as aspirin and ibuprofen). However, if the pain does not subside it could indicate a more serious injury and shoulder surgery may be necessary.

CONSERVATIVE TREATMENTS:

Common conservative treatments include:

  • Rest (six weeks is often needed to allow the area to heal)
  • Ice
  • Moist heat (such as hot baths and heating pads)
  • Activity modifications (lifting lighter weights and avoiding: throwing motions, push-ups, bench presses, power cleans, and triceps dips)
  • Anti-inflammatory medication (such as aspirin and ibuprofen)
  • Corticosteroid injections
  • Physical therapy

Although most patients respond to conservative treatment, symptoms often return when regular activities resume. Oftentimes, if conservative treatments fail to provide lasting pain relief and the patient is unwilling to change their training or performance routine, surgical options are explored.

SURGICAL TREATMENT:

Distal clavicle excision, sometimes called distal clavicle resection or the “Mumford procedure,” is the primary surgical option for weight lifters shoulder. The procedure involves removing the end of the clavicle bone to allow for a pain-free, full range of movement. The surgery can be performed as an open procedure (with an incision of 3 to 4 centimeters) or arthroscopically (a less-invasive method with smaller incisions and a quicker recovery time).

After surgery, most people resume all normal activities with no loss of function. Recovery times varies, depending on how the operation was performed (arthroscopically or open), but it generally takes up to three months.

PREPARING FOR SURGERY:

Although pre-surgery instructions may vary from patient to patient, your doctor will likely ask that you purchase post-operative recovery equipment like a shoulder sling and an ice pack. Be sure to get these items before the day of your surgery so they are waiting for you when you arrive back home. When you pack your bag for the hospital, include a soft, comfortable shirt that will not irritate your skin underneath the post-operative shoulder sling.

On the day of your operation, your doctor may request that you arrive at the surgical center or outpatient facility one or two hours prior to your operation. After you fill out your paperwork and get admitted to the facility, you will be evaluated by an anesthesiologist.

Most shoulder operations are performed under block, local or regional anesthesia which means your shoulder will be numb but you will remain awake during the procedure. Some patients, however, may receive general anesthesia and will sleep through the operation. Depending on what type of anesthesia you will receive, you may or may not be able to eat, drink or take certain medications prior to surgery. You may also receive a sedative before the procedure to help you relax. Since the effects of sedatives can take a while to wear off, it’s important to arrange for someone to drive you home after your operation.

Your physician may also request that you avoid taking anti-inflammatory medicines, such aspirin, the week leading up to surgery, to prevent excessive bleeding during the procedure. Your doctor will give you specific instructions prior to your surgery so you can prepare properly.

POST-OPERATIVE CARE:

After your shoulder surgery, you will be moved to a recovery room. When you wake up, your shoulder may be wrapped in gauze, and it will likely be in a sling, covered with an ice pack. You may feel some pain, but you will receive medication to help manage it.

Most patients will be sent home once the anesthetic wears off, which is typically about three hours after surgery. However, depending on how well you are recovering and how much pain you are in, you may be admitted for an overnight stay. Before you are sent home you may be taught how to remove your sling and how to perform gentle range of motion exercises to aid your recovery. You will also be given a prescription for pain medicine.

After you are sent home, you will continue wearing your sling for up to six weeks. However, you will only need to wear the sling continuously, all day and night, for the first few days. You should move your fingers and hands in the sling as much as possible to help circulate blood. You can remove the sling for brief periods to shower, but remember to avoid moving the injured arm.

While you’re recovering, it is important that you take steps to reduce the pain and inflammation in the shoulder. Rest, icing (20 minutes, three to four times a day), and anti-inflammatory painkillers such as ibuprofen or aspirin can all help to ease the pain.

Your physician may also instruct you to keep your surgical incisions covered, clean and dry for up to one week following the procedure. This means you may not be able to shower until the surgical dressings are removed and replaced with a waterproof covering. It is also advised that patients avoid smoking and eat a healthy, balanced diet to increase the rate of healing and recovery.

Total length of recovery depends on what type of operation you had and your body’s natural ability to heal and build scar tissue in your AC joint. Many patients regain normal use of their arms within three weeks with the help of physical therapy.

While negative and dangerous side effects are not common, call your physician if:

  • Bleeding or drainage from the wound continues beyond the first 24 to 48 hours after surgery
  • You develop a rash or irritated skin around your sling

POST-OPERATIVE LIMITATIONS:

Following shoulder surgery, certain tasks may be unsafe or painful to execute. Such tasks include:

  • Driving: You must notify your insurance company that you underwent surgery to ensure that your auto coverage is still valid. When you feel able to handle a steering wheel easily with both arms, and you can move your arms above shoulder level comfortably, you can get behind a wheel again. For most patients this is usually about one week after surgery.
  • Sleeping: Sleeping can be uncomfortable if you try and lie on the operated shoulder. Instead, try lying on your back or on the opposite side. A pillow tucked along your back helps to prevent rolling onto the operated shoulder during the night.
  • Returning to work: If you have a sedentary job you may return as soon as you feel up to it. For most patients this is usually one week after surgery. Patients that have a job that requires heavy lifting or extensive use of the arms overhead may require a longer period of absence.
  • Athletic participation: Recovery time varies from patient to patient, depending on what type of operation they had. In many cases, light activity may resume as soon as the pain subsides, which is typically two to three weeks after surgery. All patients should avoid repetitive overhead activities for up to three months, until the joint has healed substantially.

POST-OPERATIVE PHYSICAL THERAPY:

Many surgeons have their patients take part in formal physical therapy after any type of shoulder procedure. Some patients may have a pre-operative visit with their physical therapist where they are taught some of the exercises that will be done throughout recovery.

The first few physical therapy treatments after surgery are designed to help control the pain and swelling. However, over time the goals of physical therapy will expand to include:

  • Improving shoulder range of motion (ROM)
  • Increasing shoulder strength
  • Improving exercise tolerance
  • Returning to all physical and everyday activities

Although physical therapy regimens will vary from patient to patient, some typical shoulder recovery exercises may include:

  • Passive range of motion (PROM) – The goal of PROM exercises is to slowly increase a patient’s range of motion while decreasing pain, swelling and stiffness. During these exercises a therapist or a piece of assistive equipment manually moves the patient’s joints through a series of motions while the patient relaxes. PROM is typically used after surgery during the initial recovery phase to prevent loss of shoulder motion.
  • Active range of motion (AROM) exercises – Like PROM, the goal of AROM exercises is to gently increase range of motion while decreasing pain, swelling and stiffness. However, during AROM, the patient performs the exercise without any assistance.
  • Light strengthening exercises
  • Internal and external rotation exercises
  • Stretching exercises
  • Modifications of sport specific exercises

After recovery is nearly complete, physical therapy will end. The therapist will likely continue to be a resource, but the patient will need to continue doing exercises at home to complete the rehabilitation process.

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