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Cystic Lesion Of Acromion And Lateral End Of Clavicle In A Case Of Post Traumatic Acromioclavicular Arthritis

*Shirish S.Pathak, Clement Joseph, M.Aravinda, David Rajan

*Department of Orthopaedics,
Sports Injury & Arthroscopy Clinic,
GKNM Hospital, P.N.Palayam ,Coimbatore, Tamilnadu – 641037.

Address for Correspondence

Dr.Shirish S.Pathak,
Department of Orthopaedics,
Sports Injury & Arthroscopy Clinic,
GKNM Hospital, Coimbatore, Tamilnadu – 641037, India.
Phone:+91-9244401100, +91-0422-2213501

J.Orthopaedics 2006;3(3)e4


The acromioclavicular (AC) joint is a diarthrodial joint that connects the acromion to the lateral end of clavicle. Causes for AC joint arthritis are varied including degenerative osteoarthritis, posttraumatic arthritis, osteolysis of lateral end of clavicle etc. AC joint post-traumatic arthritis may develop due to single or repeated episodes of direct or indirect injury to the joint. Patients complain of pain in the AC joint area with typical pain on overhead abduction activities. Special X ray views, CT scan and MRI scan are useful tools to diagnose this condition .We report a case of AC joint arthritis with cystic lesions in acromion and lateral end clavicle which is a  rare finding. 

Case report: 

A 28 years old businessman presented with pain in right shoulder since 3 years. Patient sustained injury to right shoulder when doing weight training in gymnasium 3 years back. Pain subsided after 1 month. Patient had intermittent shoulder pain. He subsequently had a fall from bike 6 months back. After that pain increased in severity and frequency. Patient also had complaints of pain and difficulty in overhead abduction activities. Patient had night pain on lying on same side. There was no history of fever or any instability. Patient had no other joint pain or systemic illness. 

On examination there was tenderness on AC joint, cross arm test and O’brien test were positive. . Impingement test & Apprehension test were negative.  Terminal abduction was painfully restricted. AC joint was injected with local anesthetic and the pain decreased. X-ray (Zanca’s view) showed AC joint arthritis with peculiar finding of cystic lesions in acromion and lateral end of clavicle. CT scan also showed cystic lesions in acromion and lateral end of clavicle.  MRI  showed increased signal intensity in the AC joint and subchondral region of lateral end of clavicle and acromion.  Blood investigations were normal. Since the patient did not respond to previous conservative measures like ultrasound therapy, surgery was advised. 

Surgical technique: Patient underwent arthroscopy in lateral decubitus position through posterior, anterior and mid-lateral portals. There was no intraarticular pathology. The lateral end of clavicle was excised using a motorized burr. The lateral 10 mm of clavicle was excised while preserving the superior acromioclavicular ligament. The undersurface of acromion was decorticated to decompress the cysts (figure-5). At the end of 6 weeks, patient was pain free with full range of movement. Biopsy report confirmed chronic inflammatory changes suggestive of posttraumatic arthritis.

Discussion :

Causes for AC joint arthritis are varied including degenerative osteoarthritis, traumatic arthritis, post-traumatic osteolysis of lateral end of clavicle4, atraumatic osteolysis in weight lifters etc.,1,3. Our patient was young and had two episodes of significant injury to his right shoulder. Radiological investigations confirmed AC joint arthritis with a atypical finding of acromion and lateral end clavicle cysts. Another condition which we thought as a differential diagnosis was lateral end clavicle osteolysis. The characteristic findings in osteolysis are osteoclastic resorption with signs of osteogenesis with widened AC joint and normal acromion2. In this case these findings were not present. There was no soft-tissue calcification which is characteristic of post-traumatic osteolysis. In literature, there are few reports  of cases of traumatic osteolysis and posttraumatic arthritis with erosive and cystic radiological changes in the the lateral end of clavicle. 1,2,4 No report mentions the presence of cysts in acromion. We report this case of postraumatic arthritis of AC joint with cyst in acromion and lateral end of clavicle.

Reference :

  1. Scavenius M, Iversen BF. Nontraumatic clavicular osteolysis in weight lifters.Am J Sports Med. 1992 Jul-Aug;20(4):463-7.

  2. Mestan MA, Bassano JM Posttraumatic osteolysis of the distal clavicle: analysis of 7 cases and a review of the literature.J Manipulative Physiol Ther. 2001 Jun;24(5):356-61. 

  3. Shaffer BS Painful conditions of the acromioclavicular joint.J Am Acad Orthop Surg. 1999 May-Jun;7(3):176-88

  4. Zdichavsky M, Hufner T, Pape HC, Rosenthal H, Tscherne H Unfallchirurg.Post-traumatic osteolysis of the distal clavicle. A case report and review of the literature 2000 Dec;103(12):1121-3.

  5. Zawadsky M, Marra G, Wiater JM, Levine WN, Pollock RG, Flatow EL, Bigliani Osteolysis of the distal clavicle: long-term results of arthroscopic resection. Arthroscopy. 2000 Sep;16(6):600-5


This is a peer reviewed paper 

Please cite as : Shirish S.Pathak: Cystic Lesion Of Acromion And Lateral End Of Clavicle In A Case Of Post Traumatic Acromioclavicular Arthritis

J.Orthopaedics 2006;3(3)e4





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