Risk factors and management of atraumatic distal clavicular osteolysis: A scoping review.

Introduction: The aims of this review were to map the literature for risk factors, clinical and radiographic features of atraumatic distal clavicular osteolysis (ADCO) and indications for surgery. Methods: A scoping review using PRISMA-ScR guidelines. Four electronic databases [CINAHL, Emcare (Ovid), PubMed, and Scopus] were searched for cohort studies involving ADCO. Results: Eight studies were included with data on 483 patients. Bench pressing was the most common activity-based risk factor (49.1%) following by general/unspecified weight training (24.4%). Frequency and intensity of loading were noted as potential risk factors for onset of ADCO. The most common reported symptoms were distal clavicle/acromioclavicular joint (ACJ) pain (69.9%). Imaging features included marrow oedema and subchondral fracture of the distal clavicle on MRI. Most patients recovered with conservative care, but 16% required surgery due to failure of conservative care. Conclusions: Clinical signs and symptoms for ADCO were not distinguishable from other shoulder pathologies. Primary contact clinicians may benefit from consideration of sporting and loading patterns when assessing patients with ACJ pain. MRI was the most frequently utilised imaging modality but should be taken in context with clinical examination. Surgical referral resulted in largely favourable outcomes following resection.