Friday afternoon….. always the best time for tricky cases 😅
47 year old man with chronic pain at the left shoulder, no definite history
of distinct trauma, competitive sports or occupational stress.
There is what looks like prominent OA with bone marrow edema at the AC
joint, a small slap tear, and not much else in the way of pathologic
findings.
However considering the patient’s age and the lack of marked degeneration
elsewhere, I’m wondering if the AC joint changes could be something else,
namely inflammatory arthritis, or that (to me) mysterious entity,
atraumatic osteolysis of the distal clavicle (AODC), possibly induced by
some not reported repetitive stress (which I guess can also lead to early
OA….). What is your impression? Where do you draw the line?
