[OCAD] Inflammatory arthritis, atraumatic osteolysis, or just plain old osteoarthritis? (AC joint / MR arthrography)

Apologies: I mislabeled the last row “cor fs contrast” instead of just “cor
fs T1” as would have been correct. There was no i.v. contrast. This is an
MR arthrogram.
Andrei

On Fri, 2 Sept 2022 at 15:20, Andrei Dumitrescu <xisquare@gmail.com> wrote:

>
> 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?
>
> Cheers,
> Andrei
>
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