Weightlifter’s Shoulder / Osteolysis
Is your shoulder painful in the gym? You could have weightlifter’s shoulder.
Weightlifter’s shoulder is an injury where the clavicle (collar bone) joins the shoulder blade. It’s most prevalent in the gym setting, however any activity involving repetitive or heavy use of the shoulder such as overhead work, swimming, surfing, throwing and boxing can cause weightlifter’s shoulder.
It causes pain and weakness during pushing exercises like bench press and shoulder press.
Note: This page contains general advice on weightlifter’s shoulder, which is intended for general education. Book an appointment with Perth Shoulder Physio for an accurate diagnosis, treatment and more specific information about your shoulder injury.
What is the Acromioclavicular Joint (AC Joint)?
The AC joint or acromioclavicular joint is a small joint at the tip of the shoulder, between the acromium process of the shoulder blade and the clavicle or collarbone. There is a disk of soft tissue cartilage between the two bones, which is surrounded by a small joint capsule.
The AC joint forms an important link between the arm and the rest of the skeleton. It acts as a pivot point, allowing the shoulder blade to move as the arm is elevated.
Causes of Weightlifter’s Shoulder / Osteolysis
The human shoulder has evolved from a weight bearing joint into a finely tuned series of joints enabling significant mobility and precise hand placement for skillful tasks.
Whilst we are still capable of lifting and carrying heavy loads, the large compressive force on the AC joint can lead to inflammation and pain in the joint and the end of the clavicle bone.
Weightlifters of all levels are prone to developing weightlifter’s shoulder, especially those performing pushing movements like bench press, push ups, dips, and overhead press. The joint is placed under particular stress when the elbow drops below or behind the body, for example as the bar approaches the chest during bench press.
Osteolysis of the Clavicle
Continued loading of a symptomatic AC joint and clavicle may result in micro-trauma to the joint surfaces and in some cases, erosion of the bone. Osteolysis of the clavicle can be considered like a stress fracture, requiring significant offloading to allow the bone to heal.
Weightlifter's Shoulder Symptoms:
- Pain on top and/or the front of the shoulder
- Pain on palpation of the AC joint
- Pain and weakness with weight lifting, especially push-ups, bench press, dips, shoulder press and chin ups
- Potential clicking
- Potential pain with end range elevation of the arm over head
- Potential pain with reaching across the body and behind the body
- Potential muscle soreness/tightness into the neck
- Potential pain lying on the affected shoulder, especially at night
Treatment of Weightlifter’s Shoulder
Effective treatment of weightlifter’s shoulder relies on an accurate diagnosis and classification of the severity of the condition.
Rest / Modification of Aggravating Activities:
Severe cases of weightlifter’s shoulder like osteolysis require 6-12 weeks of rest to allow the bone to heal.
Moderate cases - it may be possible to avoid the aggravating activities such as bench press, push-ups, dips and shoulder press but continue with other weight lifting exercises that do not cause pain.
Mild cases - it may be possible to simply modify the technique of aggravating activities in order to reduce stress on the AC joint.
Common modifications include:
- Perform pushing exercises in outer range only - I.e. Don’t let the elbow move behind the body (don’t lower the bar too close to the chest during bench press, don’t try and get the chest too close to the ground during push-ups, etc.)
- Retract (squeeze back) your shoulder blades when performing pushing exercises like bench press
- Try a slightly narrower grip for bench press
- Try incline instead of flat bench press
- Use dumbbells instead of a barbell
Physiotherapy Treatment for Weightlifter’s Shoulder:
- Dry needling or massage to ease muscle tension and pain
- Correction of muscle imbalances
- Technique correction
Medical Treatment for Weightlifter’s Shoulder:
- Anti-inflammatory medication
- Cortisone injection into the AC Joint if inflammation persists
Surgical Management of Persistent Weightlifter’s Shoulder or Osteolysis:
If AC joint pain or osteolysis fails to resolve, a minimally invasive surgical technique may be performed. This involves the removal of less than one centimeter of bone at the end of the clavicle. Thus, preventing the bones of the AC joint grinding together, reducing pain and restoring range of movement.
Recovery time for this procedure is much shorter compared to open surgery, with most patients returning home the next day and resuming full activities within three months.