Do you even lift, Bro?


It’s not just bro’s that lift – I met a fascinating lady yesterday who lifts more than I could in just her warm up. She was suffering from ACJ osteolysis. She told me she had been told that she would “never get over the erosion of the ACJ” and was given the impression she would not be able to lift heavy or competitively. It was disappointing for me to hear that people are still wing given the impression that they should not be pushing weights or pursuing strength training.

Osteolysis means “the pathological destruction or disappearance of bone tissue”. This happens in the AC joint when the end of the clavicle rubs against the ACJ while loaded with heavy forces such as weightlifting, thereby giving it the name “weightlifter’s shoulder”.

Patients will usually be under the age of 40 and present with:

  • Pain over the AC Joint
  • Osteolysis on x-ray and
  • Positive scarf test

Treatment does not always have to involve surgery. The first course should include rest, NSAIDs, possibly an injection and physiotherapy. In this case and is most other cases where an injection is given this would be to allow something else to work – whether that something else is rest, activity modification or physical therapy (in my practice I would always counsel for physical therapy as patients who present with this are usually motivated to get back to the gym and need support to achieve this).

If surgery is indicated then the aim is to remove the eroded bone, and to provide a wide enough healthy space so that the clavicle and acromion don’t irritate each other, followed by good physical therapy.

My advice to my patient yesterday included an explanation that the shoulder joint is not like the knee, where treatment protocols are usually more straightforward. Of all the joints shoulders are pretty complex and I work closely with my physical therapy colleagues to help my patients make a full, and guided recovery.

With thanks for the 📷 to @katiepistello