Weightlifter’s shoulder, also known as distal clavicular osteolysis, is pain arising from the end of the collarbone. The bone undergoes swelling and breakdown, leading to pain near the acromioclavicular joint (or AC joint). This condition is often confused with other shoulder problems in weightlifters, such as AC joint degeneration or shoulder bursitis. So, how do you diagnose and treat the weightlifter’s shoulder?

Causes of weightlifter’s shoulder 

weightlifters shoulder

Typically, distal clavicular osteolysis arises from repetitive overload to the top of the shoulder near the AC joint. This overload causes a breakdown of the bone at the tip of the collarbone (clavicle), leading to swelling and pain. Classically, we see its condition in weightlifters and bodybuilders. However, we also see it in athletes who play a contact sport or lift heavy weights. Occasionally, this condition could be caused by a fall onto the shoulder.


Typically, a diagnosis of weightlifters shoulder is made by the history and examination. In general, pain is worse during and after the gym. Usually, chest press and bench press are the most triggering activities.

Generally, there is tenderness at the tip of the collarbone. Often, people feel pain when moving the arm across the body. It is essential to rule out other causes such as AC joint degeneration, rotator cuff tendonitis, and cartilage tears in the shoulder.

Distal clavicular osteolysis radiology

distal clavicular osteolysis on X-ray

Imaging can help confirm a diagnosis. X-rays reveal cysts and erosions at the tip of the collarbone. MRI shows bone swelling at the collarbone’s end and helps exclude other causes.

Is weightlifters shoulder different from AC joint arthritis? 

So, the simple answer is yes. In the weightlifting shoulder, the collarbone bone swells at the tip. We think this swelling occurs due to too much weight training, usually in younger people. On the contrary, AC joint arthritis is due to wear and tear in the joint and usually occurs in older people. In addition, the treatment of these conditions is different.

Treatment of weightlifters shoulder

Generally, we recommend conservative treatment for all cases of osteolysis of the clavicle.

Firstly, rest from heavy weights is essential. We advise avoiding heavy pressing and overhead activities such as chest and shoulder press. However, you don’t have to stop weights completely. You should be able to substitute other exercises such as decline barbell fly or push-ups, which are usually less painful for distal clavicular osteolysis. Secondly, anti-inflammatory treatments such as ice and ibuprofen tablets help. Thirdly, physiotherapy is helpful to regain function and slowly tiptoe into chest exercises.

In some complicated cases, a cortisone injection directed to the AC joint and tip of the collarbone will help.

Finally, we use surgery to remove the tip of the collarbone in persistent cases. Often, two small instruments are placed in the AC joint to remove swollen tissue and the end of the collar bone. Now, most surgeons do this procedure using a keyhole. However, recovery will take up to 3 months to return to heavy weights, although most people return to light weights after a few weeks.

More about a cortisone injection for a weightlifter’s shoulder

cortisone injection AC joint

Cortisone is a powerful anti-inflammatory drug that reduces inflammation and pain. In distal clavicular osteolysis, a cortisone injection helps reduce inflammation in the collarbone, accelerating recovery. Generally, the effect of a cortisone injection can last for a few months. Occasionally, it might last longer. Therefore, it’s essential to use this pain-free time to change your gym or exercise routine to allow your bone to heal.

Generally, you should have a cortisone injection with ultrasound to improve accuracy and reduce side effects.

Training around the weightlifter’s shoulder 

Matt Curly, rehab injury specialist at Amp,  says most shoulder injuries in weightlifting occur due to an imbalance between pressing and horizontal pulling exercises. Generally, too many pressing and vertical pulls (i.e., pullups) create an imbalance in the shoulder blade leading to injury.

Overall, imbalances of the shoulder blade can be corrected by stretching the pecs, back muscles, and upper traps. In addition, exercises such as scap push up will help improve the shoulder blade’s movement. Also, actively controlling the movement of the shoulder blade during pressing or pulling improves shoulder blade control.

Another fundamental principle is to ensure you perform an equal if not more volume of horizontal pulling exercises such as single arms rows, ring rows, and face pulls.

Final word from Sportdoctorlondon about weightlifter’s shoulder

Distal clavicular osteolysis is a painful condition suffered by athletes who don’t want to stop training. However, the good news is that most get better with relative rest from heavyweights, anti-inflammatory medications, and perhaps a cortisone injection. In the worst scenario, you will need surgery which is usually successful in almost all. You should see a doctor with experience diagnosing and managing this condition.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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