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Musculoskeletal and Sports Medicine

Periosteal Sleeve Avulsion Injury of the Distal Clavicle in a 32-Year-Old Male: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Co-Author(s)

  • Brandon Hassid, MD (he/him/his)

    Assistant Clinical Professor
    University of California Davis Department of PM&R
    Sacramento, California

    • Poster Presenter(s)

  • Anita Shammee, DO

    Resident Physician
    University of California (Davis) Health PM&R Program
    Albany, California

Disclosure(s):
Brandon Hassid, MD: No relevant disclosure to display
Anita Shammee, DO: No financial relationships to disclose
Case Diagnosis: Periosteal sleeve injury of distal clavicle

Case Description or Program Description: A 32-year-old male with remote history of left middle third clavicle fracture managed nonoperatively presented with acute onset of left shoulder pain after falling onto his left shoulder during a soccer match. At the time of injury, he felt a “crunching” sensation and had pain with shoulder flexion. He was seen in Sports Medicine clinic for his initial visit 11 weeks post-injury. At that time, he exhibited tenderness over the distal clavicle and pain with shoulder flexion, abduction and internal rotation.

Setting: Sports Medicine Office Visit

Assessment/Results: MRI revealed a periosteal sleeve injury of the distal clavicle without definite acute fracture as well as a low-grade sprain of the coracoclavicular ligament with no complete tear. Treatment was conservative with physical therapy and gradual return to activity. 6 months post-injury, he was able to perform light weight lifting and had resumed bouldering. He still experiences some discomfort but no significant pain or tenderness to palpation over the AC joint. His range of motion is full and pain free.

Discussion (relevance): Periosteal sleeve avulsion lesions are primarily thought of as pediatric injuries; there are few publications documenting these injuries in adult populations and to our knowledge, none describing an adult clavicle periosteal sleeve avulsion. This case suggests that this injury should be considered in the differential for AC joint and clavicle injuries in adults. Time to full return to activity was longer in this case than what would be expected for AC joint and clavicle fractures, which may guide providers in setting patient expectations. While this patient improved with conservative management over several months, there may be cases where interventional approaches may accelerate recovery.

Conclusions: Periosteal sleeve avulsion fractures need to be considered in adults when evaluating clavicular injuries to ensure appropriate treatment and expectation mangement for recovery timeline.