A bilateral benign-like lesion of the acromioclavicular joints in an early 19th century Londoner

A.E.W. Miles


On the upper surfaces of both acromions of a man aged 63 years, close to the joint with the clavicle, there were cavities of complex rounded shape showing detailed bilateral symmetry although the right acromial articular facet was destroyed and the left one only partially. Slow-growing, benign and probably lobulated or polycystic lesions were regarded as responsible. Of the tumors considered, none show any tendency to bilaterality, but synoviomas or some form of fribroma or lipoma seemed the least unlikely. The left joint showed moderately severe osteoarthrosis and it could be assumed that the right one had also. The preferred diagnosis offered is that the lesions were an unusual complication of the osteoarhrosis of which bone destruction is a feature though often passing into a bone-formative phase. Proliferating destructive tissue arises beneath the articular surface which it tends to penetrate and often the juxta-articular cortex as well so producing larger-scale destruction. The tissue often shows areas of polycystic degeneration which enhance the tendency of the tissue to enlarge. It is postulated that the stages of formation of the lesions were: bone destruction undermined the acromial articular facets and extended unusually deeply into the bone of the acromion, a process aided by cystic degeneration. Probably commencing close to the facets, the cortex of the upper surface of the acromion was broken through. Proliferating tissue came into contact with the clavicular surfaces and eroded them. The bone lining the lesional cavities suggests quiescence rather than activity so it is likely that the events postulated occurred several years previously and had since remained static.

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