Optimal management of symptomatic os acromiale: current perspectives

Abstract

The majority of os acromiale is asymptomatic and requires no treatment. In patients with shoulder pain, os acromiale is a possibility in the differential diagnosis and may imitate shoulder impingement. The diagnosis of symptomatic os acromiale can be proven by combining physical examination, conventional radiographs, magnetic resonance imaging, and selective injections. Surgical treatment is indicated in those patients with failed conservative therapy, in those with highly painful and unstable os acromiale, or in those with associated shoulder pathologies such as rotator cuff tears. Open or arthroscopic excision is indicated in patients with pre-type os acromiale. In meso-type acromiale, arthroscopic excision, acromioplasty, or open reduction and internal fixation have all been used, but fixation is usually preferred. Internal fixation should be done either with cannulated screws alone or in combination with tension band, which has biomechanical advantages.

Reverse shoulder arthroplasty with os acromiale

“…Os acromiale can be treated conservatively in asymptomatic cases or with surgery in cases with symptoms. Surgery is mainly comprised of excision, acromioplasty, and fixation [ 2 , 7 ]. Though no direct connection with rotator cuff tear has been demonstrated [ 1 ], some have argued that the lateral fragment of the os acromiale can be downsloped and cause impingement [ 8 ].…”

“…It is divided into preacromion, meso-acromion, meta-acromion, and basiacromion areas and is classified based on area ( Fig. 1 ) [ 1 , 2 ]. The prevalence of os acromiale varies from 1.9% to 15% depending on population [ 3 ].…”

Rare Symptomatic Meta–Os Acromiale in an Athlete

“…16,17 If this results in symptom resolution, it may be beneficial to perform a one-time corticosteroid injection. 2,16,17 MRI can also be helpful in identifying a symptomatic os acromiale by demonstrating marrow edema and increased signal along the opposing sides of the nonunion, as well as sclerotic and cystic changes. 16,21 In addition, MRI allows for rotator cuff evaluation.…”

“…2,16,17 MRI can also be helpful in identifying a symptomatic os acromiale by demonstrating marrow edema and increased signal along the opposing sides of the nonunion, as well as sclerotic and cystic changes. 16,21 In addition, MRI allows for rotator cuff evaluation. This is important because rotator cuff tears are sometimes associated with symptomatic meso–os acromiale.…”

“…The os acromiale was first described in 1863 by Gruber, 8 who identified 3 cases of os acromiale in his study of 100 cadavers. 16 There are 4 ossific nuclei in the acromion, which consolidate between ages 14 and 25 years. 7,16,21 The pre-acromion is the most anterior, serving as the attachment of the coracoacromial ligament and the anterior deltoid.…”