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Review
. 2018 Feb 14:10:1-7.
doi: 10.2147/ORR.S141480. eCollection 2018.

Optimal management of symptomatic os acromiale: current perspectives

Ulrich J Spiegl  1 , Peter J Millett  2 , Christoph Josten  1 , Pierre Hepp  1
Affiliations
Review

Optimal management of symptomatic os acromiale: current perspectives

Ulrich J Spiegl et al. Orthop Res Rev. .

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.

Keywords: nonoperative treatment; open or arthroscopic excision; os acromiale; osteosynthesis techniques; surgical treatment.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Three-dimensional reconstruction of the acromion including the lateral clavicle. Note: The location of pre-, meso-, and meta-type os acromiale is shown.
Figure 2
Figure 2
The technique of screw osteosynthesis with tension band is illustrated from cranial view (A) and anterior view (B).
Figure 3
Figure 3
Radiograph of 43-year-old female with a history of 1 year of therapy-resistant pain at her right shoulder with pain on pressure on the right acromion. Notes: A meso-type os acromiale is visible on the conventional axial radiograph (A). The MRI depicts edema at the region of the os acromiale (white arrows; B, C). Thus, resection of the pseudarthrosis and osteosynthesis with cannulated screws and tension band was performed (D, E). The patient was very satisfied 6 months postoperatively as she was without pain and had free shoulder function. Abbreviation: MRI, magnetic resonance imaging.
See this image and copyright information in PMC

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