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Os acromiale: evaluation and treatment.

Thomas Youm1, Jan Pieter Hommen, Bernard C Ong

  • 1Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, New York, USA. youmt01@yahoo.com

American Journal of Orthopedics (Belle Mead, N.J.)
|August 3, 2005
PubMed
Summary

Os acromiale, a condition where the acromion fails to fuse, can mimic shoulder impingement. Nonoperative treatments are recommended for at least six months before considering surgical options like decompression or fragment excision/fixation.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Skeletal Development

Background:

  • Os acromiale is a congenital condition resulting from the failure of the distal acromion to fuse.
  • It is often found incidentally but can manifest with symptoms similar to subacromial impingement syndrome.

Purpose of the Study:

  • To review the clinical presentation, diagnostic considerations, and management strategies for symptomatic os acromiale.
  • To evaluate the efficacy of both nonoperative and operative treatment modalities.

Main Methods:

  • Review of current literature on os acromiale diagnosis and treatment.
  • Analysis of nonoperative management options including physical therapy, medication, and injections.
  • Evaluation of surgical interventions such as subacromial decompression, fragment excision, and fragment fixation.

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Main Results:

  • Nonoperative management (activity modification, physical therapy, NSAIDs, corticosteroid injections) should be attempted for a minimum of six months.
  • Subacromial decompression is frequently indicated for impingement symptoms.
  • Excision is effective for smaller os acromiale fragments (<3 cm), while fixation with or without grafting is a viable option for larger fragments, often combined with physical therapy.

Conclusions:

  • Symptomatic os acromiale requires a structured treatment approach, prioritizing conservative measures.
  • Surgical intervention, including decompression, excision, or fixation, should be tailored to fragment size and patient factors.
  • Surgical fixation offers a reliable solution for larger fragments when combined with a comprehensive rehabilitation program.