Evaluation and Treatment of the Os Acromiale

Authors: A Castagna

References: Practical Arthroscopy, September 2004

The os acromiale should not be diagnosed before the age of 22. Prior to this the age, the bone is ossifying. The diagnosis can be made by the patient’s symptoms of pain, local tenderness, and x-ray evaluation. The outlet view and axillary x-ray views (best) demonstrate the os acromiale. The lesion can also be diagnosed arthroscopically by pushing on the lesion with the scope in the sub-acromial space.

But, is the os acromiale really the cause of the pain? There is a high incidence of associated rotator cuff tears in the patients with os acromiale. Perhaps the repair of the rotator cuff is what alleviates the pain.

The treatment should initially be conservative. Surgical treatment by sub-acromial decompression had poor results reported by Hutchinson. Others have reported a good result, but a bony shell should be left superiorly. In a small series of five patients reported by Costagna, with repair of rotator cuff and sub-acromial debridement of the os acromiale, the results were good. The ORIF has variable results. Removal of the fragment has been reported by Warner to have two out of three with good results. Warner also has a series of ORIF with bone graft that had good results. The results by Wolf and Savoie are also reported as good with arthroscopic excision.

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