Abstract
Objective
Acromial fusion may not be complete until age 18–25, making it questionable to diagnose os acromiale in adolescents. Os acromiale may exist in adolescents and can be differentiated from a developing acromial ossification center based on MRI findings.
Materials and methods
A total of 128 MRIs of the shoulder were randomly and blindly reviewed retrospectively by two musculoskeletal radiologists. The MRIs consisted of two groups: (1) 56 of os acromiale in adults (25–74 years old, mean, 50) and (2) 72 consecutive of adolescents (12–17 years old, mean, 14.5). The following were assessed at the interface between the distal acromion and os acromiale/developing ossification center(s): presence of os acromiale vs. developing acromion, orientation, margins, and edema within and adjacent to it.
Results
Fifty-one adults and 49 adolescents were included. Exclusions were due to poor image quality or confounding findings (n = 7) or complete acromial fusion (n = 21 adolescents). Utilizing accepted definitions of os acromiale, all adult cases (100 %) were accurately diagnosed as os acromiale, with transverse interface orientation and irregular margins (94 %, R = 0.86, p < 0.00001). Forty-five (92 %) adolescent cases were accurately diagnosed as normally developing acromion with arched interface and lobulated margins (92 %, R = 0.92, p < 0.000001). Four (8 %) adolescent cases were diagnosed as having os acromiale, with transverse orientation and irregular margins. Thirty-five (69 %) and 46 (90 %) adults had marrow and interface edema, respectively. Six (12 %) and eight (16 %) adolescents had marrow and interface edema, respectively, including the four concluded to be os acromiale.
Conclusions
Adolescents may have imaging findings consistent with os acromiale. The diagnosis of os acromiale should be based on imaging features and not limited by age.
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References
Barbier O, Block D, Dezaly C, Sirveaux F, Mole D. Os acromiale, a cause of shoulder pain, not to be overlooked. Orthop Traumatol Surg Res. 2013;99:465–72.
Frizziero A, Benedetti MG, Creta D, Moio A, Galletti S, Maffulli N. Painful os acromiale: conservative management in a young swimmer athlete. J Sports Sci Med. 2012;11:352–6.
Bedi A, Rodeo SA. Os acromiale as a cause for shoulder pain in a competitive swimmer: a case report. Sports Health. 2009;1(2):121–4.
Smith J, Dahm DL, Newcomer-Aney KL. Role of sonography in the evaluation of unstable os acromiale. J Ultrasound Med. 2008;27:1521–6.
Pagnani MJ, Mathis CE, Solman CG. Painful os acromiale (or unfused acromial apophysis) in athletes. J Should ElbSurg. 2006;15:432–5.
Demetracopoulos CA, Kapadia NS, Herickhoff PK, Cosgarea AJ, McFarland EG. Surgical stabilization of os acromiale in a fast-pitch softball pitcher. Am J Sports Med. 2006;34(11):1855–9.
Sassmannshausen G, Wilson TC, Mair SD. Operative stabilization of an unstable os acromiale in an adolescent football player. Orthopedics. 2003;26(5):509–11.
Granieri GF, Bacarini L. A little-known cause of painful shoulder: os acromiale. Eur Radiol. 1998;8:130–3.
Johnston PS, Paxton S, Gordon V, Kraeutler MJ, Abboud JA, Williams GR. Os acromiale: a review and an introduction of a new surgical technique for management. Orthop Clin N Am. 2013;44:635–44.
Harris JD, Griesser MJ, Jones GL. Systematic review of the surgical treatment for symptomatic os acromiale. Int J Should Surg. 2011;5(1):9–16.
Sahajpal D, Strauss EJ, Ishak C, Keyes JMO, Joseph G, Jazrawi LM. Surgical management of os acromiale: a case report and review of the literature. Bull Hosp Jt Dis. 2007;65(4):312–6.
Kurtz CA, Humble BJ, Rodosky MW, Sekiya JK. Symptomatic os acromiale. J Am Acad Orthop Surg. 2006;14:12–9.
Peckett WRC, Gunther SB, Harper GD, Hughes JS, Sonnabend DH. Internal fixation of symptomatic os acromiale: a series of twenty-six cases. J Should Elb Surg. 2004;13:381–5.
Ortiguera CJ, Buss DD. Surgical management of the symptomatic os acromiale. J Should Elb Surg. 2002;11:521–8.
Wright RW, Heller MA, Quick DC, Buss DD. Arthroscopic decompression for impingement syndrome secondary to an unstable os acromiale. Arthroscopy. 2000;16(6):595–9.
Warner JJ, Beim GM, Higgins L. The treatment of symptomatic os acromiale. J Bone Joint Surg Am. 1998;80(9):1320–6.
Edelson JG, Zuckerman J, Hershkovitz I. Os acromiale: anatomy and surgical implications. J Bone Joint Surg (Br). 1993;75(4):551–5.
Ouellette H, Thomas BJ, Kassarjian A, Fritz B, Tétreault P, Palmer WE, et al. Re-examining the association of os acromiale with supraspinatus and infraspinatus tears. Skeletal Radiol. 2007;36:835–9.
Abboud JA, Silverberg D, Pepe M, Beredjiklian PK, Iannotti JP, Williams GR, et al. Surgical treatment of os acromiale with and without associated rotator cuff tears. J Should Elb Surg. 2006;15:265–70.
Boehm TD, Matzer M, Brazda D, Gohlke FE. Os acromiale associated with tear of the rotator cuff treated operatively: review of 33 patients. J Bone Joint Surg. 2003;85-B(4):545–9.
Park JG, Lee JK, Phelps CT. Os acromiale associated with rotator cuff impingement: MR imaging of the shoulder. Radiology. 1994;193(1):255–7.
Gordon BH, Chew FS. Isolated acromioclavicular joint pathology in the symptomatic shoulder on magnetic resonance imaging: a pictorial essay. J Comput Assist Tomogr. 2004;28(2):215–22.
Kothary P, Rosenberg ZS. Skeletal developmental patterns in the acromial process and distal clavicle as observed by MRI. Skeletal Radiol. 2015;44(2):207–15.
Macalister A. Notes on the acromion. J Anat Physiol. 1893;23(7):245–51.
Gumina S, De Santis P, Salvatore M, Postacchini F. Relationship between os acromiale and acromioclavicular joint anatomic position. J Should Elb Surg. 2003;12:6–8.
Prescher A. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle. Eur J Radiol. 2000;35:88–102.
McClure JG, Raney RB. Anomalies of the scapula. Clin Orthop Rel Res. 1975;110:22–31.
Sammarco VJ. Os acromiale: frequency, anatomy, and clinical implications. J Bone Joint Surg Am. 2000;82(3):394–400.
Liberson F. Os acromiale – a contested anomaly. J Bone Joint Surg. 1937;19:683–9.
Symington J. On separate acromion process. J Anat Physiol. 1900;34(14):287–94.
Stirland A. A possible correlation between os acromiale and occupation in the burials from the Mary Rose. Proceedings of the Fifth European Meeting of the Paleopathology Association, Siena. 1984; 327–334.
Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology. 2015;274:201–9.
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Winfeld, M., Rosenberg, Z.S., Wang, A. et al. Differentiating os acromiale from normally developing acromial ossification centers using magnetic resonance imaging. Skeletal Radiol 44, 667–672 (2015). https://doi.org/10.1007/s00256-015-2098-4
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DOI: https://doi.org/10.1007/s00256-015-2098-4