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Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion

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Abstract

Background

Although acromial morphology is classified as flat, curved, and hooked, whether the morphology is primary or acquired is debated. There have been no investigations on the effect of acromial spurs on acromial morphology. This study therefore aimed to evaluate acromial morphology in relation to spur formation at the anterior edge of the acromion.

Materials and Methods

Acromial morphology was investigated in 40 scapulae taken from 20 cadavers (10 male and 10 female), with a median age of 82 years (range 62–97 years). Ink prints of the anteroposterior aspect of the acromion were used to evaluate acromial slope angle and curvature height in relation to spur incidence, length, and shape at the anterior edge of the acromion.

Results

Differences were observed in acromial morphology and acromial curvature in relation to acromial spurs (incidence, size, and shape). A hooked acromion was observed as a primary structure in 25% of specimens, which increased to 43% when acromial spurs were involved. No differences were observed in relation to sex or side, while a significant correlation was observed between acromial curvature and the age of the specimens.

Conclusion

Acromial spurs increase acromial curvature and therefore change acromion morphology. Nevertheless, it is concluded that a hooked acromion occurs as a primary formed structure.

Level of evidence

Basic science study, anatomy, cadaver dissection.

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References

  1. Alobaidy MA, Alraddadi AS, Soames RW (2015) Evaluation of acromial geometry in relation to the cuff tears on Thiel-embalmed cadavers using 3D microscribe digitizer. Revista Argentina de Anatomía Clínica 7(2):93–99

    Google Scholar 

  2. Aoki M, Ishii S, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10:228

    Google Scholar 

  3. Aydin A, Yildiz A, Kalali F, Yildirim OS, Topal M, Dostbil A (2011) The role of acromion morphology in chronic subacromial impingement syndrome. Acta Orthop Belg 77(6):733–736

    PubMed  Google Scholar 

  4. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D (2013) Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 84(2):178–183. https://doi.org/10.3109/17453674.2013.773413

    Article  PubMed  PubMed Central  Google Scholar 

  5. Banas MP, Miller RJ, Totterman S (1995) Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elb Surg 4(6):454–461. https://doi.org/10.1016/S1058-2746(05)80038-2

    Article  CAS  Google Scholar 

  6. Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228

    Google Scholar 

  7. Chun JM, Yoo HW (1994) Incidence of acromial spur. J Shoulder Elb Surg 3:20

    Article  Google Scholar 

  8. Cho BP, Kang HS (1998) Articular facets of the coracoclavicular joint in Koreans. Acta Anat 163(1):56–62. https://doi.org/10.1159/000046446

    Article  CAS  PubMed  Google Scholar 

  9. Edelson JG, Luchs J (1995) Aspects of coracoacromial ligament anatomy of interest to the arthroscopic surgeon. Arthrosc J Arthroscop Relat Surg 11(6):715–719. https://doi.org/10.1016/0749-8063(95)90115-9

    Article  CAS  Google Scholar 

  10. Edelson JG, Taitz C (1992) Anatomy of the coracoacromial arch: relation to degeneration of the acromion. J Bone Jt Surg (Br) 74:589–594

    Article  CAS  Google Scholar 

  11. Edelson JG (1995) The “Hooked” acromion revisited. J Bone Jt Surg (Br) 77:284–287

    Article  CAS  Google Scholar 

  12. Epstein RE, Schweitzer ME, Frieman BG, Fenlin JM Jr, Mitchell DG (1993) Hooked acromion: prevalence on MR images of painful shoulders. Radiology 187(2):479–481. https://doi.org/10.1148/radiology.187.2.8475294

    Article  CAS  PubMed  Google Scholar 

  13. Farley TE, Neumann CH, Steinbach LS, Petersen SA (1994) The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology. Skelet Radiol 23(8):641–645. https://doi.org/10.1007/BF02580386

    Article  CAS  Google Scholar 

  14. Flatow EL, Soslowsky LJ, Ticker JB, Pawluk RJ, Hepler M, Ark J, Mow VC, Bigliani LU (1994) Excursion of the rotator cuff under the acromion patterns of subacromial contact. Am J Sports Med 22(6):779–788

    Article  CAS  PubMed  Google Scholar 

  15. Getz JD, Recht MP, Piraino DW, Schils JP, Latimer BM, Jellema LM, Obuchowski NA (1996) Acromial morphology: relation to sex, age, symmetry, and subacromial enthesophytes. Radiology 199:737–742. https://doi.org/10.1148/radiology.199.3.8637998

    Article  CAS  PubMed  Google Scholar 

  16. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD (2012) Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elb Surg 21(10):1289–1298. https://doi.org/10.1016/j.jse.2011.09.028

    Article  Google Scholar 

  17. Hirano M, Ide J, Takagi K (2002) Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation. J Shoulder Elb Surg 11(6):576–578. https://doi.org/10.1067/mse.2002.127097

    Article  Google Scholar 

  18. MacGillivray JD, Fealy S, Potter HG, O’Brien SJ (1998) Multiplanar analysis of acromion morphology. Am J Sports Med 26(6):836–840

    Article  CAS  PubMed  Google Scholar 

  19. Mahakkanukrauh P, Surin P (2003) Prevalence of osteophytes associated with the acromion and acromioclavicular joint. Clin Anat 16(6):506–510. https://doi.org/10.1002/ca.10182

    Article  PubMed  Google Scholar 

  20. Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S (2014) Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elb Surg 23(4):536–541. https://doi.org/10.1016/j.jse.2013.11.008

    Article  Google Scholar 

  21. Musil D, Sadovský P, Rost M, Stehlík J, Filip L (2012) Relationship of acromial morphology and rotator cuff tears. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 79(3):238–242

    CAS  PubMed  Google Scholar 

  22. Natsis K, Tsikaras P, Totlis T, Gigis I, Skandalakis P, Appell HJ, Koebke J (2007) Correlation between the four types of acromion and the existence of enthesophytes: a study on 423 dried scapulae and review of the literature. Clin Anat 20(3):267–272. https://doi.org/10.1002/ca.20320

    Article  CAS  PubMed  Google Scholar 

  23. Neer CSII (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Jt Surg 54(Am):41–50. https://doi.org/10.2106/JBJS.8706.cl

    Article  Google Scholar 

  24. Neer CS (1983) Impingement lesion. Clin Orthop Rel Res 173:70–77

    Google Scholar 

  25. Nicholson GP, Goodman DA, Flatow EL, Bigliani LU (1996) The acromion morphologic condition and age-related changes: a study of 420 scapulae. J Shoulder Elb Surg 5:1–11. https://doi.org/10.1016/S1058-2746(96)80024-3

    Article  CAS  Google Scholar 

  26. Ogata S, Uhthoff HK (1990) Acromial enthesopathy and rotator cuff tear: a radiologic and histologic postmortem investigation of the coracoacromial arch. Clin Orthop Rel Res 254:39–48. https://doi.org/10.1097/00003086-199005000-00006

    Article  Google Scholar 

  27. Oh JH, Kim JY, Lee HK, Choi JA (2010) Classification and clinical significance of acromial spur in rotator cuff tear: heel-type spur and rotator cuff tear. Clin Orthop Relat Res 468:1542–1550. https://doi.org/10.1007/s11999-009-1058-5

    Article  PubMed  Google Scholar 

  28. Panni AS, Milano G, Lucania L, Fabbriciani C, Logroscino CA (1996) Histological analysis of the coracoacromial arch: correlation between age-related changes and rotator cuff tears. J Arthroscop Relat Surg 12(5):531–540. https://doi.org/10.1016/S0749-8063(96)90190-5

    Article  CAS  Google Scholar 

  29. Paraskevas G, Tzaveas A, Papaziogas B, Kitsoulis P, Natsis K, Spanidou S (2008) Morphological parameters of the acromion. Folia Morphol 67(4):255–260

    CAS  Google Scholar 

  30. Prescher A (2000) Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle. Eur J Radiol 35(2):88–102. https://doi.org/10.1016/S0720-048X(00)00225-4

    Article  CAS  PubMed  Google Scholar 

  31. Sangiampong A, Chompoopong S, Sangvichien S, Thongtong P, Wongjittraporn S (2007) The acromial morphology of Thais in relation to gender and age: study in scapular dried bone. J Med Assoc Thai 90(3):502–507

    PubMed  Google Scholar 

  32. Shah NN, Bayliss NC, Malcolm A (2001) Shape of the acromion: congenital or acquired: a macroscopic, radiographic, and microscopic study of acromion. J Shoulder Elb Surg 10(4):309–316. https://doi.org/10.1067/mse.2001.114681

    Article  CAS  Google Scholar 

  33. Speer KP, Osbahr DC, Montella BJ, Apple AS, Mair SD (2001) Acromial morphotype in the young asymptomatic athletic shoulder. J Shoulder Elb Surg 10(5):434–437. https://doi.org/10.1067/mse.2001.117124

    Article  CAS  Google Scholar 

  34. Toivonen DA, Tuite MJ, Orwin JF (1995) Acromial structure and tears of the rotator cuff. J Shoulder Elb Surg 4:376–383. https://doi.org/10.1016/S1058-2746(95)80022-0

    Article  CAS  Google Scholar 

  35. Tuite MJ, Toivonen DA, Orwin JF. Wright DH (1995) Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears. AJR Am J Roentgenol 165(3):609–613. https://doi.org/10.2214/ajr.165.3.7645479

    Article  CAS  PubMed  Google Scholar 

  36. Vahakari M, Leppilahti J, Hyvonen P, Ristiniemi J, Paivansalo M, Jalovaara P (2010) Acromial shape in asymptomatic subjects: a study of 305 shoulders in different age groups. Acta Radiol 51(2):202–206

    Article  PubMed  Google Scholar 

  37. Vassalou E, Fragkiadoulaki V, Maidas P, Magkanas E, Karantanas A, Heraklion GR (2012) Age-related coracoacromial arch morphometry: a MR imaging study. Skelet Radiol 40:810

    Google Scholar 

  38. Wang J, Huang F (2009) A biomechanical study on coracoacromial ligament as anterosuperior restraint of shoulder joint. Chin J Reparative Reconstr Surg 23(1):49–51

    CAS  Google Scholar 

  39. Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J (2003) Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc 12:23–26

    CAS  PubMed  Google Scholar 

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Acknowledgements

Special thanks to the Centre for Anatomy and Human Identification (CAHID) for providing a professional environment to enable this study to be undertaken, and to those who donated their bodies for medical education and research.

Funding

A. Alraddadi received funding from King Saud bin Abdulaziz University for Health Sciences.

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Authors and Affiliations

  1. Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK

    Abdulrahman Alraddadi, Abduelmenem Alashkham, Clare Lamb & Roger Soames

  2. Department of Basic Medical Sciences, College of Medicine-Riyadh, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Mail Code 3127, P.O. Box 3660, Riyadh, 11481, Kingdom of Saudi Arabia

    Abdulrahman Alraddadi

  3. Centre for Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK

    Abduelmenem Alashkham

Authors
  1. Abdulrahman Alraddadi
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  2. Abduelmenem Alashkham
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  3. Clare Lamb
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  4. Roger Soames
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Contributions

AA: data collection, analysis, and interpretation, and manuscript writing; AA: data collection; RS and CL: study supervision and manuscript writing.

Corresponding author

Correspondence to Abdulrahman Alraddadi.

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Ethical approval

As the study was conducted on cadaveric material relevant consent had been obtained at the time of body donation in accordance with the Human Anatomy (Scotland) Act 2006.

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Obtained prior to and at the time of body donation.

Conflict of interest

None of the authors have any conflict of interest with the content of this manuscript.

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Alraddadi, A., Alashkham, A., Lamb, C. et al. Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion. Surg Radiol Anat 41, 409–414 (2019). https://doi.org/10.1007/s00276-018-2141-y

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  • DOI: https://doi.org/10.1007/s00276-018-2141-y

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