The acromion is the flat bony projection of the scapular spine that forms the roof of the shoulder joint and the lateral shoulder bony landmark. It articulates with the lateral clavicle at the acromioclavicular joint and with the coracoacromial ligament medially to form the coracoacromial arch — the structural arch under which the rotator cuff and subacromial bursa reside. Its shape (flat, curved, or hooked) determines subacromial space dimensions and impingement risk.
Bigliani type I (flat), II (curved), and III (hooked) acromial morphology determines subacromial space dimensions. Type III hooked acromia are associated with higher rates of rotator cuff tears from direct supraspinatus contact with the acromion undersurface during elevation. Subacromial decompression (acromioplasty) removes the anterior inferior acromion hook to increase subacromial space.
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