The os acromiale is a failure of fusion of the acromial secondary ossification centre, present in approximately 8 percent of the population and bilateral in up to 60 percent of cases. The unfused acromial segment is mobile rather than rigidly attached to the scapular spine, and this mobility produces subacromial impingement from inferior displacement of the os acromiale during deltoid contraction, which narrows the subacromial space dynamically.
Os acromiale can produce impingement symptoms indistinguishable from rotator cuff impingement from conventional subacromial causes. MRI may show oedema at the synchondrosis (unstable os acromiale syndrome) or simply the ossicle without oedema. Treatment ranges from conservative management to acromioplasty (resection of the os acromiale) or open reduction and internal fixation (ORIF) of the mobile segment for young patients.
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