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The Journal of the American Academy of... Nov 2018Management of a persistently symptomatic, unstable os acromiale remains controversial. An unstable os acromiale is an easy diagnosis to miss and should be specifically... (Review)
Review
Management of a persistently symptomatic, unstable os acromiale remains controversial. An unstable os acromiale is an easy diagnosis to miss and should be specifically evaluated for in patients with shoulder pain and a high degree of clinical suspicion. Surgical options include open or arthroscopic excision and open reduction and internal fixation. Open excision of large fragments has had poor results. Arthroscopic treatment is commonly used for small fragments (preacromion), and the technique has also been used in larger fragments (meso-os), but concerns persist over postoperative weakness secondary to shortening of the deltoid lever arm. Open reduction and internal fixation through a transacromial approach has been shown to have predictable union rates but can be complicated by symptomatic implant. Recent biomechanical studies have expanded our understanding of optimal fixation constructs, which may also decrease implant-related issues. Ultimately, the choice of which procedure to use will be dictated by patient factors such as age, activity level, and the nature of rotator cuff pathology. LEVEL OF EVIDENCE:: Level V.
Topics: Acromion; Arthroscopy; Biomechanical Phenomena; Humans; Magnetic Resonance Imaging; Orthopedic Procedures; Radiography; Shoulder Pain
PubMed: 30199476
DOI: 10.5435/JAAOS-D-17-00011 -
Surgical and Radiologic Anatomy : SRA Jun 2019Anatomical variations of the lateral offset of the acromion (LOA) are supposed to be a factor favoring of the development of rotator cuff tears. The primary objective of...
INTRODUCTION
Anatomical variations of the lateral offset of the acromion (LOA) are supposed to be a factor favoring of the development of rotator cuff tears. The primary objective of this study is to quantify the inter-individual variations of the lateral offset of the acromion.
METHODS
The morphology of 103 dried scapula was studied. Scapula with an os-acromiale, fractures and osteoarthritic changes of the glenoid cavity were excluded. We measured the distance between the medial edge of the spine and the supra-glenoidal tubercle of the glenoid fossa (L), as well as the distance between this medial point and the most lateral point of the acromion (L). Then, the acromial offset = (L - L), in absolute value (mm) and in relative value (% of L) were calculated.
RESULTS
The absolute average offset is 3.2 cm (SD = 0.4040 cm), the relative average offset is 23.07% (SD = 2.195%). We observed a non-Gaussian distribution of the LOA, with two peaks of distribution of which average and the median offset measurements are situated between these two distributions.
CONCLUSION
This study shows that there are two different morphologies for the scapula, characterized by the lateral offset of their acromion: small or large lateral offset. Clinical implications in shoulder pathology seem important because the resultant of the constraints applied by the deltoid to the joint would favor either rotator cuff tears, or scapulohumeral arthrosis.
Topics: Acromion; Anatomic Variation; Deltoid Muscle; Humans; Osteoarthritis; Rotator Cuff Injuries; Shoulder Joint
PubMed: 30989351
DOI: 10.1007/s00276-019-02241-8 -
Acta Ortopedica Mexicana 2023the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the...
INTRODUCTION
the acromion is a small portion of the scapula that extends towards the anterior region from the spine of the scapula. Traditionally, the acromion is classified by the shape of its inferior surface in a sagittal plane. Acromial morphology has been found to be related to rotator cuff injury.
OBJECTIVE
to determine the association between the type of acromion with a higher incidence of rotator cuff rupture. Study population: patients who come to the Traumatology and Orthopedics Service of a third level hospital at Monterrey, Mexico, due to a painful shoulder and who have undergone a simple magnetic resonance of the shoulder.
MATERIAL AND METHODS
a cross-sectional, retrospective and descriptive study was carried out, in which 273 magnetic resonance studies were reviewed in patients who met the inclusion criteria. The type of acromion was reported according to the morphological classification in type I to IV and the state of the rotator cuff: without rupture, partial rupture or complete rupture, making a comparison between right and left shoulder.
RESULTS
in this study we found a value of p = 0.473 which concludes that there is no relation between the type of acromion and the injury of the rotator cuff.
CONCLUSION
in the present study, unlike what has been published in the literature, it was found that type II acromion was the one that was associated in most cases with a rotator cuff tear.
Topics: Humans; Rotator Cuff; Acromion; Retrospective Studies; Cross-Sectional Studies; Shoulder Joint; Rotator Cuff Injuries; Rupture; Magnetic Resonance Spectroscopy
PubMed: 38373729
DOI: No ID Found -
Clinics in Orthopedic Surgery Jun 2017Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was...
BACKGROUND
Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations.
METHODS
We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups.
RESULTS
The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups (<0.001, 95% confidence interval). The AI was not related to tear size.
CONCLUSIONS
Our study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.
Topics: Acromion; Adult; Aged; Aged, 80 and over; Asian People; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; ROC Curve; Republic of Korea; Retrospective Studies; Rotator Cuff Injuries
PubMed: 28567226
DOI: 10.4055/cios.2017.9.2.218 -
Operative Orthopadie Und Traumatologie Jun 2014Reconstruction of the acromion, to achieve pain relief and better function of the deltoid muscle.
OBJECTIVE
Reconstruction of the acromion, to achieve pain relief and better function of the deltoid muscle.
INDICATIONS
After partial or complete removal of the acromion.
CONTRAINDICATIONS
General surgical contraindications. Paresis of the axillary nerve.
SURGICAL TECHNIQUE
Strategy of the operation with X-ray and CT scan. Patient in beach chair position. Disinfection of the shoulder and lateral pelvic region. Exploration of the defect area and searching for the lateral clavicula and spinascapulae end. Removal of a pelvic bone block. Fixation of the pelvic bone block to the spina scapulae with K-wires and finally osteosynthesis by a Reco plate (Synthes, Umkirch, Germany), wound closure.
POSTOPERATIVE MANAGEMENT
For the first 6 weeks, a cast with the arm in 90° abduction. Passive motion without the cast should be performed once a day. Starting in week 7, weekly reduction of abduction (90°/60°/30°/0°). Active mobilization starting in week 10. Start to practice with weight bearing in week 13.
RESULTS
Pain relief improved from VAS 7-9 to VAS 2-3. Improved ROM can be seen postoperatively and after 6 months for abduction/adduction 50-0-50°, anteversion/retroversion 80-0-10°, rotation out/in 40-0-10°.
Topics: Acromion; Arthroscopy; Bone Resorption; Combined Modality Therapy; Decompression, Surgical; Humans; Plastic Surgery Procedures; Treatment Outcome
PubMed: 24924507
DOI: 10.1007/s00064-013-0281-0 -
Orthopaedic Surgery Oct 2019Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the... (Review)
Review
Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X-ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT-CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti-inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently.
Topics: Acromion; Arthroscopy; Diagnosis, Differential; Humans; Internal Fixators; Musculoskeletal Abnormalities; Radiography
PubMed: 31486589
DOI: 10.1111/os.12518 -
The American Journal of Sports Medicine 1998To more completely describe acromion morphology and its relationship to impingement syndrome, we performed three-dimensional magnetic resonance imaging (N = 111) or...
To more completely describe acromion morphology and its relationship to impingement syndrome, we performed three-dimensional magnetic resonance imaging (N = 111) or computed tomography (N = 27) on 132 symptomatic shoulders. The mean patient age was 46.2 years (range, 14 to 86). Four parameters were evaluated: the angle of anterior slope of the acromion in the midsagittal and lateral-sagittal planes, lateral acromial angulation in the coronal plane, and the presence or absence of medial encroachment in the acromioclavicular joint. Twenty-five asymptomatic age-matched shoulders were used as controls. All imaging data were combined because no significant differences existed between the two imaging techniques. The mean acromion angle was 19.4 degrees in the midsagittal plane and 20 degrees in the lateral-sagittal plane. In the coronal plane, 97 (73%) acromions were neutral and 35 (27%) were downward sloping. Medial encroachment was present in 31 (24%) shoulders. Age distribution from the 2nd to 8th decade demonstrated a consistent and gradual transition from a flat acromion in the younger decades to a more hooked acromion in the older decades that was significant in both the midsagittal and lateral-sagittal planes. Furthermore, a greater percentage of patients were found to have downward angulating acromions with increasing age. Ninety-eight patients (74%) had stage II or III impingement. Of these shoulders, 39 (40%) had type I acromions, 51 (52%) type II, and 8 (8%) type III. Twenty-eight of 33 acromions with coronal lateral downward sloping had impingement, and all 31 shoulders with medial encroachment had impingement.
Topics: Acromion; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radiography; Shoulder Impingement Syndrome; Shoulder Joint
PubMed: 9850788
DOI: 10.1177/03635465980260061701 -
Journal of Orthopaedic Trauma 1996Fractures of the acromial process or coracoid process of the scapula are rare. We present a combined fracture of the coracoid and acromion after direct trauma to the... (Review)
Review
Fractures of the acromial process or coracoid process of the scapula are rare. We present a combined fracture of the coracoid and acromion after direct trauma to the shoulder. An anteroposterior radiography with the central x-ray beam angled 25 degrees cephalad or an axillary lateral radiograph may be needed to detect these fractures.
Topics: Acromion; Adult; Female; Fractures, Bone; Humans; Scapula; Tomography, X-Ray Computed
PubMed: 8854324
DOI: 10.1097/00005131-199608000-00013 -
Clinical Biomechanics (Bristol, Avon) Apr 2020Repetitive glenohumeral joint movement during manual wheelchair propulsion has been associated with shoulder pain in individuals with spinal cord injury. Clinical... (Comparative Study)
Comparative Study
BACKGROUND
Repetitive glenohumeral joint movement during manual wheelchair propulsion has been associated with shoulder pain in individuals with spinal cord injury. Clinical guidelines for shoulder health maintenance encourage semi-circular over arc propulsion to reduce loading frequency. This study aimed to determine the difference in estimated supraspinatus to acromion compression risk, and shoulder, thorax kinematics between (1) arc and semi-circular propulsion; and (2) self-selected and coached strategies.
METHODS
Shoulder and thorax kinematics were captured during wheelchair propulsion, noting individually self-selected styles. Participants were then coached to perform the other style(s) of interest, arc and/or semi-circular. CT bone models of the humerus and scapula were animated using glenohumeral kinematics to estimate the minimum distance between the supraspinatus humeral attachment and the acromion. Compression risk was defined as the proportion of each propulsion phase where the minimum distance fell below 5 mm. Comparisons were made between conditions evaluating compression risk, minimum distances and kinematics at events throughout propulsion.
FINDINGS
Ten individuals with spinal cord injury (9 male) participated. Arc and semi-circular propulsion did not significantly differ in compression risk or minimum distance across propulsion phases. Self-selected styles yielded lower compression risk and larger proximity values compared to coached styles. Glenohumeral horizontal abduction and thorax flexion differed between arc and semi-circular propulsion. Multiple glenohumeral and humerothoracic differences emerged between self-selected and coached conditions.
INTERPRETATION
Supraspinatus compression was observed during both arc and semi-circular propulsion, suggesting risk may be unavoidable in this task. Self-selected styles yield less risk, likely related to coached style unfamiliarity.
Topics: Acromion; Adult; Biomechanical Phenomena; Humans; Male; Mechanical Phenomena; Movement; Pilot Projects; Pressure; Shoulder; Thorax; Wheelchairs
PubMed: 32120286
DOI: 10.1016/j.clinbiomech.2020.01.016 -
Clinical Orthopaedics and Related... Mar 1983
Topics: Acromion; Adult; Diagnosis, Differential; Edema; Hemorrhage; Humans; Muscles; Radiography; Rupture; Shoulder Injuries; Shoulder Joint; Tendinopathy; Tendon Injuries
PubMed: 6825348
DOI: No ID Found