Os Acromiale

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Case

A 14-year-old football goalkeeper presents with a painful left shoulder. He reports this developing after a heavy landing onto his left side. Further questioning suggests that this may have appeared relatively insidiously.

The only significant clinical finding is tenderness over the left acromion. Otherwise the player’s symptoms are hard to provoke.

Findings

The x-ray images show an os acromiale. This is best appreciated on the axillary x-ray view. An MRI was then conducted to define this further. The growth plate across the acromion is not fused. There is high signal within the growth plate and the adjacent bone particularly laterally and small cystic changes consistent with a stress response. The shape of the acromion is normal. The acromioclavicular joint is normal.

Discussion

This patient was successfully treated with an eight-week period of relative rest. He was able to continue playing and training as an outfield player while his symptoms settled. A planned return to normal training was allowed when he had no pain with daily life, had no residual tenderness to palpation and had completed a graded return to training.

The acromion has a normal secondary centre of ossification that usually fuses to the rest of the acromion by the time a patient reaches their mid-20’s. An injury to the physis (acromial apophysiolysis) is a risk factor for the development of an os acromiale. An os acromiale may increase the risk of shoulder impingement, rotator cuff disease or degenerative changes in the acromioclavicular joint.

In general terms, most patients can be successfully treated by removing (or reducing) the activity that provoked the pain. In a very small number of cases surgical excision may be required.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Mark Fulcher
01 juin 2018 5:06

Thank you all for your comments. As you know there was an error with this case. The correct text has now been added. Please accept our apologies.

Dr. SUKDEB MAHANTA
22 mai 2018 15:02

hi to all,

Its a nice information indeed.
want to share:
1. Sometimes this trigonum forms anteromedially inside the ankle joint and it wont be seen in lateral view of radiography though it can be managed to see by oblique radiography.

2. Taping for this posterior impingement syndrome :Very important to apply a Low irritant tape as underlay to the tape to avoid the irritation.

fuhaim
19 mai 2018 6:25

there is an error on heading and case presentation please correct it

Bangoura
12 mai 2018 23:21

Les lésions de la cheville chez un sportif de haut niveau doivent être prises au sérieux après un examen correct suivi d une bonne imagerie
La prise en charge doit être immédiate surtout lorsqu un doute plane
L utilisation excessive des corticoïdes ne résous pas le problème car elle cause plus de dégâts
La conduite à tenir c est de fait une intervention chirurgicale suivie d une bonne kinésithérapie et d un repos

Drmanara
Drmanara
12 mai 2018 10:01

The report is on the Os Trigonum not on the ACJoint