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.
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.
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.
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