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Os Acromiale


- Discussion:
    - results from failure of an anterior acromial ossification center to fuse to the acromial process;
    - caused by failure of one of three ossification centers;
           - ossification centers appear at age 15 and should fuse by age 22-25;
    - subtypes: (from anterior to posterior)
           -  preacromion, mesacromion, metacromion, and basiacromion types;
           - mesacromion and metacromion are most common;
    - patients may show impingement like symptoms but will also have localized tenderness;
    - strong association with rotator cuff tear;
    - references:
           - Rotator cuff tears associated with os acromiale.   
           - Rotator cuff tears associated with os acromiale.
           - Os acromiale: frequency, anatomy, and clinical implications.

- Radiographs:
    - may be seen axillary or Stryker notch views;
    - reference:
          - The double-density sign: a radiographic finding suggestive of an os acromiale.

- Treatment:
    - references:
          - Os acromiale: anatomy and surgical implications.
          - Os acromiale associated with tear of the rotator cuff treated operatively. Review of 33 patients.
          - Surgical management of the symptomatic os acromiale.
          - Arthroscopic decompression of shoulder impingement secondary to os acromiale
          - Internal fixation of symptomatic os acromiale: a series of twenty-six cases.
          - Transacromial approach to obtain fusion of unstable os acromiale. 
          - The treatment of symptomatic os acromiale

Os acromiale: evaluation and treatment.

Surgical treatment of os acromiale with and without associated rotator cuff tears.

Painful os acromiale (or unfused acromial apophysis) in athletes.