Os Acromiale

Home » Sports Injuries » Shoulder Injuries » Os Acromiale
Os Acromiale 2017-07-20T22:10:25+00:00

Os Acromiale

By Matthew L. Busbee, MD


The acromion is part of the scapula or shoulder blade that extends laterally over the shoulder joint. When one of the four ossification centers or growth plates of the acromion fails to fuse, an os acromiale forms. While most os acromiale do not cause any symptoms, a few can severely limit a patient’s shoulder function because of pain.

How common is an os acromiale? Who is at risk for developing an os acromiale? 

Studies have shown that about 8% of the population have an os acromiale. Of the patients with an os acromiale, 30-60 % of them will have them on both sides. Os acromiale are more commonly found in blacks and males than whites and females. 

How does an os acromiale occur? 

The acromion develops from four ossification centers or growth plates. The growth plates generally fuse by age 18 but can fuse as late as age 25. When there is failure of the growth plates to fuse an os acromiale develops. Failure of fusion can occur at any of the ossification centers but more commonly occurs anteriorly or in the front of the acromion.

What type of symptoms can develop from an os acromiale? 

Most people who have an os acromiale do not have any problems. It is usually discovered when looking at the shoulder for another reason. Patients with symptomatic os acromiale can have pain with overhead activity. Pain will be located along the superior aspect of the shoulder. Symptoms can also occur at night. Along with pain, patients may have decreased shoulder motion and strength. Patients will be tender to palpation at the site of the os acromiale and there may also be frank movement of the bone at the site.

How does an os acromiale cause pain? 

An os acromiale can cause pain in two ways. First there can be pain from the movement of the unfused bones. The movement of the bone from the pull of the shoulder muscles can also pinch the soft tissue within the shoulder. This impingement can irritate the muscles, tendons, and bursa (fluid filled sac between muscles and bones) resulting in pain with shoulder movement. Patients can also get impingement within the shoulder from other sources though and be asymptomatic from their os acromiale.

How does a doctor diagnose an os acromiale? 

A patient’s history of symptoms and findings on physical exam can help the doctor make the diagnosis. X-rays will show the nonunion of the acromion. A MRI will also show the os acromiale along with other structures within the shoulder. The MRI may help differentiate the source of the pain.

What are nonsurgical treatment options for os acromiale? 

Patients who do not have symptoms from their os acromiale do not require any treatment. For symptomatic os acromiale, the first goal of treatment is pain relief. Non-steroid anti-inflammatory drugs (NSAIDs) like Motrin®, ibuprofen, or Aleve® can help with pain control and decrease inflammation. Activities that cause symptoms should be avoided. A physical therapy program that focuses on establishing non-painful shoulder motion and strengthening of the shoulder muscles will also be helpful. Selective injection within the nonunion site or in the subacromial space (between the acromion and shoulder joint) may provide pain relief and will also help differentiate the source of the patient’s pain.

How long should I try nonsurgical treatments for os acromiale? 

It is recommended to continue non-operative treatments for os acromiale for at least 6 months unless the patient has other conditions like a torn rotator cuff  that may require earlier surgical intervention.

What are surgical treatment options for os acromiale? 

There are three main options available for the treatment of os acromiale. Surgical treatment options are based on the size and location of the os acromiale, the patient’s symptoms, age, and functional demands.

Small fragments located in the anterior or front of the acromion can be surgically removed. Patient’s who fail more extensive procedures may also require excision of the fragment as a salvage procedure. Removal of larger fragments though, may impair the function of shoulder’s deltoid muscle. This in turn may limit the shoulder’s function.

Larger fragments may require fixation with screws and wires along with bone graft (usually taken from the patient’s hip) in order to get the two fragments to fuse. A second surgery may be required to remove the hardware if they irritate the patient. It generally takes 9-12 weeks for the bone to heal. There is always the risk that the bone does not heal though.

A third option is to debride the undersurface of the acromion and the bursa to help with pain relief. There are minimal risks with this procedure but results may be mixed with persistent pain.


Find a Doctor who specializes in OS Acromiale:

American Orthopedic Society for Sports Medicine
6300 North River Rd.
Suite 200
Rosemont, IL 60018
Toll-Free: (877) 321-3500

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Rd.
Rosemont, IL 60018-4262
Toll-Free: (800) 346-2267

American Physical Therapy Association
1111 North Fairfax St.
Alexandria, VA 22314-1488
Toll-Free: (800) 999-2782

National Athletic Trainers’ Association
2952 Stemmons Freeway
Dallas, TX 75247-6196
Phone: (214) 637-6282



  • Hutchinson, M. R., and Veenstra, M. A. Arthroscopic decompression of shoulder impingement secondary to os acromiale. Arthroscopy,9: 28-32, 1993
  • Kurtz CA, Humble BJ, Rodosky MW, Sekiya JK. Symptomatic Os Acromiale. Journal of the American Academy of Orthopaedic Surgeons 2006; 14:12-19
  • Phillips, BB. “Arthroscopy of the Upper Extremity.” Campbell’s Operative Orthopaedics 11th Edition. Canale, ST, Beaty JH. Philadelphia: Mosby, 2008. 2966
  •  Vanderbeck JL et al. “Congenital Anomalies and Variational Anatomy of the Shoulder.” The Shoulder 4th Edition. Rockwwod Jr. CA et al. Philadelphia: Saunders, 2009. 122-124
  • Warner JJ, Beim GM, Higgins L. The treatment of symptomatic os acromiale. J Bone Joint Surg Am 1998;80: 1320-1326.

Disclaimer: SportsMD Media Inc. does NOT offer medical advice. The content on this website is for informational purposes only. Do not rely or act upon information from www.sportsmd.com without seeking professional medical advice. Consultations on SportsMD.com are not a substitute to physical consultation with a doctor or hospital services. The service should not to be used for medical emergencies. Do not delay seeing a doctor if you think you have a medical problem. In case of a medical emergency, call 911.

  • Nee Jaye

    My doctor has recommended surgery to put screws in tho help the bones fuse. I’m 41 and I have 2 children. I need to know how long the recovery will be.

    • Sandra

      I think this depends on how severe your condition is. I was first diagnosed when I was 16. My orthopaedic doc at the time told me to hold off as long as I could if I could bear the pain because it was a very extensive surgery and involved a lot of healing time. I finally had a bone graft with screws and wires done when I was 18 to repair (I’m 34 now). I played a lot of sports and had really bad pain, to a point where I could barely move my arm. When I got this done, it was the longest recovery from surgery that I’ve ever had (I should also mention that by the time I got this done I had 4 knee surgeries). I was unable to drive for a month – dr’s orders, but it was also painful to move my arm to turn the wheel. I couldn’t wear a bra or wash my hair and had trouble performing simple daily tasks. Your doctor should have explained the recovery and risks if (s)he suggested surgery. Best of luck to you!

      • AV

        While you mention it was the longest surgical recovery time you had experienced, was it worth it? They are proposing this for my 14 yr old daughter (volleyball player) who has been almost a year with very limited use of her shoulder due to pain.