Os Acromiale

with Rehab

The acromion is the bony roof of the shoulder. The bone has three separate cartilage growth centers, and in the process of development, the acromion transforms from four separate bones into one single bone. In certain people, one of the three growth centers does not become bone. This condition is called os acromiale. The remaining cartilage growth center allows for a small degree of motion of the acromion. This motion may have the ability to pinch the group of tendons responsible for function of the shoulder and upper arm (rotator cuff), or may pinch a fluid-filled sac that reduces the fiction between the acromion and the rotator cuff (subacromial bursa). This condition may or may not cause rotator cuff inflammation and shoulder pain.

SYMPTOMS

Os acromiale is a condition that may be found on an x-ray, and often results in no symptoms. If there are symptoms, they may include the following:

  • Tenderness and sometimes redness and warmth on the top of the shoulder.

  • Shoulder pain.

  • Pain that gets worse when moving the shoulder against resistance or with lifting, and particularly reaching overhead.

  • Pain that may wake you up at night.

  • Limitation of shoulder motion.

  • Crackling sound (crepitation) when the shoulder is moved.

CAUSES

Os acromiale is caused by one of the growth centers of the acromion failing to become bone, during skeletal maturation.

RISK INCREASES WITH:

There are no known risk factors for os acromiale, but certain activities may increase your risk of painful symptoms, including:

  • Overhead activity, including sports such as tennis, volleyball, swimming, and baseball, as well as heavy lifting (more than10 lbs/4.5 kgs).

  • Poor strength and flexibility.

PREVENTION

  • Appropriately warm up and stretch before practice or competition.

  • Maintain appropriate conditioning:

  • Shoulder muscle strength.

  • Flexibility and endurance.

  • Use proper exercise technique.

PROGNOSIS

For mild cases of os acromiale, symptoms often go away with a slight reduction of activity level. Moderate to severe cases may require significantly reduced activity for 3 to 4 months. Sometimes, surgery is needed.

RELATED COMPLICATIONS

  • Persistence and recurring symptoms.

  • Rotator cuff tear.

  • Risks of surgery, including infection, bleeding, injury to nerves, shoulder stiffness, not healing (nonunion), healing incorrectly (malunion), and pain from wires or screws used to fix the problem.

  • Persisting bump (prominence) on the roof of the shoulder.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity, especially exercises that emphasize shoulder blade stabilization. These exercises may be performed at home or with a therapist. Your caregiver may recommend a corticosteroid injection to reduce inflammation, but this is uncommon. If symptoms persist, despite non-surgical treatment for 3 to 6 months, surgery may be advised. Surgery fuses the growth plate and repairs the rotator cuff, if torn.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • After surgery, you develop increasing pain, swelling, redness, increased warmth, bleeding, drainage of fluids, or fever.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Os Acromionale

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH – Flexion, Standing

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm in front of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Abduction, Supine

  • Stand with good posture. With an underhand grip on your right / left and an overhand grip on the opposite hand, grasp a broomstick or cane so that your hands are a little more than shoulder width apart.

  • Keeping your right / left elbow straight and shoulder muscles relaxed, push the stick with your opposite hand to raise your right / left arm out to the side of your body and then overhead. Raise your arm until you feel a stretch in your right / left shoulder, but before you have increased shoulder pain.

  • Try to avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine. Hold __________ seconds.

  • Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ROM – Flexion, Active-Assisted

  • Lie on your back. You may bend your knees for comfort.

  • Grasp a broomstick or cane so your hands are about shoulder width apart. Your right / left hand should grip the end of the stick, so that your hand is positioned "thumbs-up," as if you were about to shake hands.

  • Using your healthy arm to lead, raise your arms overhead until you feel a gentle stretch in your shoulder. Hold __________ seconds.

  • Use the stick to assist in returning your right / left arm to its starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ROM - Internal Rotation, Supine

  • Lie on your back on a firm surface. Place your right / left elbow about 60 degrees away from your side. Elevate your elbow with a folded towel so that the elbow and shoulder are the same height.

  • Using a broomstick or cane and your strong arm, pull your right / left hand toward your body until you feel a gentle stretch, but no increase in your shoulder pain. Keep your shoulder and elbow in place throughout the exercise.

  • Hold for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH - Internal Rotation

  • Place your right / left hand behind your back, palm-up.

  • Throw a towel or belt over your opposite shoulder. Grasp the towel with your right / left hand.

  • While keeping an upright posture, gently pull up on the towel, until you feel a stretch in the front of your right / left shoulder.

  • Avoid shrugging your right / left shoulder as your arm rises by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold __________ seconds. Release the stretch by lowering your opposite hand.

Repeat __________ times. Complete this exercise __________ times per day.

ROM - Internal Rotation

  • Using underhand grips, grasp a stick behind your back with both hands.

  • While standing upright with good posture, slide the stick up your back until you feel a mild stretch in the front of your shoulder.

  • Hold __________ seconds. Slowly return to your starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Os Acromionale

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Shoulder Abductors, Isometric

  • With good posture, stand or sit about 4-6 inches from a wall with your right / left side facing the wall.

  • Bend your right / left elbow. Gently press your right / left elbow into the wall. Increase the pressure gradually until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the outside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame, as if you were trying to swing the back of your hand away from your stomach. Gradually increase the tension until you are pressing as hard as you can without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators, Isometric

  • Keep your right / left elbow at your side and bend it 90 degrees.

  • Step into a door frame so that the inside of your right / left wrist can press against the door frame without your upper arm leaving your side.

  • Gently press your right / left wrist into the door frame, as if you were trying to draw the palm of your hand to your stomach. Gradually increase the tension until you are pressing as hard as you can, without shrugging your shoulder or increasing any shoulder discomfort.

  • Hold __________ seconds.

  • Release the tension slowly. Relax your shoulder muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - External Rotators

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your healthy side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it away from your body, as if pivoting on your elbow. Be sure to keep your body steady, so that the movement is coming only from your rotating shoulder.

  • Hold __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Internal Rotators

  • Secure a rubber exercise band or tubing to a fixed object, so that it is at the same height as your right / left elbow when you are standing or sitting on a firm surface.

  • Stand or sit so that the secured exercise band is at your right / left side.

  • Bend your elbow 90 degrees. Place a folded towel or small pillow under your right / left arm so that your elbow is a few inches away from your side.

  • Keeping the tension on the exercise band, pull it across your body toward your stomach. Be sure to keep your body steady, so that the movement is coming only from your rotating shoulder.

  • Hold __________ seconds. Release the tension in a controlled manner, as you return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Supraspinatus

  • Stand or sit with good posture. Grasp a __________ weight, or an exercise band or tubing, so that your hand is "thumbs-up," like you are shaking hands.

  • Slowly lift your right / left hand from your thigh into the air, traveling diagonally, about 30 degrees from straight out at your side. Lift your hand to shoulder height or as far as you can, without increasing any shoulder pain. At first, many people do not lift their hands above shoulder height.

  • Avoid shrugging your right / left shoulder as your arm rises, by keeping your shoulder blade tucked down and toward your mid-back spine.

  • Hold for __________ seconds. Control the descent of your hand, as you slowly return to your starting position.

Repeat __________times. Complete this exercise __________ times per day.

STRENGTH - Scapular Protractors, Standing

  • Stand arm's length away from a wall. Place your hands on the wall, keeping your elbows straight.

  • Begin by dropping your shoulder blades down and toward your mid-back spine.

  • To strengthen your protractors, keep your shoulder blades down, but slide them forward on your rib cage. It will feel as if you are lifting the back of your rib cage away from the wall. This is a subtle motion and can be challenging to complete. Ask your caregiver for further instruction, if you are not sure you are doing the exercise correctly.

  • Hold for __________ seconds. Slowly return to the starting position, resting the muscles completely before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Protractors, Supine

  • Lie on your back on a firm surface. Extend your right / left arm straight into the air while holding a __________ weight in your hand.

  • Keeping your head and back in place, lift your shoulder off the floor.

  • Hold __________ seconds. Slowly return to the starting position and allow your muscles to relax completely before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Protractors, Quadruped

  • Get onto your hands and knees with your shoulders directly over your hands (or as close as you can comfortably be).

  • Keeping your elbows locked, lift the back of your rib cage up into your shoulder blades so your mid-back rounds out. Keep your neck muscles relaxed.

  • Hold this position for __________ seconds. Slowly return to the starting position and allow your muscles to relax completely before starting the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Scapular Depressors

  • Find a sturdy chair without wheels, such as a dining table chair, and place your hands on the armrests.

  • Keeping your feet on the floor, lift your bottom from the seat and lock your elbows.

  • Keeping your elbows straight, allow gravity to pull your body weight down. Your shoulders will rise toward your ears.

  • Raise your body against gravity by drawing your shoulder blades down your back, shortening the distance between your shoulders and ears. Although your feet should always maintain contact with the floor, your feet should progressively support less body weight as you get stronger.

  • Hold __________ seconds. In a controlled and slow manner, lower your body weight to begin the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Retractors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a palm-down grip, grasp an end of the band in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band until it becomes tense.

  • Squeezing your shoulder blades together, draw your elbows back as you bend them. Keep your upper arm lifted away from your body throughout the exercise.

  • Hold __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Shoulder Extensors

  • Secure a rubber exercise band or tubing, so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a thumbs-up grip, grasp an end of the band in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band until it becomes tense.

  • Squeezing your shoulder blades together, pull your hands down to the sides of your thighs. Do not allow your hands to go behind you.

  • Hold for __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Horizontal Abductors

Choose one of the two positions to complete this exercise .

Prone: lying on stomach:

  • Lie on your stomach on a firm surface so that your right / left arm overhangs the edge. Rest your forehead on your opposite forearm. With your palm facing the floor and your elbow straight, hold a __________ weight in your hand.

  • Squeeze your right / left shoulder blade to your mid-back spine and then slowly raise your arm to the height of the bed.

  • Hold for __________ seconds. Slowly reverse the directions and return to the starting position, controlling the weight as you lower your arm.

Repeat __________ times. Complete this exercise __________ times per day.

Standing:

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • Grasp an end of the band in each hand and have your palms face each other. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band until it becomes tense.

  • Squeeze your shoulder blades together. Keeping your elbows locked and your hands at shoulder-height, bring your hands out to your sides.

  • Hold __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Retractors and External Rotators

  • Secure a rubber exercise band or tubing, so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a palm-down grip, grasp an end of the band in each hand. Bend your elbows 90 degrees and lift your elbows to shoulder height at your sides. Step back away from the secured end of band until it becomes tense.

  • Squeezing your shoulder blades together, rotate your shoulder so that your upper arm and elbow remain stationary, but your fists travel upward to head height.

  • Hold __________ for seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Scapular Retractors and External Rotators, Rowing

  • Secure a rubber exercise band or tubing, so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a palm-down grip, grasp an end of the band in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band until it becomes tense.

  • Step 1: Squeeze your shoulder blades together. Bending your elbows, draw your hands to your chest, as if you are rowing a boat. At the end of this motion, your hands and elbow should be at shoulder-height and your elbows should be out to your sides.

  • Step 2: Rotate your shoulder to raise your hands above your head. Your forearms should be vertical and your upper arms should be horizontal.

  • Hold for __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.