PubMed · 12216968
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Daniel W Carlson, David H Kim. 2002. Os acromiale.. https://pubmed.ncbi.nlm.nih.gov/12216968/
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The impingement syndrome is a clinical entity characterized by shoulder pain due to primary or secondary mechanical irritation of the rotator cuff. The primary factors for the development of impingement are a curved or hook-shaped anterior acromion as well as subacromial osteophytes, which may lead to tearing of the supraspinatus tendon. Secondary impingement is mainly caused by calcific tendinopathy, glenohumeral instability, os acromiale and degenerative changes of the acromioclavicular joint. Conventional radiographs are initially obtained, mainly for evaluation of the bony structures of the shoulder. If available, sonography can be used for detection of lesions and tears of the rotator cuff. Finally, MR-imaging provides detailed information about the relationship of the acromion and the acromioclavicular joint to the rotator cuff itself. In many cases however, no morphologic cause for impingement syndrome can be found. While patients are initially treated conservatively, chronic disease usually requires surgical intervention.
Osteochondromatosis is classified into primary and secondary lesions; primary osteochondromatosis is a tumor-like lesion, whereas secondary lesions are due to such joint or bursal disorders as osteoarthritis and osteochondral fractures. There is no clinical distinction between these two conditions. Only the pathological findings of loose bodies and synovium can clearly distinguish between them. In this report, we present two patients with secondary osteochondromatosis in the subacromial bursa. Both had shoulder pain and were treated surgically. We discuss methods of differentiating between primary and secondary lesions and elucidate the pathogenesis of osteochondromatosis in the subacromial bursa by analyzing findings for 17 shoulders with this condition reported in the literature. We also present two more cases. We reviewed the 12 cases of osteochondromatosis in the literature for histopathological findings of loose bodies and the presence or absence of acromial osteophytes. Our findings suggest that osteochondromatosis of the subacromial bursa is secondary in most cases, and that osteocartilaginous fragments from acromial osteophytes can be shed into the subacromial bursa and grow into loose bodies.
This article describes a case of arthroscopic removal of a bullet fragment from the subacromial space. The bullet tore the rotator cuff and imbedded itself on the inferior surface of the acromion, producing pain and impingement. The bullet was removed, and the rotator cuff repaired arthroscopically. The patient noted complete relief of pain and improved range of motion.