Five baseball pitchers, three college and two professional, with an average age of 24 years, exhibited pain between the acceleration phase and follow-through phase of the pitching motion. This caused the players to be unable to continue at the level of competition necessary to play. A significant osteophyte on the posteromedial aspect of the olecranon process was identified in all pitchers. This caused impingement with the articular wall of the olecranon fossa and often created an area of chondromalacia. The more commonly identified posterior osteophyte was present in all cases. However, if just this posterior osteophyte is removed, the described lesion will be missed, with resultant persistent disability. Surgical excision of the posteromedial osteophyte through a relatively atraumatic posterolateral approach allowed early return of function without morbidity. With an average follow up of 1 year, all of the pitchers returned for one full season at maximum effectiveness.

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Impingement of the shoulder is a relatively common clinical entity. The os acromiale anomaly is an uncommon one (1-8%) but can be an important cause of the impingement syndrome. The most common place of nonfusion is between the meso- and meta-acromion. The key to diagnosis is a history and physical examination compatible with the impingement syndrome and appropriate radiologic studies (i.e., an axillary view or profile view or computed tomographic scan if necessary). After diagnosis, the initial treatment is conservative with rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), injections of corticosteroids in the subacromial space, and most importantly, an appropriate rehabilitation program. If unsuccessful, treatment should be planned based on the size of the unfused fragments. Small fragments (< 4 cm) may be removed by either arthroscopic or open means. Larger fragments may require an attempt at bone grafting and fixation since their removal may result in loss of strength of the deltoid.

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