Acromial apophysitis in a 13-year-old adolescent boy: a common condition in an uncommon location

Abstract

Objective: Traction apophysitis is a common condition in physically active and skeletally immature adolescents. This case study describes the clinical presentation and plain film imaging of traction apophysitis of the acromion process of the scapula. Clinical Features: A physically active 13-year-old adolescent boy presented to a chiropractic physician with an acute onset of moderate shoulder pain. Plain film radiographs of the shoulder were performed that revealed fragmentation, sclerosis, and irregularity of the left acromial apophysis. Intervention and Outcome: The patient was treated with conservative therapy for 10 weeks, with complete resolution of symptoms. Follow-up radiographs 9 weeks later revealed no radiographic change in the appearance of the apophysis; however, clinical symptoms were absent. The apophyseal growth cartilage is the most vulnerable site in the muscle-tendon unit in the skeletally immature patient and is more susceptible to very small avulsion fractures. Repetitive microtrauma following chronic overuse at a tendon insertion site in a skeletally immature patient may result in traction apophysitis. Conclusions: Acromial apophysitis should be included in the differential diagnosis when presented with a young active patient with shoulder pain. Early treatment with restriction of activities is important in the prevention of permanent injury to the acromial cartilaginous growth plate. This case demonstrates that a prompt diagnosis can be made with a careful history, physical examination, and conventional imaging.

Overuse Upper Extremity Injuries in the Skeletally Immature Patient: Beyond Little League Shoulder and Elbow

“…In the patient with an open acromial apophysis, stress is imparted to the pre or meso-acromial ossification centers; the coracoacromial ligament has been shown to largely attach to the inferior surface of the acromion formed by these ventral ossification centers. 32 Repetitive tractional and eccentric muscular compressive forces applied to the open acromial apophyses can result in similar findings of localized apophyseal widening, reactive bone marrow edema, and hypertrophic reparative response, a condition referred to as acromial apophysitis 33,34 or acromial apophysiolysis. 35 ►Fig.…”