From the Research
The management of pediatric os acromiale is typically conservative and observation-based, as this condition often remains asymptomatic in children. Initial treatment includes activity modification, rest, physical therapy focusing on rotator cuff and periscapular strengthening, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (10 mg/kg/dose every 6-8 hours) for pain relief, as recommended by recent studies 1. Most cases resolve with conservative management as the child grows.
Some key points to consider in the management of pediatric os acromiale include:
- Conservative treatment is the first-line management, with surgical techniques described in case of initial treatment failure 1
- Corticosteroid injections are rarely used in pediatric patients but may be considered in older adolescents with persistent symptoms
- Surgical intervention is generally avoided in children unless there is significant functional impairment or persistent pain despite conservative measures
- When surgery is necessary, options include fragment excision, open reduction and internal fixation, or arthroscopic procedures, depending on the size and location of the unfused fragment, with recent studies suggesting arthroscopic techniques offer encouraging results 1
- The decision for surgical management should consider the child's skeletal maturity, as premature intervention could disrupt normal shoulder development, as highlighted in a study on the optimal management of symptomatic os acromiale 2
Regular follow-up with serial imaging is important to monitor for potential progression or complications such as impingement syndrome or rotator cuff pathology, and to assess the effectiveness of treatment, as noted in a review of the surgical treatment for symptomatic os acromiale 3. Overall, the goal of management is to alleviate symptoms, promote normal growth and development, and prevent long-term complications, with the most recent and highest quality study guiding treatment decisions 1.