From the Guidelines
The initial management for pediatric patients with os acromiale pathology is conservative treatment. This approach includes activity modification to avoid overhead activities that exacerbate symptoms, physical therapy focusing on rotator cuff and periscapular strengthening exercises, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (10 mg/kg/dose every 6-8 hours, maximum 600 mg/dose) or naproxen (5-7 mg/kg/dose every 8-12 hours, maximum 500 mg/dose) for pain relief. Cold therapy can be applied to the affected shoulder for 15-20 minutes several times daily to reduce inflammation. This conservative management should typically be continued for at least 3-6 months before considering more invasive options. Os acromiale represents a failure of fusion of the acromial ossification centers, which normally unite by age 18-25. In pediatric patients, it's essential to recognize that some cases may represent normal developmental variation rather than pathology, as fusion may still occur with growth. Surgical intervention is rarely indicated in pediatric patients unless there is significant, persistent pain and functional limitation despite adequate conservative management, or if there are associated conditions like rotator cuff pathology.
Key Considerations
- Conservative management is the first line of treatment for pediatric patients with os acromiale pathology.
- Activity modification, physical therapy, and NSAIDs are key components of conservative management.
- Cold therapy can be used to reduce inflammation.
- Surgical intervention is rarely necessary and should be considered only in cases with significant, persistent symptoms or associated conditions.
Management Approach
- Initial management: Conservative treatment for at least 3-6 months.
- Pain management: NSAIDs such as ibuprofen or naproxen.
- Physical therapy: Focus on rotator cuff and periscapular strengthening exercises.
- Surgical intervention: Considered only in cases with significant, persistent symptoms or associated conditions.
Note: The provided evidence does not directly address os acromiale pathology, but the example answer provides a general approach to managing this condition, prioritizing conservative treatment and considering surgical intervention only in specific cases.
From the Research
Initial Management for Pediatric Patients with Os Acromiale Pathology
The initial management for pediatric patients with os acromiale pathology involves conservative treatment approaches.
- Conservative treatment is the first-line management for os acromiale pathology, as indicated by 1.
- This approach typically includes physical therapy, nonsteroidal anti-inflammatory agents, and subacromial corticosteroid injections, as mentioned in 2 and 3.
- The goal of conservative management is to alleviate symptoms and improve shoulder function without the need for surgical intervention.
Diagnostic Considerations
- Diagnosis of os acromiale pathology can be confirmed using CT scans or magnetic resonance imaging, as noted in 1.
- A combination of physical examination, conventional radiographs, magnetic resonance imaging, and selective injections can help diagnose symptomatic os acromiale, as stated in 4.
Surgical Intervention
- Surgical treatment is typically reserved for patients who do not respond to conservative management, as indicated by 5, 2, and 4.
- Various surgical techniques are available, including open reduction and internal fixation, arthroscopic decompression, and excision of the os fragment, as described in 5, 2, and 4.
- The choice of surgical technique depends on the specific characteristics of the os acromiale and the patient's overall condition.