A Longitudinal Study on the Rare Entity of Acromial Apophysitis in Paediatric and Adolescent Ages

Abstract

Introduction: Acromial apophysitis is a traction apophysitis caused by repetitive stress to the distal acromion. Although it is a common non-traumatic cause of shoulder pain in adolescence, data is scarce in the literature. There is a need for a better understanding of acromial apophysitis regarding its cause, diagnosis and management. Aim: To determine the cause, clinical features, radiological findings, management, and outcome of the patients diagnosed with acromial apophysitis. Materials and Methods: A longitudinal descriptive study was carried out at Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC), Jaipur, Rajasthan, India, from August 2018 to August 2022. A total of 30 patients aged 10-20 years with shoulder pain, diagnosed with acromial apophysitis based on history, clinical, and radiological examination, were included in the study. The treatment given, duration of disease, and outcome were noted. Descriptive statistics were performed using Microsoft Office Excel. Results: Out of 30 patients diagnosed with acromial apophysitis, 24 (80%) were male, and 6 (20%) were female, with a mean age of 13.47 (range 10-18) years. The cause was repetitive microtrauma following chronic overuse during athletic and sports activities in 24 patients (80%). Among these patients, 13 played cricket, three played basketball, three played volleyball, two did weightlifting, one was a wrestler, one was a tennis player, and one was a judo player. Six patients (20%) did not give a history of playing any kind of sports. All patients had anterior shoulder pain with tenderness at the antero-lateral acromion. Radiographs showed fragmentation, sclerosis, and irregularity of the acromial apophysis. Conservative treatment included rest and restriction of sporting activities. The duration for the analgesics taken by patients was 8.9 days (range 3-21). The duration from the onset of symptoms to recovery was 5.8±1.61 weeks. None of the patients showed a recurrence of symptoms after complete recovery. Conclusion: Acromial apophysitis is a common cause of shoulder pain in paediatric and adolescent age. It occurs due to repeated overhead abduction, overuse, and throwing activities, mostly in sports persons. It is diagnosed clinically and confirmed with plain radiographs. It is a self-limiting disease with a short benign course. It is treated conservatively with rest and analgesics and has an excellent outcome. This diagnosis should be kept in mind for shoulder pain in young patients to prevent undue investigations and surgery.