Hemostasis should be achieved because the acromial
branch of the thoracoacromial artery travels in proximity to the CA ligament.
Age-related changes have been defined for structures of the shoulder such as the acromial
beak and rotator cuff muscles (reviewed by Lewis 2011).
These factors include abnormal acromial
morphology (3), aberrant kinematics patterns due to poor rotator cuff or scapular muscle function (4), shoulder capsular abnormalities (5), poor posture (6), and overuse secondary to repetitive eccentric loading or sustained use of the arm above 90 degrees of elevation (7).
An os acromiale (OA) originates from failure of fusion of the anterior acromial
apophysis (Kurtz et al.
The system collected the coordinates of retroreflective markers attached to the right acromial
end, C7 vertebrae, sacrum, right olecranon, styloid process of the radius and ulna, third metacarpal head, and wheel axis.
However, all had MRI abnormalities, including coracoacromial ligament edema (96%), entheseal region edema (82%), distal clavicular region edema (75%), coracoacromial ligament thickening (71%), acromioclavicular degenerative joint disease (64%), acromial
region edema (61%), acromioclavicular joint edema (43%), and osseous spur (39%).
There is an additional sharper cut at the acromial
end, made in the opposite direction, and overlies the second chop mark (Figure 9).
There are normally 3 acromial
ossification centers that fuse between 22 and 25 years of age.
The standard of care, at minimum, required that the aforementioned factors be considered before administering the injection at a 90-degree angle approximately two inches below the acromial
process into the deltoid muscle at a depth so as to not come in contact with the major brachial plexus nerves in the upper arm of the patient.
The anterior branch passes forward around the humerus on the posterior aspect of the deltoid, to which it supplies motor innervation, lying just 3 to 5 cm below the anterior acromial