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Acromial fracture is a rare complication that has been reported after both open and arthroscopic acromioplasty.[104–107] Osteopenic patients are more at risk for stress fractures; however, the most likely causes of acromial fracture are technical error or excessive thinning of the bone.[107,108] Anecdotally, authors often cite an increased likelihood of fracture with resection of greater than 50% of the acromial thickness.[105]

These fractures can occur intraoperatively or within the first several months following surgery. In either case, there is often a delay in diagnosis. In Matthews and colleague's series, most patients had an acute onset of pain during physical therapy.[104]However, diagnosis was not confirmed until routine radiographs, including an axillary view, were obtained. Patients with acromial stress fractures often complain of a sudden, marked increase in pain and swelling, despite what may be a rather minor precipitating event. Point tenderness …