Acromial Stress Fractures in Reverse Total Shoulder Arthroplasty: Diagnosis, Prevention, and Treatment

Kriechling P, Hodel S, Paszicsnyek A, Schwihla I, Borbas P, Wieser K. Incidence, radiographic predictors, and clinical outcome of acromial stress reaction and acromial fractures in reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2022;31(6):1143–53. https://doi.org/10.1016/j.jse.2021.11.012.

Article  Google Scholar 

Cho CH, Rhee YG, Yoo JC, Ji JH, Kim DS, Kim YS, et al. Incidence and risk factors of acromial fracture following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2021;30(1):57–64. https://doi.org/10.1016/j.jse.2020.04.031.

Article  Google Scholar 

Su F, Kucirek N, Goldberg D, Feeley BT, Ma CB, Lansdown DA. Incidence, risk factors, and complications of acromial stress fractures after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2024;33(1):65–72. https://doi.org/10.1016/j.jse.2023.06.008.

Article  Google Scholar 

Cui H, Cheong J, McKenzie D, Gould D, Rele S, Patel M. Outcomes of conservative treatment of acromial and scapular spine stress fracture post reverse shoulder arthroplasty: a systematic review with meta-analysis. J Shoulder Elb Surg. 2023;32(12):2613–30. https://doi.org/10.1016/j.jse.2023.07.011.

Article  Google Scholar 

Wiemer F, Coghlan JA, Bell SN. Acromial stress fractures and reactions after reverse total shoulder arthroplasty: a case-control study. J Shoulder Elb Surg. 2025;34(8):1897–903. https://doi.org/10.1016/j.jse.2024.11.035.

Article  Google Scholar 

Group ACRR, Mahendraraj KA, Abboud J, Armstrong A, Austin L, Brolin T, et al. Predictors of acromial and scapular stress fracture after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. J Shoulder Elb Surg. 2021;30(10):2296–305. https://doi.org/10.1016/j.jse.2021.02.008.

Article  Google Scholar 

Schenk P, Aichmair A, Beeler S, Jentzsch T, Gerber C. Clinical results of conservative versus operative treatment of acromial and scapular spine fractures following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2022;31(10):2076–81. https://doi.org/10.1016/j.jse.2022.03.005.

Article  Google Scholar 

Levy JC, Anderson C, Samson A. Classification of postoperative acromial fractures following reverse shoulder arthroplasty. J Bone Joint Surg Am. 2013;95(15):e104. https://doi.org/10.2106/JBJS.K.01516.

Article  PubMed  Google Scholar 

Boltuch A, Grewal G, Cannon D, Polisetty T, Levy JC. Nonoperative treatment of acromial fractures following reverse shoulder arthroplasty: clinical and radiographic outcomes. J Shoulder Elb Surg. 2022;31(6S):S44–56. https://doi.org/10.1016/j.jse.2021.12.024.

Article  Google Scholar 

Glener J, Vegas A, Schodlbauer DF, Levy JC. Acromion fractures after reverse shoulder arthroplasty occur in predictable clusters. J Shoulder Elb Surg. 2024;33(5):1150–6. https://doi.org/10.1016/j.jse.2023.09.035.

Article  Google Scholar 

Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res. 2011;469(9):2544–9. https://doi.org/10.1007/s11999-011-1881-3.

Article  PubMed  PubMed Central  Google Scholar 

Otto RJ, Virani NA, Levy JC, Nigro PT, Cuff DJ, Frankle MA. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elb Surg. 2013;22(11):1514–21. https://doi.org/10.1016/j.jse.2013.02.007.

Article  Google Scholar 

Davie RA, Nathan K, Persaud SG, Oladeji LO, Taylor SA, Dines JS, et al. Inconsistent reporting of risk factors for acromial stress fractures following reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2025;34(11):e975–84. https://doi.org/10.1016/j.jse.2025.02.032.

Article  Google Scholar 

Rhee SM, Kantanavar R, Woo CW, Jung J, Oh JH, Kim YS, et al. Acromial and scapular spine fractures following reverse total shoulder arthroplasty: treatment dilemma and radiographic prognosticators for enhanced clinical outcomes: a multicenter study. J Shoulder Elb Surg. 2026;35(1):49–58. https://doi.org/10.1016/j.jse.2025.05.005.

Article  Google Scholar 

Noble MB, Galasso LA, Werner BC, Denard PJ. Patient characteristics are more important than preoperative radiographic factors in predicting the risk of acromial stress fracture following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2025;34(6S):S1–9. https://doi.org/10.1016/j.jse.2025.01.022.

Article  Google Scholar 

Jungmann PM, Jaeger M, Wagner FC, Bogner B, Molotkov A, Diallo T, et al. Metal-artifact reduced MR imaging for reverse shoulder arthroplasty: findings 1 year after surgery. Skeletal Radiol. 2026;55(5):1087–100. https://doi.org/10.1007/s00256-025-05121-y.

Article  PubMed  PubMed Central  Google Scholar 

Paszicsnyek A, Jo O, Rupasinghe HS, Ackland DC, Treseder T, Pullen C, et al. Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies. J Clin Med. 2022;11(2). https://doi.org/10.3390/jcm11020361.

Moverman MA, Menendez ME, Mahendraraj KA, Polisetty T, Jawa A, Levy JC. Patient risk factors for acromial stress fractures after reverse shoulder arthroplasty: a multicenter study. J Shoulder Elb Surg. 2021;30(7):1619–25. https://doi.org/10.1016/j.jse.2020.09.012.

Article  Google Scholar 

Verstraete O, Van der Mast B, Van Tongel A, Karelse A, Van der Bracht H, Berghs B, et al. Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty: a multicentric retrospective study. Int Orthop. 2021;45(1):209–16. https://doi.org/10.1007/s00264-020-04849-7.

Article  CAS  PubMed  Google Scholar 

Miller M, Chalmers PN, Nyfeler J, Mhyre L, Wheelwright C, Konery K, et al. Rheumatoid arthritis is associated with increased symptomatic acromial and scapular spine stress fracture after reverse total shoulder arthroplasty. JSES Int. 2021;5(2):261–5. https://doi.org/10.1016/j.jseint.2020.10.010.

Article  PubMed  Google Scholar 

Moverman MA, Puzzitiello RN, Glass EA, Swanson DP, Efremov K, Lohre R, et al. Implant-Positioning and Patient Factors Associated with Acromial and Scapular Spine Fractures After Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group. J Bone Joint Surg Am. 2024;106(15):1384–94. https://doi.org/10.2106/JBJS.23.01203.

Article  PubMed  Google Scholar 

Roche CP, Fan W, Simovitch R, Wright T, Flurin PH, Zuckerman JD, et al. Impact of accumulating risk factors on the acromial and scapular fracture rate after reverse total shoulder arthroplasty with a medialized glenoid-lateralized humerus onlay prosthesis. J Shoulder Elb Surg. 2023;32(7):1465–75. https://doi.org/10.1016/j.jse.2022.12.026.

Article  Google Scholar 

Yeazell ST, Malige A, Visser T, Carolan GF. The role of acromial morphometry in the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elb. 2021;13(3):296–302. https://doi.org/10.1177/1758573220906764.

Article  Google Scholar 

Archambault SD, Kakazu R, Jimenez AE, Polisetty T, Cusano A, Berthold DP, et al. Variations in the Anatomic Morphology of the Scapular Spine and Implications on Fracture After Reverse Shoulder Arthroplasty. J Am Acad Orthop Surg. 2024;32(15):712–8. https://doi.org/10.5435/JAAOS-D-22-00557.

Article  PubMed  Google Scholar 

Townsend CB, Wright J, Wright TW, Pazik M, Schoch B, Gil J, et al. Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty. JSES Int. 2022;6(2):236–40. https://doi.org/10.1016/j.jseint.2021.11.008.

Article  PubMed  Google Scholar 

Shah SS, Gentile J, Chen X, Kontaxis A, Dines DM, Warren RF, et al. Influence of implant design and parasagittal acromial morphology on acromial and scapular spine strain after reverse total shoulder arthroplasty: a cadaveric and computer-based biomechanical analysis. J Shoulder Elb Surg. 2020;29(11):2395–405. https://doi.org/10.1016/j.jse.2020.04.004.

Article  Google Scholar 

Haidamous G, Merimee S, Simon P, Denard PJ, Ladermann A, Mighell MA, et al. Acromial fractures following reverse shoulder arthroplasty: the role of the acromial morphology and a comparison of clinical outcomes. J Shoulder Elb Surg. 2022;31(6S):S34–43. https://doi.org/10.1016/j.jse.2022.01.132.

Article  Google Scholar 

Gilat R, Johnson MC, Budin JS, Carpenter ML, Tabbaa A, Villareal-Espinosa JB, et al. Pre-operative corticosteroid injections are associated with a dose-dependent risk for complications following anatomic and reverse total shoulderarthroplasty. J Shoulder Elb Surg. 2026. https://doi.org/10.1016/j.jse.2026.01.024.

Article  Google Scholar 

Lockhart JS, Wong MT, Langohr GDG, Athwal GS, Johnson JA. The effect of load and plane of elevation on acromial stress after reverse shoulder arthroplasty. Shoulder Elb. 2021;13(4):388–95. https://doi.org/10.1177/1758573220910093.

Article  Google Scholar 

Werthel JD, Walch G, Vegehan E, Deransart P, Sanchez-Sotelo J, Valenti P. Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop. 2019;43(10):2349–60. https://doi.org/10.1007/s00264-019-04365-3.

Article  PubMed  Google Scholar 

Eisenberg MT, Hui C, Schwartz K, Qubain L, Amini MH. In reverse shoulder arthroplasty, selectively medializing the glenoid in higher-risk patients is associated with reduced risk of acromial stress fracture. J Shoulder Elb Surg. 2026. https://doi.org/10.1016/j.jse.2026.04.029.

Article  Google Scholar 

Johnson JE, Anderson DD, Bozoghlian MF, Galvin JW, Patterson BM. Computational analysis of compressive joint stability and acromial stress associated with varied rotator cuff integrity after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2026;35(5):1349–59. https://doi.org/10.1016/j.jse.2025.08.023.

Article  Google Scholar 

Pak T, Ardebol J, Menendez ME, Gobezie R, Sears BW, Lederman E, Robert H, Cofield MD, Award for Best Oral Presentation. 2023: Up to 8 mm of glenoid-sided lateralization does not increase the risk of acromial or scapular spine stress fracture following reverse shoulder arthroplasty with a 135 degrees inlay humeral component. J Shoulder Elbow Surg. 2024;33(6S):S1–S8. https://doi.org/10.1016/j.jse.2023.11.018

Article  Google Scholar 

Wong MT, Langohr GDG, Athwal GS, Johnson JA. Implant positioning in reverse shoulder arthroplasty has an impact

Comments (0)

No login
gif