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Bony or skeletonized shoulders are when a hard prominence is clearly seen rising above the surrounding profile of the shoulders. This could be due to a lack of adequate muscle development of the deltoid and trapezius muscles. It can also be caused by a prominent acromioclavicular (AC) joint interface due to its natural development or by an old injury to the joint.

The acromioclavicular joint sits on top of the shoulder and is formed by the union of the lateral end of the clavicle and the acromion process of the scapula.  This makes it a bony knob that has little soft tissue sitting over it. Adequate shoulder muscle may make it appear as a minimal bump. But in some people it sticks up quite prominently.

Treatment of the bony shoulder is typically non-surgical with development of muscle bulk around it. With enough muscle tissue around it, the bony knob of the shoulder can be disguised. For some people, however, exercising to build the musculature can be difficult and/or may not be able to be sustained without persistent exercising. An alternative approach is to build up the deltoid muscle profile by fat injections.

Fat injections are well known to take best in muscle tissue. Building up the deltoid muscle profile by a combination of muscle and subcutaneous injections over the shoulder can help obscure a prominent AC joint appearance. It is necessary to also inject fat in the thin subcutaneous tissues directly around the AC joint where there is little natural fat tissue.

The success of fat injections in the shoulder area can be significant if injected properly.The key is to get most of the fat injectate under the fascia and into the actual muscle. Fat needs to also be injected into the subcutaneous space between the skin and the fascia but greater survival of the fat while occur in the muscle tissue that is not exposed to the stress of movement across a tight skin sleeve. (patient picture results available on request)

Dr. Barry Eppley

Indianapolis, Indiana

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