Shoulder impingement syndrome is one of the most common painful shoulder disorders. The diagnosis of shoulder impingement syndrome is usually accomplished through careful clinical examination. Appropriate radiologic studies sometimes can indicate the causes of impingement and document the diagnosis. Os acromiale is a rare predisposing factor of shoulder impingement syndrome. Here, we report a 77-year-old man found to have os acromiale associated with impingement of infraspinatus muscle and tendon which was well demonstrated on magnetic resonance (MR) imaging. To our knowledge, the impingement of os acromiale on infraspinatus muscle and tendon was rarely been reported in the literature.