Anterior Shoulder Pain Research Articles

Conjoint tendon lengthening for recalcitrant anterior shoulder pain after reverse shoulder arthroplasty: a technique article

The incidence of reverse shoulder arthroplasty (RSA) has increased since the Food and Drug Administration approved its use in the United States in 2004. With the current RSA implants available for surgeon use within the United States of America, each design, regardless of humeral inlay vs. onlay, distalizes the shoulder's center of rotation. This new center of rotation purposely increases tension to the deltoid, which is the main working muscle in RSA, but also retensions the adjacent tendons. Some patients after RSA experience continued anterior shoulder discomfort that limits their active range of motion and overall patient satisfaction. It has been isolated with physical examination that there is tenderness to palpation at the coracoid process and throughout the conjoint tendon. We have completed conjoint tendon lengthening procedures on this subset of patients with excellent clinical results. This article describes the technique for patients who underwent conjoint tendon lengthening after RSA for recalcitrant anterior shoulder pain.

Arthroscopic Evaluation of the Long Head of the Biceps Tendon: Traditional Versus Allis Clamp Techniques.

Using a probe to retract the long head of the biceps tendon (LHBT) into the joint is common practice for visualizing the extra-articular portions during arthroscopy. However, extra-articular lesions may be missed in up to half of cases. Greater excursion of the LHBT may be achieved with an Allis clamp grasper. Our goal was to quantify portions of the extra-articular LHBT that could be visualized during shoulder arthroscopy with the Allis clamp and probe techniques. Shoulder arthroscopy was performed on 8 forequarter cadaveric specimens in the simulated beach chair position, and the most distal extent of the intra-articular LHBT was marked. The tendon was pulled into the joint with both techniques, and the additional exposed tendon portion was marked. An open approach was performed, and the locations of the 3 marks were assessed relative to total tendon length. Mean LHBT total length was 96.25 mm. Diagnostic arthroscopy allowed visualization of a mean of 21.75 mm of the intra-articular tendon (22.6% of the total length). The traditional probe technique provided visualization of 31.13 mm (32.8%). The Allis clamp technique provided visualization of 49.38 mm (52%) and increased visualization of the LHBT by 58.6% (P<.0001). A mean of 46.87 mm (48%) of the LHBT remained unvisualized. The Allis clamp technique maximizes arthroscopic visualization of extra-articular LHBT. The distal 48% eludes evaluation, but can be visualized when combined with an open technique without the need to divide the transverse humeral ligament. The Allis clamp technique facilitates additional identification of LHBT pathology that could otherwise remain hidden during shoulder arthroscopy. Because the LHBT is a major source of pain in the shoulder, this technique may improve outcomes of shoulder arthroscopy and reduce the need for revision because of remnant anterior shoulder pain. [Orthopedics. 2022;45(1):38-42.].

Assessing/Imaging the Subcoracoid Space: From Anatomy to Dynamic Sonography

In the pertinent literature, standardized sonographic protocols have been widely described to evaluate the different compartments of the shoulder. However, the subcoracoid space is a complex anatomical region-usually not included/described in basic ultrasound approaches. Accordingly, starting from its anatomy, we describe a two-phase dynamic ultrasound protocol to scan the subcoracoid space. This way, we aim to optimize the diagnosis and management of patients with anterior shoulder pain and subcoracoid effusion.

Mini-Open Subpectoral Biceps Tenodesis Using a Suture Anchor with Bone-Bridge Backup

Pathology of the long head of the biceps tendon is a known cause of anterior shoulder pain. Current surgical management options include tenotomy and tenodesis. Tenodesis can be performed arthroscopically or as an open procedure. Arthroscopic tenodesis typically uses a suprapectoral attachment, which may fail to address tendon pathology in the bicipital groove. Open tenodesis carries iatrogenic risk to neurovascular structures and a fracture risk while drilling, as well as the morbidity of an open procedure. This technique paper describes a mini-open subpectoral approach using a suture anchor and bone bridge backup for dual fixation. Use of a suture anchor instead of an interference screw reduces drill hole diameter reducing the risk of iatrogenic humeral fracture. Dual fixation provides a robust repair which may be of use for athletic patients desiring an accelerated recovery.

Prevalence and Morphology of the Coracoclavicular Joint: An Osteological Study of 2,724 Subjects Using Univariable and Multivariable Logistic Regression Analyses.

Background: The coracoclavicular joint (CCJ) is an anomalous articulation between the surfaces of the inferior clavicle and superior coracoid and its etiology is controversial. Reportedly, symptomatic patients demonstrate significant functional limitations including shoulder abduction loss and potential for brachial plexus compression and impingement.Purpose: To determine the prevalence of CCJ across age, gender and ethnicity, and to identify clinically useful morphological characteristics.Methods: 2,724 subjects with intact clavicles and scapulae from the Hamann-Todd Osteological Collection were evaluated for the presence of CCJ. Logistic regression was used to determine the effect of age, height, gender, and race on prevalence of CCJ. 354 clavicles with CCJ were measured for size and location of the CCJ facet.Results: CCJ was observed in 9% of subjects. CCJ was more prevalent in African-Americans (12%) than Caucasian-Americans (6%) (p < 0.001) and more prevalent in females (11%) than males (8%) (p = 0.055). Facet location along clavicle length was consistent (average 25%, range 15–35%). But, facet location along clavicle width varied (average 60%, range 10–90%), with males having a more posterior location. For every 10-year increase in age, facet elevation (p = 0.001) and surface area (p < 0.001) increased.Conclusions: CCJ prevalence was 9% in our large osseous population, found more commonly in African-Americans and females. Facet location is predictable with respect to clavicle length, but less so along clavicle width. The clavicular facet may develop at some point in life and continue to grow in size after its appearance.Clinical Relevance: Presence of a CCJ represents a potential overlooked source of anterior shoulder pain and supracoracoid impingement. Epidemiologic and morphological characteristics presented in our study can aid in the identification, clinical understanding, and surgical excision of a symptomatic CCJ. Level of Evidence: Level IV.

Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction

Background: Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series. Purpose: To identify the incidence and characteristics of clavicle and coracoid fractures after CC ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: The US Military Health System Data Repository was queried for patients with a Current Procedural Terminology code for CC ligament repair or reconstruction between October 2013 and March 2020. The electronic health records, including patient characteristics, radiographs, operative reports, and clinical notes, were evaluated for intraoperative or postoperative clavicle or coracoid fractures. Initial operative technique, fracture management, and subsequent clinical outcomes were reviewed for these patients. Results: A total of 896 primary CC ligament repairs or reconstructions were performed during the study period. There were 21 postoperative fractures and 1 intraoperative fracture in 20 patients. Of these fractures, 12 involved the coracoid and 10 involved the clavicle. The overall incidence of fracture was 3.81 fractures per 1000 person-years. In 5 patients who sustained a fracture, bone tunnels were not drilled in the fractured bone during the index procedure. A total of 17 fractures were ultimately treated operatively, whereas 5 fractures had nonoperative management. Of the 16 active-duty servicemembers who sustained intraoperative or postoperative fractures, 11 were unable to return to full military duty after their fracture care. Conclusion: Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. Fractures associated with CC ligament procedures occurred at a rate of 2.46 per 100 cases. Most patients were ultimately treated surgically with open reduction and internal fixation or revision CC ligament reconstruction. Although the majority of patients with intraoperative or postoperative fractures regained full range of motion, complications such as anterior shoulder pain, AC joint asymmetry, and activity-related weakness were common sequelae resulting in physical limitations and separation from military service.

High Incidence of Anterior Shoulder Pain in Young Athletes Undergoing Arthroscopic Posterior Labral Repair for Posterior Shoulder Instability

PurposeThe purposes of this study were to determine the incidence of anterior shoulder pain in young athletes undergoing arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability and in patients with preoperative anterior shoulder pain treated without biceps tenodesis at the time of arthroscopic posterior labral repair who underwent a revision biceps tenodesis procedure at short-term follow up.MethodsA retrospective review was performed at a single institution over a 24-month period. The study included young patients who underwent an arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability. The electronic medical record, magnetic resonance arthrograms, and arthroscopic images were reviewed to exclude patients with posterior labral tears with anterior labral tear or SLAP (superior labrum anterior-to-posterior) tear extension on advanced imaging and arthroscopic examination. Data collected included the presence of preoperative tenderness to palpation of the biceps tendon in the groove, the results of a preoperative Speed test, postoperative Subjective Shoulder Value, the presence of postoperative anterior shoulder pain, and the need for a secondary biceps tenodesis.ResultsWe identified 65 patients who underwent arthroscopic labral repair for posterior shoulder instability. From this cohort, 26 patients with symptomatic unidirectional posterior shoulder instability underwent an arthroscopic posterior labral repair. The incidence of preoperative anterior shoulder pain with Zone 2 biceps groove tenderness and a positive Speed test was identified in 20 of 26 patients (76.9%). Of 26 patients, 5 (19%) had concomitant biceps tenodesis. The median postoperative Subjective Shoulder Value was 80 (interquartile range, 60-90) at median follow-up of 2.1 years. Of the 20 patients with preoperative anterior shoulder pain, 8 of 20 (40%) reported persistent anterior pain. One patient (4.7%) underwent a secondary biceps tenodesis.ConclusionsThere is a high incidence of anterior shoulder pain and Zone 2 biceps groove tenderness in patients undergoing isolated arthroscopic posterior labral repair for unidirectional posterior shoulder instability. At short-term follow-up, few patients required a secondary biceps tenodesis procedure; however, 30% of patients had persistent anterior shoulder pain.Level of EvidenceLevel IV, retrospective diagnostic case series.

The Effectiveness of Ultrasound-Guided Soyeom Pharmacopuncture Therapy at Acromioclavicular Joint of Shoulder in Patients with Anterior Shoulder Pain: A Retrospective Study

The Effectiveness of Ultrasound-Guided Soyeom Pharmacopuncture Therapy at Acromioclavicular Joint of Shoulder in Patients with Anterior Shoulder Pain: A Retrospective Study

Minimum 2-Year Clinical Outcomes After Arthroscopic Treatment for Glenolabral Articular Disruption (GLAD) Lesions: A Matched Case-Control Study

Objectives:The presence of glenolabral articular disruption (GLAD) lesions has been shown to be associated with higher rates of recurrent anterior shoulder instability and the need for repeat surgery; however, no series has yet reported clinical outcomes in a GLAD-specific cohort. Further investigation is warranted to characterize the prognosis of GLAD injuries and to identify risk factors associated with inferior outcomes.Purpose:The purpose of this study was to compare clinical outcomes between anterior shoulder instability patients with and without GLAD lesions after undergoing arthroscopic anterior shoulder stabilization and to evaluate potential risk factors that may predispose patients with GLAD lesions to inferior outcomes.Methods:Prospectively collected data was retrospectively reviewed for patients who underwent arthroscopic anterior shoulder instability repair with and without GLAD lesions at a minimum of 2 year follow-up. Consecutive patients who underwent arthroscopic surgery for GLAD lesion were matched to patients who underwent arthroscopic anterior Bankart repair by age, sex, and number of anchors. Patient reported outcomes (PROs) were evaluated pre- and post-operatively, including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and satisfaction (10-point scale). Recurrent instability, defined as recurrent dislocation, as well as reoperation were analyzed. Patients were asked to report their subjective shoulder stability compared to preoperatively (much better, better, same, worse, or much worse). Additionally, outcome scores were assessed based on GLAD lesion morphology and surgical treatment including lesion thickness (full vs. partial), size (mm3), anchor placement (in the defect vs. outside the defect), and microfracture (performed vs. not performed). Statistical significance was defined as P < .05.Results:A total of 58 patients (29 GLAD, 29 non-GLAD (Bankart only)) with a mean age of 28.5 ± 11.9 years were analyzed at 4.1 ± 1.7 years (range, 2.0-8.2) postoperatively. Seventy-six percent (44/58) of the patients were males and 24% (14/58) were females. Patients in both groups experienced significant improvements in all outcome scores after surgery (P < .05 for all) (Table 1). No significant differences were found in postoperative scores between the GLAD and non-GLAD groups [ASES (94.8 ± 8.5 vs 93.4 ± 14.1), SF-12 PCS (55.5 ± 4.5 vs 54.2 ± 8.5), SANE (90.4 ± 7.7 vs 91.3 ± 15.5), DASH (9.4 ± 15.1 vs 7.0 ± 14.9) ( P > .05 for all)] (Table 2). The median satisfaction for the GLAD and non-GAD groups was 10 (range, 1-10) and 10 (range, 1-10), respectively. Two patients in the GLAD cohort underwent reoperation: 1 for symptoms of instability at 1.5 years and the other for persistent anterior shoulder pain at 1 year post-operatively. No patients in the non-GLAD cohort underwent reoperation. No statistical differences in recurrent dislocation were observed between the GLAD (n=2, 9%) and non-GLAD (n=4, 15%; P = .67) groups; however, a significantly greater proportion of patients in the GLAD group reported worse or much worse (n=11, 50%) shoulder instability after surgery compared to the non-GLAD group (n=1, 3.8%; P=.0004). No significant differences in outcome scores were observed in GLAD patients based on thickness of the lesion, labral advancement into the defect, or treatment with microfracture (P >.05 for all). Additionally, there was no significant association between PROs and GLAD lesion size (P >.05 for all) (Table 3).Conclusions:Patients with GLAD lesions had significantly higher subjective shoulder instability when compared with a matched cohort of non-GLAD (Bankart only) patients. No difference between frank shoulder dislocation was seen. All patients had significant improvements in post-operative outcome scores with high satisfaction. There was no difference in outcomes in those with larger GLAD lesions nor if a microfracture or labral advancement was performed. Anterior shoulder instability patients with GLAD lesions were not found to have inferior outcomes but do have higher subjective instability compared with patients with Bankart only lesions. Longer term studies are necessary to evaluate the risk of arthritic change in those with GLAD lesions.

Long head of the biceps tendon ruptures treatment: literature review

Ignas Floreskul1, Dainius Misevičius1, Jokūbas Vitkus1 1 Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania Abstract The long head of the biceps tendon is a common site of anterior shoulder pain. The complex anatomical position often causes ruptures associated with rotator cuff lesions. These ruptures require clinical evaluation and appropriate treatment. When conservative treatment is not possible, two main surgical procedures are chosen: tenotomy and tenodesis. Both of these methods achieve effective clinical results, although in clinical practice there is still a dilemma in choosing one of them. Tenodesis is technically more complex and, even though it requires longer rehabilitation, does not cause cosmetic defects. Tenotomy is simpler, faster, and less invasive. Aim: evaluation of the advantages of tenodesis and tenotomy by analyzing clinical outcomes. Methods: the search of literature sources was carried out using these databases: Pubmed, UpToDate, Medline and ScienceDirect. Used keywords: „biceps“, „tenotomy“, „tenodesis“, „rotator cuff“, „long head of the biceps tendon“, „rotator cuff injuries“, „shoulder“. The newest articles, representing the topic were analyzed. The article provides a comprehensive review of the analyzed literature on biceps long tendon treatment by tenodesis and tenotomy methods. Conclusions: In majority of the literature reviewed, the results of ASES, CMS, and VAS do not differ between both tenotomy and tenodesis. The most important difference is the Popeye deformation, which was statistically more common after tenotomy in all the literature reviewed. The flexion and rotation force of the forearm also did not differ between the outcomes of the two surgical treatments in most of the studies. Keywords: tenodesis, tenotomy, rotator cuff, biceps. https://doi.org/10.53453/ms.2021.06.14

All-Arthroscopic Anatomic Length-Tension Biceps Tenodesis With Unicortical Button

The long head of the biceps tendon is a frequent cause of persistent anterior shoulder pain. Biceps tenodesis is a popular choice for surgical management of this pathology, with myriad approach and fixation variations described. We describe an all-arthroscopic suprapectoral biceps tenodesis in the anatomic length-tension relation using a unicortical button. This technique offers an alternative method that provides proper tendon fixation at anatomic length with minimized additional surgical morbidity and postoperative complications.

Diagnosis of Biceps Incarceration: Observations on the Biceps Incarceration Maneuver

Instability of the long head of the biceps brachii tendon is a recognized source of shoulder pain. However, this diagnosis is usually associated with concomitant pathology including subscapularis tendon tears. The appropriate diagnosis of biceps incarceration or instability remains challenging, with failure to address instability being likely to result in persistent pain and disability despite arthroscopic management of concomitant shoulder pathology. The objective of this article is to (1) describe a dynamic test performed both preoperatively and intraoperatively, termed the “biceps incarceration maneuver,” to help identify biceps instability; (2) reinforce the concept that biceps instability must be ruled out in young patients presenting with anterior shoulder pain; and (3) report that with proper diagnosis and treatment, patients with biceps instability will experience rapid symptomatic resolution after management.

Clinical and radiological outcomes of arthroscopic subcoracoid decompression for idiopathic coracoid impingement, a stepped approach

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Idiopathic subcoracoid impingement is considered now as a well-established cause of anterior shoulder pain. There are multiple techniques reported for management of subcoracoid impingement. Open decompression and reattachment of conjoint tendon as well as arthroscopic resection of coracoid tip. The aim of this study was to evaluate the results of arthroscopic stepwise approach for management of idiopathic coracoid impingment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective therapeutic case series study included 26 consecutive patients suffering from anterior shoulder pain and were diagnosed as subcoracoid impingement. All cases were evaluated preoperatively and followed up for 12 months after surgery both clinically and radiologically. Arthroscopic subcoracoid decompression, coracoplasty and arthroscopic repair of partial subscapularis tear if present were done for all cases.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age at the time of surgery was 45.3±5.4years. At the final follow up, the mean VAS score improved significantly to 0.8±0.8points postoperatively (p&amp;lt;0.01). The mean Constant score improved significantly to 87.8±7.8 at the final follow-up (p&amp;lt;0.001). The mean UCLA score improved significantly to 32.1±2.4 at the end of follow-up (P&amp;lt;0.001)&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Coracoid impingement should be in mind when evaluating any patient with anterior shoulder pain. The arthroscopic management in form of bone, bursal and tendon procedures (triple attack) is a good treatment to relieve clinical symptoms with excellent patient reported outcomes.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Anterior Shoulder Instability in the Throwing Athlete

Throwers, particularly baseball players, are dependent on a delicate balance of shoulder mobility and stability to excel at their sport. Disruptions to this balance can lead to a number of different types of anterior shoulder instability: microinstability, acute atraumatic instability and traumatic instability. Pathologic microinstability can develop over time in a pitcher, as repetative throwing (ie extreme external rotation in abduction) causes stretch to the joint capsule anteriorly and impingement posteriorly. The resultant anterior or posterior shoulder pain can affect pitch velocity and control. Over time, the anterior capsule and ligaments can also become attenuated. They can tear abruptly during routine pitching, resulting in acute atraumatic instability. While microinstability and acute atraumatic instability typically occur in pitchers, position players are at a higher risk of traumatic shoulder instability. Diving for a ball or sliding into a base with an arm outstretched can cause the shoulder to sublux or frankly dislocate. These traumatic instability events often lead to injury of the anterior labrum and can result in recurrent instability. Treatment of instability in these throwing athletes includes physical therapy to restore the strength and coordination of the periscapular muscles, rotator cuff, deltoid and biceps. When nonoperative treatments fail, a number of arthroscopic and open procedures are available, with the type of procedure depending on the type of instability. While these techniques can adequately restore stability to the shoulder and many throwers do return to play, throwers do so at lower rates and often at lower levels than athletes of other sports.

Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament for Anterior Shoulder Instability

Humeral avulsion of the glenohumeral ligament (HAGL) is a rare cause of anterior shoulder instability. Recurrent instability and anterior shoulder pain could be caused by an unrepaired HAGL; therefore, making the diagnosis is crucial. Only a few articles describe arthroscopic HAGL repair. This uncommon technique uses lateral decubitus arthroscopy and standard Bankart instrumentation. Different methods used to facilitate visualization of the working space as well as anchor placements are described.

Clinical Effectiveness of Various Surgical Procedures Addressing Long Head of Biceps Pathology: Protocol for a Systematic Review and Meta-Analysis.

Introduction:The long head of biceps tendon is a common source of anterior shoulder pain and impaired function. Multiple surgical procedures are available as treatment options, but the optimal procedure is not known. The aim of this systematic review and meta-analysis is to review the literature to assess the clinical effectiveness of various surgical procedures to treat pain arising from the long head of biceps.Methods:The study protocol was designed and registered prospectively on PROSPERO (International prospective register for systematic reviews). Electronic databases used for the literature search will include MEDLINE, EMBASE, PsycINFO, and The Cochrane Library. Randomised controlled trials (RCTs) evaluating surgical procedures on the long head of biceps will be included. Our primary outcome is any functional patient-reported outcome measure related to the shoulder. Secondary outcomes will include the rate of ‘Popeye’ deformity, the rate of biceps cramping pain, the rate of complications, objective measurements of strength testing such as dynamometer, and other patient-reported outcome measures not specific to the shoulder such as the Visual-Analog Scale (VAS) for pain. Methodological quality of included studies will be assessed using The Cochrane Risk of Bias Tool 2.0 and the Jadad score. Inconsistency and bias across included studies will be assessed statistically. Comparable outcome data will be pooled and analysed quantitatively or qualitatively as appropriate.Ethics and dissemination:No ethical clearances required for this study. We plan to publish this systematic review and meta-analysis in a peer-reviewed journal. It will also be presented at various national and international conferences.HighlightsEvaluating the clinical effectiveness of surgical procedures for long head of biceps pathology.Randomised controlled trials.Biceps tenodesis and biceps tenotomy.Systematic review compliant with the PRISMA guideline.

Adhesion of the Long Head of the Biceps Tendon: A Case Series

PurposeTo present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy.MethodsPatients with intra-articular LHBT adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up. Demographic data, images, and physical examinations were recorded. LHBT release, tenotomy, or tenodesis were performed according to the patient’s age and surgeon’s preference.ResultsTwelve patients were included in the study. All of them presented with chronic anterior shoulder pain and positive Speed and O’Brien tests. The average age was 46.8 ± 17 years (range 20-79 years) and the pain sustained from 6 to 96 (average 25.5 ± 28.6) months. Before the operation, 6 patients had a positive Jobe’s test, 1 had a positive lift-off test, and all had positive O’Brien and Speed tests and tenderness over the LHBT. Three release, 4 tenotomy, and 5 LHBT tenodesis were done in addition to other procedures if needed. All range of motion except external rotation, pain visual analog score, and functional outcome scores showed significant improvement at 6 months after surgery. There were no significant differences in range of motion and functional scores between 6 months and 12 months postoperatively. No difference was found in LHBT scores at 6 and 12 months after the operation. Magnetic resonance imaging revealed thickened coracohumeral ligament overlying the LHBT.ConclusionsPatients who had intra-articular LHBT adhesion to the undersurface of the rotator cuff and underwent release of the adhesion around LHBT, tenotomy, or tenodesis all had good clinical outcomes. The lesion was observed in 2.2% of all shoulder arthroscopies. Although difficult to diagnose before surgery, surgeons should be aware of this unusual condition in patients with chronic and insidious anterior shoulder pain.Level of EvidenceLevel IV, Therapeutic case series.

Diagnosis and Management of Subcoracoid Impingement.

Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Stenosis of the subcoracoid space between the lesser tuberosity and the coracoid process <6 mm can lead to anterior shoulder pain and associated rotator cuff and biceps pathology. Multiple imaging modalities are available to assess narrowing of the coracohumeral interval, each with its strengths and limitations. If the patient can be accurately diagnosed with subcoracoid impingement, both conservative and surgical management options are available. Despite earlier case series demonstrating promising results with arthroscopic treatment, comparative studies have yet to support these initial claims.

CME Sonography 95: Sonographic Differential Diagnosis of Anterior Shoulder Pain

CME Sonography 95: Sonographic Differential Diagnosis of Anterior Shoulder Pain Abstract. Anterior shoulder pain is common, and, compared to high-resolution dynamic sonography, the clinical examination is usually not precise enough for the exact classification of the cause of the pain. In this review we discuss possible causes of anterior shoulder pain with special emphasis on the ultrasound diagnosis of causes of subcoracoidal impingement and of anterior snapping syndrome. We use high-resolution ultrasound images to illustrate various possible underlying pathologies in anterior shoulder pain.

What the Radiologist Needs to Know About Biceps Tenodesis: Normal Postprocedure Imaging Appearance and Complications

Proximal long head biceps tendon (LHBT) pathology is a common and well-recognized cause of anterior shoulder pain.1–4 Various surgical procedures have been developed to address LHBT pathology. Postoperative imaging can be confusing if the radiologist is not aware of the various surgical techniques. An astute radiologist may be the first to identify a postoperative complication. An understanding of the LHBT anatomy, surgical indications, surgical procedures, and both normal and abnormal postoperative imaging appearance will enhance the radiologist's accuracy in imaging interpretation and interactions with referring providers.