Coracoid Impingement Research Articles

The Trillat Procedure for Anterior Glenohumeral Instability.

Anterior glenohumeral instability (AGI) is a challenging condition that requires close attention to osseous and soft-tissue abnormalities. The morphometric variance of the periarticular scapular anatomy may be involved in the pathogenesis of recurrent traumatic anterior instability. The Trillat procedure repositions the coracoid medially and downward by a partial wedge osteotomy, mimicking the sling effect of the Latarjet procedure by moving the conjoint tendon closer to the joint line in throwing position. The Trillat procedure decreases the coracohumeral distance without affecting the integrity of the subscapularis muscle and tendon. Joint preservation methods, such as the Trillat procedure, may be explored in older patients to treat AGI with simultaneous irreparable rotator cuff tears (RCTs) with a static centered head and a functional subscapularis. Shoulder hyperlaxity and instability can be challenging to treat with isolated soft-tissue procedures. In cases without glenoid bone loss, free bone block techniques are ineffective because of the subsequent potential graft resorption, apprehension, or recurrence. The Trillat surgery, in conjunction with an anteroinferior capsuloplasty, seems to be helpful in preventing recurrent instability and in reducing shoulder apprehension. Recently, several variations of the original technique have been described. In the future, anatomical, biomechanical, and clinical studies need to be conducted to further evaluate the morphometric characterization of the procedure, enhance the technical features, improve indications, and avoid coracoid impingement and other potential complications with the Trillat procedure.

Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears.

This study describes measurements between the coracoid, glenoid, and humerus; characterizes coracoid shape, rotator cuff fatty infiltration, and quantitatively evaluates coracoid impingement and its association with anterosuperior rotator cuff tears (ASCT). 193 shoulder magnetic resonance imaging (MRI) scans demonstrating: rotator cuff tear; isolated tear of the supraspinatus; tear of supraspinatus and subscapularis, were included. MRI measurements included coracohumeral interval (CHI), coracoid overlap (CO), coracoid recess (CR), coracoglenoid angle (CGA), and coracoglenoid interval (CGI) on axial slices; acromiohumeral interval (AHI) on coronal slices; and coracohumeral interval (CHI) and coracoacromial ligament (CAL) thickness on sagittal slices. The coracoid shape was classified as flat, curved, or hooked. An Independent T-test was used to compare the MRI measurements and the different rotator cuff tear groups. In 79% of the patients with ASCT tears, the coracoid was curved. Axial CHI, CGA, sagittal CHI, and AHI were decreased in ASCT when compared to no tears and isolated supraspinatus tears (p < 0.05). CO was increased in ASCT compared to no tears and isolated supraspinatus tears (p < 0.05). Patients with an ASCT had a significantly increased subscapularis and supraspinatus Goutallier fatty infiltration score when compared to no tear and isolated supraspinatus tears (p < 0.05). These quantitative measurements may be useful in identifying patients at risk for ASCT. Level of Evidence III.

Dual osteochondromas arising from the coracoid process and the glenoid of scapula

Abstract Introduction: Scapular osteochondromas represent 3% to 4% of all osteochondromas. Although many cases of osteochondromas affecting the body of the scapula have been reported in the first three decades of life, case reports of osteochondroma affecting the coracoid process or the glenoid of the scapula are limited. Patient concerns: We report a case of a 56-year-old male with progressive pain and swelling of the left shoulder for six months. Diagnoses: The diagnosis was dual osteochondromas arising from the coracoid process and the glenoid of the left scapula. Interventions: Complete excision was performed. Outcomes: The patient was discharged without any complications after 10 days of postoperative wound care. His symptoms relieved at three months after surgery. At the last follow-up (two years postoperatively), the patient remained in good condition. He had full range of motion of the shoulder without any signs of recurrence. Conclusion: Dual osteochondromas arising from the glenoid and the coracoid process can cause severe dysfunction with coracoid impingement syndrome of the ipsilateral shoulder. In older individuals, it is necessary to differentiate osteochondroma from a malignant tumor.

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;

Measurement of the coracohumeral distance on magnetic resonance imaging in a large patient cohort

Coracoid impingement syndrome is an increasingly recognized etiology of anterior shoulder pain. Numerus studies have documented the coracohumeral distance (CHD) as a primary or secondary measurement in symptomatic individuals, but there lacks an evaluation of CHD in a large cohort of asymptomatic individuals. The purpose of this study was to quantify a normative distribution of the CHD in a large cohort of healthy, asymptomatic subjects with no history of impingement or shoulder instability. Incoming first-year students in the United States Military Academy were offered enrollment in this study as part of a prospective cohort to assess the normal anatomic relationships of the shoulder girdle. Magnetic resonance images were obtained, and a board-certified, fellowship-trained musculoskeletal radiologist performed measurements of the smallest distance from the coracoid to the humeral head on axial images. Magnetic resonance images of 714 subjects were available for analysis, including 630 males and 84 females, with a total of 1120 individual shoulders with images of adequate quality. The mean CHD for all shoulders imaged was 13.7 mm. The mean CHD in male shoulders was 13.8 mm, and in female subjects the average was 12.4 mm. This study is the largest of its kind to evaluate the CHD in asymptomatic, healthy shoulders to dateand demonstrates a mean CHD of 13.7 mm for all subjects. This information can help to standardize "normal" ranges and act as a comparison for future work, when taken in the context of age and imaging in neutral rotation.

Subcoracoid Impingement – A Global View

Abstract Modifications in joint anatomy on both soft and bony tissue level play a key role in subcoracoid impingement syndrome. The diagnostic is primarily clinical and is based on patient history and functional tests. Imaging tests support, but do not establish the diagnostic. Approach can take the form of targeted exercises with progressive load, or that of invasive surgery. Shoulder pain has a diverse etiology which derives from the complex local anatomy which includes the clavicle, acromion, coracoid process and humeral head, the soft tissues surrounding this area, in particular the rotator cuff, but can also be unrelated to all of the above and be a reflection of a pathology located in the neck, arm or trunk, or adjacent visceral organs. More often, it is the manifestation of a traumatic episode or an anatomical anomaly, or it can be secondary to inflammation, tumors, or surgery. It is the third most common musculoskeletal complaint presenting to physiotherapy, and largely impacts both an individual’s quality of life and the public health system. Coracoid impingement syndrome can present itself as a cause of rotator cuff disease, but its role is not fully established yet. It is less prevalent than subacromial impingement, can coexist with it, and therefore should be considered into the differential diagnosis of anterior shoulder pain when a patient presents themselves with activity related anterior shoulder pain.

Arthroscopic-Assisted Subpectoral Biceps Tenodesis for Symptomatic Biceps Tendon Disorder

Lesions of the long head of the biceps tendon have been recognized to be a common source of anterior shoulder pain and dysfunction. Common syndromes include primary biceps tendinitis, symptomatic biceps tendon subluxation, traumatic biceps tearing, coracoid impingement, and biceps tendinitis associated with either superior labrum anterior-to-posterior lesions or rotator cuff tears. The diagnosis is made on history of anterior shoulder pain, tenderness in the bicipital groove, and symptomatic relief of the pain with an injection of local anesthetic into the bicipital groove. MRI is not reliable in the diagnosis of biceps tendon disorders. When nonoperative treatment fails to relieve the symptoms of painful biceps tendinitis, biceps tenotomy or biceps tenodesis are often considered. In this chapter, we will review the pathology and anatomy of biceps tendon lesions, and the advantages of arthroscopic-assisted subpectoral biceps tenodesis. Excellent outcomes have been reported with this technique.

In vivo analysis of coracoid and subacromial shoulder impingement mechanism during clinical examination.

Understanding the mechanisms of shoulder impingement created by clinical tests is crucial to accurately evaluate the condition. The objective of this study was to relate mechanisms of subacromial and coracoid impingement occurring in positions of the shoulder during clinical examination, in quantitative and qualitative terms. A 1.0T open magnetic resonance imaging system was used in 18 female and 19 male subjects, to determine the distances between the humeral head and the acromion or coracoid, and contact with the rotator cuff (RC). Measurements were taken with the shoulder in neutral, "Hawkins", "Neer", and 90° abduction/15° internal rotation (horizontal impingement test) positions. Additionally, impingement was classified based on the grade of RC contact with the acromion or coracoid. In the Hawkins position, distance between the supraspinatus and the coracoid was closest (14.5±4.5mm), while the coracohumeral distance (CHD) narrowed (p<0.001). In the horizontal impingement test position, the minimum distance between the subscapularis and coracoid was found, whereas the CHD increased (27.4±5.7mm). In the Neer and Hawkins positions, the space between the greater tuberosity and acromion was significantly narrowed, which was also the case in the horizontal impingement test position compared to neutral position (p<0.001). Shoulder movements of forward flexion and internal rotation (Hawkins test) and abduction and internal rotation (horizontal impingement test) can lead to different coracoid impingement mechanisms during clinical examination. The Hawkins, Neer, and horizontal impingement tests lead to comparable narrowed acromiohumeral distances and subacromial contact of the RC. Therapeutic level III.

Decreased axial coracoid inclination angle is associated with rotator cuff tears.

Coracoid morphology has been related to coracoid impingement mainly resulting in anterior shoulder pain aggravated by forward flexion and internal rotation. However, the coracoid process morphology can also affect the inclination of the coracoacromial ligament and subsequently the subacromial space in the same way that acromial slope does. The purpose of this study was to evaluate the influence of the coracoid body-glenoid surface, coracoid tip-glenoid surface, and coracoid body-coracoid tip angles (coracoid inclination angles) on rotator cuff tears (RCTs). Fifty patients with documented RCT and 50 patients with normal rotator cuff (control) were included. The coracoid inclination angles were determined in both groups by measuring on computed tomography scans the angle created by the coracoid body and the glenoid surface (A1), the angle created by the coracoid tip and the glenoid surface (A2), and the angle created by the coracoid body and the coracoid tip (A3). All angles were significantly lower in the RCT group compared to the control group: mean A1 angle of 49.7° and 54.61°, respectively ( p = 0.011); mean A2 angle of 76.45° and 93.6°, respectively ( p < 0.001); and mean A3 angle of 132.33° and 144.34°, respectively ( p < 0.001). Decreased coracoid body-glenoid surface, coracoid tip-glenoid surface, and coracoid body-coracoid tip angles are associated with RCT. Decreased angles may reduce subacromial space by projecting the coracoacromial ligament more vertically.

Magnetic Resonance Imaging of the Subcoracoid Region and Its Relationship with Subscapularis Lesions in the Chinese Population: 在中國人群組中用磁力共振來評估下喙突區域及其與肩胛下肌病變的關係

IntroductionCoracoid impingement is considered a known yet frequently overlooked cause of anterior shoulder pain. Subcoracoid stenosis has been shown to be related to subscapularis tear. Studies have shown that patients with coracoid impingement have a shorter coracohumeral distance (CHD) and a larger coracoid overlap (CO) but these are based on data from Western populations. The aim of our study was to provide a local database on the MRI measurement of these parameters in our Chinese population and raise the awareness of this disease entity. MethodsAll the shoulder MRI films taken in our hospital in 2011 were retrospectively reviewed and classified into two cohorts. The control group consisted of patients who had no subscapularis lesion. The subscapularis lesion group consisted of patients with complete tear, partial tear or abnormal signal over the subscapularis tendon. The CHD and CO were measured. ResultsWe reviewed 133 sets of shoulder MRI obtained in our hospital during 2011. Thirteen patients were noted to have subscapularis lesion. The CHD in the subscapularis lesion group was 6.24 ± 2.18 mm. The CHD in the control group was 9.95 ± 3.9 mm. Women had shorter CHD (8.18 ± 2.57 mm) than men (11.0 ± 4.54 mm). We failed to notice any statistically significant difference with regards to CO, coracoid process and lesser tuberosity morphology between the two groups of patients. ConclusionMRI assessment of CHD can be useful in identifying patients at risk of having subscapularis lesion and coracoids impingement.

MRI analysis of coracohumeral interval width and its relation to rotator cuff tear.

Coracoid impingement is an uncommon cause of the shoulder pain. It is stimulated by adduction, internal rotation and forward flexion. These positions decrease the width of the coracohumeral interval. Owing to restriction of movement, rotator cuff tendons may be overloaded. Thus, in this study, we aimed to determine whether coracoid impingement increase the tendency of rotator cuff tears. Routine clinical MRI sequences of 117 shoulders were reviewed, and axial coracohumeral interval measurements were taken. Rotator cuff tendon integrity was evaluated. Relation between rotator cuff tear and coracohumeral interval width was commented statically. Seventy-nine of the patients were women, 38 of them men. The average age was 44.8 ± 14.2 (14-75). The mean age of patients with rotator cuff tear was significantly higher than patients without tear (p = 0.001). The mean value of coracohumeral interval width was 8.853 ± 2.491 mm (min: 2.9-max: 15.8). There were no significant differences between coracohumeral interval width of women and men (p = 0.139). The mean value of coracohumeral interval width with rotator cuff tear was 8.362 ± 2.382, and without tear was 9.351 ± 2.520. There was a significant differences between them (p = 0.031). According to our study, there was a relationship between coracohumeral interval width and rotator cuff tear, so decreasing coracohumeral interval width may increase tendency of rotator cuff tear.

AB0725 Quantitative measurement of humero-acromial, humero-coracoid, and coraco-clavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint

BackgroundShoulder impingement is an important entity and has to be proved with imaging and pathologically if needed. This research is acquired for the clinical and surgical applications of impingement, based...

Coracoplasty

Coracoplasty has become a more commonly performed surgical procedure, as coracoid impingement has become increasingly recognized as a cause of persistent anterior shoulder pain. Open and arthroscopic techniques have shown satisfactory results. This article will provide a current review about the indications and techniques for coracoplasy, including both arthroscopic and open techniques and the expected outcomes.

Paper 27: The Subcoracoid Space: An Anatomical Study

To evaluate the amplitude of the subcoracoid space under maximum internal and external rotations of the humeral head and measure the distance between the apex of the coracoid process (ACP) and the following anatomical structures: (a) point of entry of the musculocutaneous nerve (MCN) and its branches into the coracobrachial muscles (CBM) and into the short head of the biceps brachii muscle; (b) acromial artery (AA); (c) lesser tubercle of the humerus (LTH). Knowledge of the anatomical relationships between these structures and the ACP is important not only for understanding the etiology of coracoid impingement, but also to prevent vasculonervous injuries, particularly during arthroscopic surgical approaches. Thirty shoulders from of fresh cadavers (nine male and 6 female), without of any kind of shoulder disease, were dissected and the distances (in mm) were measured between the anatomical structures defined above and the ACP. The mean distance between the ACP and the MCN was 49.2 mm (in all specimens a proximal branch of the nerve was identified 34.2 mm away from the ACP), which was not significantly different between the sexes or body sides. The mean distance between the ACP and the AA was 12.4 mm, which was not significantly different between the sexes and body sides. The mean distance between the ACP and the LTH, with the humeral head under internal rotation, was 10.6 mm in men and 8.6 mm in women, thus presenting a significant difference between the sexes. The smaller distance between the ACP and the LTH in internal rotation of the arm suggests that there is a higher chance of impingement between those bone structures among women.

Coracoid impingement: current concepts

For many years, coracoid impingement has been a well-recognized cause of anterior shoulder pain. However, a precise diagnosis of coracoid impingement remains difficult in some cases due to the presence of multifactorial pathologies and a paucity of supporting evidence in the literature. This review provides an update on the current anatomical and biomechanical knowledge regarding this pathology, describes the diagnostic process, and discusses the possible treatment options, based on a systematic review of the literature. Level of evidence V.

Coracoid Impingement: Diagnosis and Treatment

Coracoid impingement is a controversial, well-known diagnosis that results in anterior shoulder pain. Idiopathic, traumatic, and iatrogenic etiologies have been identified. Proper diagnosis requires a focused clinical examination of the anterior shoulder and adjacent structures. MRI and CT are helpful in evaluating coracoid morphology as well as the integrity of the rotator cuff and long head of the biceps. Imaging is an essential diagnostic tool. Initial management consists of physical therapy and injection therapies. Surgery may be required when nonsurgical methods are unsuccessful. Successful functional and subjective outcomes have been reported with both open and arthroscopic techniques.

Coracoid impingement syndromeの治療経験

Coracoid impingement syndromeの治療経験

Coracoid Impingement Syndrome Due to Intensive Rock Climbing Training

Overuse and acute injuries to the upper body are common in rock climbing. Such injuries primarily affect the fingers; but shoulder problems are increasingly common, especially among more experienced and older climbers who climb at a high ability level. Such shoulder problems are often due to subacromial impingement, shoulder dislocations with bankart lesions, hyperlaxity, SLAP lesions or irritations of the long biceps tendon. In contrast to these known conditions, we describe a case of an ambitious female rock climber who trained intensively and developed a coracoid impingement caused by hypertrophied subscapularis tendon and muscle following sport-specific training. Diagnosis was made through clinical evaluation and confirmed by magnetic resonance tomography. Coracoid impingement syndrome is a less common cause of shoulder pain and occurs when the subscapularis tendon impinges between the coracoid and the lesser tuberosity of the humerus. The patient was treated successfully with a conservative therapy and returned to full activity within 6 weeks.

양궁 선수의 오구 충돌 증후군의 치료 후 발생한 회전근 간격의 손상에 대한 치료 - 증례 보고 -

Purpose: Coracoid impingement syndrome refers to subscapularis impingement between the coracoid process and lesser tuberosity of the humerus, and pain may occur when the arm is positioned in forward flexion, internal rotation and adduction. This position is common for archers. Material and methods: A female archer with coracoid impingement syndrome that was uncontrolled by conservative therapy underwent arthroscopic subcoracoid decompression. At the 20th postoperative month of follow up, she complained of painful rotator interval widening and so she underwent arthroscopic rotator interval plication. Results: At the postoperative 6th month of follow up after the second operation, she showed no pain and good functional results, and she returned to competing as an archer. Conclusion: We have reported here on a case of successful treatment of painful rotator widening after subcoracoid decompression in an elite archer.

Troubles du comportement : les maladies métaboliques par intoxication

Lesions of the long head of the biceps tendon have been recognized to be a common source of anterior shoulder pain and dysfunction. Common syndromes include primary biceps tendinitis, symptomatic biceps tendon subluxation, traumatic biceps tearing, coracoid impingement, and biceps tendinitis associated with either superior labrum anterior-to-posterior lesions or rotator cuff tears. The diagnosis is made on history of anterior shoulder pain, tenderness in the bicipital groove, and symptomatic relief of the pain with an injection of local anesthetic into the bicipital groove. MRI is not reliable in the diagnosis of biceps tendon disorders. When nonoperative treatment fails to relieve the symptoms of painful biceps tendinitis, biceps tenotomy or biceps tenodesis are often considered. In this chapter, we will review the pathology and anatomy of biceps tendon lesions, and the advantages of arthroscopic-assisted subpectoral biceps tenodesis. Excellent outcomes have been reported with this technique.