IntroductionSnapping scapula syndrome is an unusual condition characterized by an audible, grating, and snapping sound upon shoulder movement, often observed in young adults. Clinical severity ranges from gentle friction sounds to louder grating noises or crepitus, which may or may not be associated with pain and limited motion. Multiple etiologies include congenital malformations such as Sprengel′s deformity, exostosis, subscapular mass, and scapulothoracic bursitis.Case PresentationA 28‐year‐old right‐handed male presented a 12‐year history of crepitus and snapping of the right scapula, with pain and worsening crepitus in the past year. Clinical examination revealed a symmetrical glenohumeral range of motion with combined scapular dyskinesia. CT scan showed a bony mass near the superior border and superomedial angle of the scapula, resembling a second glenoid with a smaller, less concave surface. The mass included a protuberance that suggested a second coracoid process and spine of the scapula. Surgical excision of the bony mass and surrounding bursa, along with partial resection of the superomedial angle, was performed. The patient fully recovered after 3 months and presented no symptoms of recurrence at the 2‐year follow‐up. The excised mass consisted of mature bony tissue with interspersed trabeculae, suggestive of exostosis.ConclusionBone masses arising from the scapula vary in origin, presentation, and morphology. We describe a unique bony projection resembling a second glenoid, treated successfully with surgical resection and resulting in complete cosmetic and functional recovery.

Most common pathologies resulting in shoulder pain are usually a consequence of degenerative, traumatic or metabolic aetiologies involving various structures around the shoulder. Benign tumours leading to pain and functional disturbance in the shoulder are rare. We report a case of a man in his 20s who presented with shoulder pain that remained unresolved for 1.5 years. Clinical examination revealed no signs of instability related to labral or rotator cuff injury. A plain radiograph of the shoulder revealed sclerosis in the coracoid process. A CT scan of the shoulder showed a nidus at the base of the coracoid, confirming the diagnosis of osteoid osteoma. He was managed by arthroscopic excision of the lesion. Postoperatively, he was able to return to all his activities within 3 months. At 1 year follow-up, no recurrence was observed.

Biomechanical Evaluation of the Therapeutic Efficacy of Different Screw Fixation Methods for Ogawa Type I Coracoid Process Base Fracture

Prevalence and Risk Factors Associated with Anterior Shoulder Pain Following Reverse Total Shoulder Arthroplasty.

To compare the effectiveness of using a composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process and using a clavicular hook plate for fixation in treatment of Rockwood type Ⅲ acute acromioclavicular joint dislocation. A retrospective analysis was conducted on the clinical data of 60 patients with Rockwood type Ⅲ acute acromioclavicular joint dislocation who were admitted between June 2022 and September 2023 and met the selection criteria. Among them, 30 patients were treated with the composite loop plate to reconstruct the coracoclavicular ligament around the coracoid process (loop plate group) and 30 with clavicular hook plate fixation (hook plate group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, injured side, cause of injury, disease duration, preoperative visual analogue scale (VAS) score for pain, and Constant-Murley score. The incision length, operation time, length of hospital stay, and the occurrence of complications during follow-up were recorded. The Constant-Murley score and VAS score were used to evaluate shoulder joint function and pain, and the differences (change values) of the indicators between before operation and at 6 months after operation were calculated for inter-group comparison. In the loop plate group, the coracoclavicular distance (CCD) on the anteroposterior X-ray films of the acromioclavicular joint was measured at 1 day and 6 months after operation to assess the loss of acromioclavicular joint reduction. The incision length of the loop plate group was significantly shorter than that of the hook plate group ( P<0.05). There was no significant difference in the operation time and the length of hospital stay between the two groups ( P>0.05). All incisions healed by first intention after operation. All patients were followed up 12-18 months (mean, 16.3 months). There was no significant difference in the follow-up time between groups ( P>0.05). The Constant-Murley scores and VAS scores of both groups significantly improved at 6 months after operation when compared with those before operation ( P<0.05); the differences in the change values of the two indicators between groups were significant ( P<0.05). The CCD of the loop plate group were (10.40±0.83) mm at 1 day and (10.70±0.68) mm at 6 months and no repositioning loss was observed. Three cases in the hook plate group had residual shoulder joint pain after operation. The difference in the accidence of complications between groups was not significant ( P>0.05). For Rockwood type Ⅲ acute acromioclavicular joint dislocation, compared with the clavicular hook plate fixation, the composite loop plate for reconstructing the coracoclavicular ligament around the coracoid process has the advantages of simple operation, safety, minimally invasive, good functional recovery, and fewer complications. Moreover, it avoids the need for a second surgery to remove the internal fixation device, and the patient acceptance and satisfaction are higher.

Abstract OBJECTIVE To demonstrate that Prostate-specific membrane antigen (PSMA) PET imaging, though primarily used in prostate cancer surveillance, can reveal PSMA uptake in non-prostatic tumors due to neovascular PSMA expression. BACKGROUND PSMA PET imaging is increasingly used for staging and monitoring prostate cancer. However, PSMA uptake is not exclusive to prostate carcinoma and may be observed in non-prostatic malignancies, including glioblastoma, due to neovascular expression. CASE REPORT We present a 67-year-old gentleman with metastatic prostate carcinoma, diagnosed in 2014 and treated with neoadjuvant Lupron, prostatectomy, and salvage radiation. In 2019, he developed nodal recurrence in retroperitoneal and bilateral iliac chain nodes, treated with lymphadenopathy, six cycles of Taxotere-based chemotherapy, and consolidative proton beam radiation (56.25 Gy/25 fractions). He later developed progression to the right proximal humerus and left coracoid process, treated with stereotactic body radiation therapy (25Gy/5 fractions). Follow-up PSMA PET/CT revealed no systemic abnormalities but showed a new PSMA-avid lesion in the right medial temporal lobe. Brain MRI confirmed a 3.5 x 1.7 x 2.5 cm ring-enhancing, intra-axial lesion with edema. The patient was asymptomatic. PSA was undetectable on abiraterone/prednisone and leuprolide. He underwent right frontotemporal craniotomy and resection. Pathology confirmed Glioblastoma, IDH-wildtype, CNS WHO Grade 4 with focal epithelioid features and positive MGMT promoter methylation. He received standard-of-care treatment with radiation, temozolomide, and TTF device. Surveillance PSMA PET and MRI showed no residual brain avidity or progression. Discussion: PSMA is a type II transmembrane glycoprotein expressed by prostatic and various non-prostatic tissues. In healthy brain parenchyma, PSMA expression is typically absent but is overexpressed in neovasculature of high-grade gliomas, including glioblastoma, IDH-wildtype, allowing for radiotracer uptake, as seen in this case. CONCLUSION This case illustrates the potential role of PSMA as a diagnostic tool, as it allows for easy identification of glioblastoma neovasculature, as demonstrated in our case report.

The application of “Hand as Foot” in teaching the supraspinatus, scapula and coracoid process

Background: This study investigates the association between subscapularis tendon tears and the anatomical characteristics of the coracoid process, as assessed by magnetic resonance imaging (MRI) and to determine the predictive cut-off values for significant measurements.Methods: Patients who underwent surgery for rotator cuff injury between 2020 and 2024 were retrospectively reviewed. Those with a subscapularis tear were classified as Group 1, while those with an intact subscapularis were classified as Group 2. MRI images were analyzed to measure axial and sagittal coracohumeral distance (axCHD, sagCHD), coracoid overlap (CO), and coracoid angle (CA). The diagnostic utility of these parameters was assessed using receiver operating characteristic (ROC) curve analysis.Results: A significant association was found between subscapularis tear and axCHD, sagCHD, and CO measurements. Among these, sagCHD demonstrated the strongest predictive power, with an optimal threshold of 9.5 mm, a sensitivity of 77.8% and a specificity of 80.4%.Conclusion: Our study demonstrated that decreased axCHD and sagCHD, and increased CO, are associated with subscapularis tears. The intracoracoid angle, however, does not appear to influence the incidence of subscapularis tears.

A rotator cuff tear (RCT) refers to a partial or complete rupture of the rotator cuff (the tendons of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles). It is commonly caused by degenerative changes or trauma and manifests as shoulder pain, weakness, and limited range of motion.This study aimed to explore the correlation between inferior position of coracoid process and risk factors for rotator cuff injury. (1) Does the inferior position of the coracoid process increase the probability of risk factors leading to RCT? (2) Does a lower positioning of the coracoid process increase the probability of subcoracoid impact? (3) Does a lower positioning of the coracoid process correlate with the shape of the acromion? From May 2018 to Dec 2019, 93 patients (38 males and 55 females) with rotator cuff injuries were analyzed, with an average age of 57.7 ± 6.2 years. All patients received X-ray examination with Anterior-posterior view and supraspinatus outlet view to distinguish acromion morphology before surgery. MRI scan was used to assess the rotator cuff injury. Three-dimensional computerized tomography examination measured the position of coracoid process. The location of rotator cuff injury and the subcoracoacromial arch impingement were evaluated by arthroscopy. Pearson chi-square test was used for statistical analysis of the position of coracoid process. 76.3% (71/93) of the patients had rotator cuff tear (RCT) within 1.5 cm of the biceps tendon groove lateral, and the rates were higher in Type III/IV coracoids. Total 60 cases had subacromial impact, while 28 cases had subcoracoid impacts. Type III/IV coracoids had a higher probability of impact. The prevalence of Type III/IV coracoid processes was 22 (78.6%) in the 28 cases with type III acromion, which was significantly higher than that in cases with Type I/II acromion (P = 0.034). The inferior position of the coracoid process increases the probability of RCT, which may be related to the high incidence of type III acromion in such patients and the reduction of the subcoracoid gap. Level III, therapeutic study.

Suture anchors are widely used for tendon and ligament repair, but their fixation strength is compromised in osteoporotic bone and limited bone volume such as the coracoid process. Existing designs are prone to penetration and insufficient cortical engagement under such conditions. In this study, we developed a novel short expandable-wing (SEW) suture anchor (Ti6Al4V) designed to enhance pull-out resistance through a deployable wing mechanism that locks directly against the cortical bone. Finite element analysis based on CT-derived bone material properties demonstrated reduced intra-bone displacement and improved load transfer with the SEW compared to conventional anchors. Mechanical testing using matched artificial bone surrogates (N = 3 per group) demonstrated significantly higher static pull-out strength in both normal (581 N) and osteoporotic bone (377 N) relative to controls (p < 0.05). Although the sample size was limited, results were consistent and statistically significant. After cyclic loading, SEW anchor fixation strength increased by 25–56%. In a 3D-printed anatomical coracoclavicular ligament reconstruction model, the SEW anchor provided nearly double the fixation strength of the hook plate, underscoring its superior stability under high-demand clinical conditions. This straightforward implantation protocol—requiring only a 5 mm drill hole without tapping, followed by direct insertion and knob-driven wing deployment—facilitates seamless integration into existing surgical workflows. Overall, the SEW anchor addresses key limitations of existing anchor designs in small bone volume and osteoporotic environments, demonstrating strong potential for clinical translation.

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research.

Background:Arthroscopic suprascapular nerve release treats suprascapular neuropathy, but surgical challenges require precise anatomic landmarks and optimal instrument positioning.Purposes:To examine the anatomic relationships of the suprascapular nerve to bony and arthroscopic landmarks, evaluate sex- and height-related variations, and provide insights to improve arthroscopic surgical accuracy and reduce complications.Study Design:Descriptive laboratory study.Methods:A total of 22 shoulders from 11 Thiel-embalmed cadavers (6 male, 5 female) were dissected to measure distances from the suprascapular nerve to bony landmarks (acromion, coracoid process, glenoid) and arthroscopic landmarks (coracoacromial ligament and conoid ligament). Notch dimensions and angles relevant to arthroscopic portal placement were also evaluated. Measurements were analyzed for correlations with sex and height.Results:The mean distance from the suprascapular nerve to the posterolateral acromion (D1) was 58.34 ± 6.58 mm, and to the anterolateral acromion (D2) was 59.50 ± 5.22 mm, both statistically significantly greater in male patients (D1, 63.38 ± 3.90 mm vs 52.29 ± 2.79 mm; D2, 63.09 ± 3.49 mm vs 55.20 ± 3.30 mm; P < .001). Arthroscopic landmarks showed no statistically significant correlation with height. The suprascapular notch was predominantly type 3 (90.9%) with a mean width of 9.93 ± 1.34 mm and nerve-to-lateral border distance of 4.67 ± 1.27 mm, consistent across sex. Moderate, statistically significant correlations with height were noted for distances D1 (r = 0.51).Conclusion:This study demonstrated that the suprascapular nerve's distance to bony landmarks varies by sex, while arthroscopic and notch dimensions remain consistent. Height moderately influences certain bony landmark distances.Clinical Relevance:These results provide essential anatomic references to enhance the precision of arthroscopic decompression

Musculoskeletal comparison of the pectoral fin in mudskippers (Gobiidae: Oxudercinae).

ObjectiveThe purpose of this study was to evaluate and compare the clinical efficacy and radiological results of three surgical methods for treating Rockwood III–V acromioclavicular dislocation.MethodsA retrospective analysis was conducted on 62 patients with acute Rockwood III–V acromioclavicular dislocation who were admitted to our hospital from September 2017 to December 2022. Among these patients, 19 received the modified Weaver-Dunn technique (Group A), 20 underwent the arthroscopic single tunnel technique (Group B), and 23 received the arthroscopic coracoid sling technique (Group C). The clinical outcomes assessed included perioperative indicators, shoulder joint function outcomes, VAS scores, acromioclavicular joint redislocation rates, and complications. The radiological results primarily focused on the changes in the distance between the beak and the clavicle (CCD).ResultsAll patients were followed for an average duration of 32.72 ± 7.93 months. At the final follow-up, the shoulder joint function scores, pain scores, and imaging findings of all three patient groups exhibited significant improvements compared to their preoperative values. Three months post-surgery, a comparative analysis among the three groups revealed that Groups B and C demonstrated significantly superior shoulder joint function scores and pain relief in comparison to Group A (p 0.05). Regarding complications, all three groups experienced various postoperative complications; however, no significant differences were found in the incidence of complications among the groups (p > 0.05).ConclusionThree surgical methods have demonstrated favorable and comparable clinical and imaging outcomes in the treatment of acute acromioclavicular dislocation. Compared to the modified Weaver-Dunn technique, coracoid process single tunnel fixation and coracoid process non-tunnel suspension fixation may be more effective and provide a higher level of mobility.

Anthropometric Evaluation of the Coracoid Process in the Indian Population Using 3D CT Imaging

Rationale:Glenoid fractures, representing approximately 10% of scapular fractures, are uncommon but clinically significant due to their frequent association with high-energy trauma. Without timely and adequate management, such injuries may lead to complications including nonunion, osteoarthritis, and chronic instability, especially when fracture patterns are complex or extend into the scapular body. This report highlights the unique diagnostic and therapeutic challenges of managing an Ideberg type Vb glenoid fracture.Patient concerns:A 32-year-old male motorcyclist presented with significant swelling and ecchymosis around the left shoulder and axilla, accompanied by complete functional impairment of the shoulder joint. Despite the severity of the trauma, neurological sensitivity was preserved on admission.Diagnoses:Imaging through radiography and computed tomography with 3-dimensional reconstruction revealed a comminuted glenoid cavity fracture, displacement of the coracoid process, and extension of the fracture line into the scapular body – classified as an Ideberg type Vb fracture.Interventions:Surgical management was conducted via the Judet approach, involving open reduction and internal fixation using 2 reconstruction plates. These were precontoured on a cadaver scapula model and intraoperatively adapted to the patient’s anatomy. Postoperative immobilization with a Velpeau bandage was maintained for 30 days. At 6 months, a secondary procedure – neurotization using sural nerve grafts and direct neuromuscular neurorrhaphy via the Giorgio Brunelli technique – was performed due to persistent motor deficits attributed to infraspinatus nerve injury.Outcomes:Initial postoperative follow-up showed persistent deficits in external rotation and abduction. Following neurotization, the patient exhibited gradual and substantial functional recovery, with a Constant shoulder score of 86 documented at 2 years post-trauma.Lessons:This case emphasizes the complexity of Ideberg type Vb glenoid fractures and the necessity for comprehensive diagnostic imaging, individualized surgical planning, and interdisciplinary collaboration. Preoperative plate contouring with cadaveric models and targeted neurological reconstruction were pivotal in achieving a favorable long-term outcome.

Scapular morphological variations and sex-related and generational differences in global scapular shape: three-dimensional morphometric analysis using a homologous model

Background: The biceps brachii muscle is known for its significant variability in the human body. This study aims to detail the distal branching patterns of the motor branches of the musculocutaneous nerve, with the goal of developing surgical guidelines tailored to the Myanmar population. Materials and Methods: A total of 62 arms from 31 adult cadavers (26 males, 41.9%, and 36 females, 58.1%) were dissected. A reference line was drawn from the tip of the coracoid process to the humerus's lateral epicondyle. The primary motor nerve to the biceps originated from the musculocutaneous nerve, and the gross motor entry point (GMEP) for each muscle head was measured from the tip of the coracoid process, expressed as a percentage of the reference line. Results: Innervation pattern Type I, characterized by a single primary motor branch (PMB), was present in 48 arms (77.4%), while Type II, with two separate PMBs, was identified in 11 arms (17.4%). Type III, where a common PMB bifurcated to supply both heads, with an additional motor branch innervating the common muscle belly, was seen in three arms (4.8%). The mean distance of the PMB was 12.23 cm in males and 11.49 cm in females. The mean percentage of PMB relative to the reference line was 44.78% in males and 44.04% in females. The mean distance from the GMEP to the long head was 13.48 cm in males and 12.5 cm in females. The mean distance from the GMEP to the short head was 12.115 cm in males and 11.514 cm in females. Conclusion: An anterior surgical approach is recommended for identifying the motor branches and locating the motor points, which facilitates clinical application and reduces errors due to anthropometric differences. KEYWORDS: Biceps brachii muscle, Musculocutaneous nerve, primary motor branch to biceps, gross motor entry point.

Background: The study was conducted to determine the practical area for inserting the coracoclavicular (CC) screw through the plate by analyzing three-dimensional (3D) shoulder models featuring virtually implanted, actual-size plates and screws.Methods: Ninety cadaveric shoulders (41 males and 49 females) underwent continuous 1.0-mm slice computed tomography scans. The data were imported into image-processing software to generate a 3D shoulder model, including the scapula and clavicle. The overlapping area between the clavicle and the horizontal portion of the coracoid process (horizontal portion_CP) was analyzed in the cranial view. A curved pelvic recon plate was virtually placed on the upper surface of the distal clavicle, and an actual-size (3.5 mm) CC screw was inserted through the plate.Results: The distal clavicle directly overlapped with the horizontal portion_CP in the vertical direction. The overlapping area was sufficient to place the 3.5 mm and 4.5 mm-sized screws. In all shoulder models, the CC screw could be inserted through the plate into the vertical direction, with an average length of 35.5 mm (range, 26.2–62.5 mm; standard deviation, 1.2 mm). In 87 models, the CC screw was inserted through the third hole from the lateral end of the plate. Two models were inserted through the second hole, and one model through the fourth hole.Conclusions: The upper surface of the clavicle has sufficient overlapping area to place CC screws through the plate in the vertical direction in the corresponding hole. Supplemental CC screw fixation through the plate can be performed without additional or special equipment.Level of evidence: IV

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19-45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6-35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21-37) % and Hill-Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16-40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30-100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0-20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome.