Subcoracoid Impingement Research Articles

Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: an arthroscopic approach

Purpose: The purpose of this study was to evaluate the surgical outcome of patients with combined subcoracoid and subacromial impingement with associated rotator cuff tears. Type of Study: Case series. Methods: Eight patients with a mean age of 63.6 (± 8.9) years were reviewed. All patients had combined subscapularis, supraspinatus, and infraspinatus tears of the rotator cuff with associated subacromial and subcoracoid impingement. All patients were treated with arthroscopic subacromial decompression, subcoracoid decompression, and rotator cuff repair. Results: At a mean follow-up of 8.8 months (range, 6–12 months), all patients were satisfied with the procedure. The mean University of California Los Angeles (UCLA) score increased from 11.0 ± 2.6 preoperatively to 30.9 ± 2.9 postoperatively ( P < .00001). Preoperatively, all patients were in the poor category by UCLA criteria. Postoperatively, 2 patients had excellent results, 5 patients had good results, and 1 patient had a fair result. All patients had significant reduction in pain postoperatively, with 4 patients showing complete elimination of pain during all activities. No patient complained of pain anteriorly over the coracoid or had positive impingement signs postoperatively. Active forward elevation increased from a mean of 103.1° ± 46.5° preoperatively to a mean of 155° ± 18.5° ( P < .02). Preoperatively, 4 patients had no active overhead function with positive Napoleon tests. Postoperatively, all showed improvement of the Napoleon test and regained active overhead function. Conclusions: Arthroscopic treatment of combined subcoracoid and subacromial impingement can lead to good results in this patient population. A high index of suspicion for these combined lesions, along with adequate surgical decompression and rotator cuff repair, is essential in providing pain relief and improved function.

The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and tuff lesions of the subscapularis

With the advent of arthroscopy and arthroscopic repair techniques, the diagnosis and treatment of subscapularis tears have been significantly advanced. The precise etiologic factors related to subscapularis tears remain unclear. We propose that subcoracoid stenosis and subcoracoid impingement cause a “roller-wringer effect” on the subscapularis tendon. This effect increases the tensile loads on the articular surface of the subscapularis tendon that may lead to tensile undersurface fiber failure (TUFF) of the subscapularis insertion. Collectively, these factors may in part contribute to the pathogenesis of subscapularis tears.

Accessory coracobrachialis muscle as a cause of anterior impingement syndrome of the rotator cuff in an athlete

Subcoracoid impingement is a rare but well-know cause of anterior shoulder pain in throwing and overhead athletics. Bulging of the walls or the contents of the coracohumeral space may hamper the smooth gliding of soft tissue between the coracoid process and glenohumeral joint, especially in forward elevation and internal rotation of the arm. Following is a case report of subcoracoid impingement caused by an accessory coracobrachialis muscle in an alpinist treated by resection of the muscular supernumerary slip.

Old Unreduced Posterior Sternoclavicular Dislocation and Coracoid Impingement

Old Unreduced Posterior Sternoclavicular Dislocation and Coracoid Impingement

Postoperative subcoracoid impingement syndrome in patients with rotator cuff tear

Impingement of the tendinous rotator cuff on the coracoid process (subcoracoid impingement syndrome) has rarely been reported as a cause of pain after surgery for rotator cuff tear. We evaluated clinical features, surgical results, and histopathology findings of resected coracoid processes in patients with subcoracoid impingement syndrome after anterior acromioplasty and management of rotator cuff tear. Pain at the anterior aspect of the shoulder, localized tenderness of the coracoid process, anterior shoulder pain on horizontal adduction testing, and positive subcoracoid block suggest subcoracoid impingement syndrome. Postoperative subcoracoid impingement syndrome was investigated in 11 of 216 cases with rotator cuff surgery. The average patient age at the time of surgery was 61.2 y (range, 28-78 y). Coracoplasty (partial resection of the posterolateral side of the coracoid process) was performed in 9 shoulders that had not responded to a 6-month regimen of conservative treatment. Complete pain relief was achieved in all cases. Histopathologic findings revealed hypertrophic changes of the fibrocartilage layer at the posterior aspect of the resected coracoid process. We concluded that subcoracoid impingement syndrome was an important factor in unsuccessful rotator cuff surgery and recommend that coracoplasty be performed on patients with symptoms of subcoracoid impingement syndrome after management of the rotator cuff tear. (J Shoulder Elbow Surg 2000;9:275-8.)

Subcoracoid impingement after ossification of the subscapularis tendon

Subcoracoid impingement after ossification of the subscapularis tendon

Anatomic and functional aspects of the kinetics of the shoulder joint capsule and the subacromial bursa.

This anatomic study was devoted to the kinetics of the shoulder joint and especially the subacromial region. Following dissection of the shoulder joint capsule and subacromial region of 80 unpreserved shoulder joints, the anatomic relationships of the subacromial space in the neutral position and in continuous abduction (30 degrees, 60 degrees and 90 degrees with fixed scapulae) were examined. These investigations were supplemented by histologic preparations. In the course of our examinations we discovered a gliding mechanism of the subacromial bursa. Moreover, we found a subcoracoid attachment of the shoulder joint capsule and a precoracoid ligamentous connection running between the short head of the biceps brachii m. and the coracoacromial ligament. We termed this the coracoid aponeurosis, which facilitates gliding behaviour of the shoulder joint capsule beneath the coracoid process. In view of this gliding mechanism of the subacromial bursa and the coracoid aponeurosis, discovered in the course of our investigations, we have to reassess the kinetics of the sub-acromial and subcoracoid space. Further, we should reconsider our operative technique in cases of the subacromial or subcoracoid impingement syndrome.

The Clinical Results of Coracoplasty for patients with Subcoracoid Impingement Syndrom e

The Clinical Results of Coracoplasty for patients with Subcoracoid Impingement Syndrom e

Subcoracoid impingement secondary to an ossification of the subscapularis tendon

Subcoracoid impingement secondary to an ossification of the subscapularis tendon

Kinematic MRI of the shoulder.

Clinical evaluation of shoulder pain can be difficult. Pain in the shoulder is often dynamic/positional, and it can often be elicited only during specific activity or function. Soft tissue deforms or changes in shape through motion. These complex interrelationships at the glenoid humeral joint require dynamic studies to accurately evaluate normal anatomy and abnormal pathology. The objective of our study was to evaluate the use of a dynamic cyclic cine imaging to evaluate the glenoid humeral joint. Kinematic MRI was performed using axial 5 mm sections of the gradient echo and dedicated shoulder surface coil. The patient's arm was placed in the Bonutti cine shoulder system and allowed fixed incremental rotational movement of the shoulder at 10 degrees intervals. Images were reformatted onto a dynamic cine motion by oscillating from internal to external rotation then back to internal rotation. A total of 24 asymptomatic shoulders and 35 symptomatic painful shoulders were studied. Normal variations in the glenoid labrum were readily identified. The glenoid labrum in external rotation is taunt and triangular with well-identified capsular attachments. In neutral rotation the labrum often has increased signal and the middle glenoid humeral ligament occasionally blends with the labrum, making identification difficult. In maximum internal rotation the labrum is rounded and occasionally infolded. Variations in signal through the labrum are not indicative of tears. Capsular attachment must be followed from maximum internal to external rotation to identify stripping. The middle and inferior glenoid humeral ligaments often blend with labrum and internal rotation; however, in external rotation they can be identified as distinct and separate structures. Subcoracoid impingement can be identified in maximum internal rotation with a narrowing of the subcoracoid space to < 11 mm and buckling of the subscapularis and lesser tuberosity against the coracoid process. Accurate evaluation of the capsular/labral complex requires cine studies for accurate diagnosis. Signal changes alone or labral morphology alone varies through rotation, and static MRI does not accurately assess these morphologic changes, which vary with extremity position. Capsular attachments can be identified with cine studies accurately and reproducibly. Subcoracoid impingement can be identified with a narrowing of the coracohumeral distance to < 11 mm in internal rotation, which is suggestive of pathology.

Glenoplasty for Recurrent Posterior Shoulder Instability

Posterior glenoplasty, as performed for the treatment of recurrent posterior shoulder instability, was shown to thrust the humeral head forward and was able to cause symptomatic impingement of the anterior cuff between the coracoid process and the humeral head. Such subcoracoid impingement is relieved by resection of the inferolateral part of the coracoid tip and of the coracoacromial ligament.

The Subcoracoid Space

Soft tissue impingement under the coracoid process has recently been identified as a cause of painful shoulder disability. In this study the normal space between the humeral head and the coracoid process in two functional positions of the arm was measured in an attempt to delineate anatomic risk factors predisposing to subcoracoid impingement. Forty-seven normal shoulders were studied by computerized tomography (CT) in adduction, 20 additionally in forward flexion/internal rotation, which is the position most frequently causing subcoracoid impingement. The distance between the humeral head and the coracoid tip averaged 8.7 mm for the adducted arm and 6.8 mm for the flexed arm. Modifications of the coracohumeral relationship were found to affect the subcoracoid clearance roughly 1.5 times more in flexion than with arm at the side. Subcoracoid impingement appeared particularly likely during forward flexion of a shoulder with a coracoid tip close to the scapular neck and projecting far laterally.