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.

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Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117731996 ◽

2017 ◽

Vol 5 (10) ◽

pp. 232596711773199 ◽

Cited By ~ 8

Author(s):

Anthony J. Dugarte ◽

Rocklend J. Davis ◽

T. Sean Lynch ◽

Mark S. Schickendantz ◽

Lutul D. Farrow

Keyword(s):

Internal Rotation ◽

Shoulder Pain ◽

Older Patients ◽

Morphological Changes ◽

Young Female ◽

Coracoid Process ◽

Subscapularis Tendon ◽

The Mean ◽

Tendon Tears ◽

Anterior Shoulder Pain

Background: Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears. Purpose/Hypothesis: The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space. Study Design: Descriptive laboratory study. Methods: In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes. Results: The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively. Conclusion: The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders. Clinical Relevance: Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.

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Subacromial Tenoxicam Injection in the Treatment of Impingement Syndrome

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00199 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0019

Author(s):

Hakan Çift ◽

Feyza Ünlü Özkan ◽

Ali Şeker ◽

Mehmet İşyar ◽

Erman Ceyhan ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Adhesive Capsulitis ◽

Adhesion Formation ◽

Impingement Syndrome ◽

Therapeutic Effects ◽

Women Patients ◽

Alternative Treatment Option ◽

Vas Scores ◽

The Mean

Objectives: As subacromial bursa injection is widely used for pain relief and functional improvements in patients with periarticular shoulder disorder, we aimed to present our results of subacromial tenoxicam injection in the treatment of impingement syndrome. Methods: Patients presented to the Department of Orthopaedics and Traumatology, Istanbul Medipol University with the primary complaints of shoulder pain from January 2012 to June 2013 were selected. Those who met the following inclusion criteria were finally considered: 1) who had a clinical sign of a painful arc and positive in Hawkins test and/or Neer impingement sign; 2) who had a precise rotator cuff injury including partial cuff tears, or subacromial bursitis detected during ultrasonography or MRI. The exclusion criteria were as follows: 1) who underwent shoulder surgery; 2) who had full thickness rotator cuff rupture; 3) who had hemiplegic shoulder pain; and 4) who displayed any suspected fracture on X-ray or had a recent shoulder trauma; 5) who showed limited active ROM and stiffness due to adhesive capsulitis. Thirty one shoulders out of thirty patients were treated with subacromial tenoxicam injection. Ten of them were left shoulders. Fifteen of the patients were women.. Patients had a mean age of 51.6 (30-73). Patients were evaluated 4 times. Before the first injection, 1 week after the first injection, 2 weeks after the second injection and 3 weeks after the third injection. In every injection 20 mg tenoxicam was performed. Results: In order to relieve the pain; two patients were given only one injection, thirteen patients were given two injections and “3 injections protocol” were done to fifteen patients. The mean pre- and posttreatment VAS scores were 7.9 (between, 7-9) and 2.7 (between, 2-4) points respectively. The average pre and posttreatment DASH scores were 59.41 (between, 45-80) and 14 (between, 8.3-25.8) points respectively. The mean pre and posttreatment range of motion were 106.1 (between, 80-130 and 170i7 (between, 140-180) degrees respectively. Differences between all pre- and post-treatment parameters were statistically significant (p<0.05). Conclusion: Tenoxicam is a cheap NSAID and an analgesic of the oxicam class, is closely related to proxicam, and has a long half-life, which enables it to be administrated once daily. It also readily penetrates the synovial fluid and intraarticular intravenous administration provides superior postoperative analgesic benefits. Tenoxicam also has the ability to prevent adhesion formation. Besides it has no detrimental effect on cartilage structure. It can be safely administrated intraarticularly. Given the positive therapeutic effects of subacromial tenoxicam injection, it can be used as an alternative treatment option.

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How do people perceive different labels for rotator cuff disease? A content analysis of data collected in a randomised controlled experiment

BMJ Open ◽

10.1136/bmjopen-2021-052092 ◽

2021 ◽

Vol 11 (12) ◽

pp. e052092

Author(s):

Joshua R Zadro ◽

Zoe A Michaleff ◽

Mary O'Keeffe ◽

Giovanni E Ferreira ◽

Romi Haas ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Rotator Cuff Tear ◽

Poor Prognosis ◽

Impingement Syndrome ◽

Subacromial Impingement Syndrome ◽

Subacromial Impingement ◽

Rotator Cuff Disease ◽

Cuff Tear ◽

Randomised Controlled

ObjectivesExplore how people perceive different labels for rotator cuff disease in terms of words or feelings evoked by the label and treatments they feel are needed.SettingWe performed a content analysis of qualitative data collected in a six-arm, online randomised controlled experiment.Participants1308 people with and without shoulder pain read a vignette describing a patient with rotator cuff disease and were randomised to one of six labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator-cuff-related shoulder pain, shoulder sprain and episode of shoulder pain.Primary and secondary outcomesParticipants answered two questions (free-text response) about: (1) words or feelings evoked by the label; (2) what treatments they feel are needed. Two researchers iteratively developed coding frameworks to analyse responses.Results1308/1626 (80%) complete responses for each question were analysed. Psychological distress (21%), uncertainty (22%), serious condition (15%) and poor prognosis (9%) were most often expressed by those labelled with subacromial impingement syndrome. For those labelled with a rotator cuff tear, psychological distress (13%), serious condition (9%) and poor prognosis (8%) were relatively common, while minor issue was expressed least often compared with the other labels (5%). Treatment/investigation and surgery were common among those labelled with a rotator cuff tear (11% and 19%, respectively) and subacromial impingement syndrome (9% and 10%) compared with bursitis (7% and 5%).ConclusionsWords or feelings evoked by certain labels for rotator cuff disease and perceived treatment needs may explain why some labels drive management preferences towards surgery and imaging more than others.

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Coracoid Impingement Syndrome: A treatable cause of anterior shoulder pain

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf03169174 ◽

2006 ◽

Vol 175 (3) ◽

pp. 57-61 ◽

Cited By ~ 10

Author(s):

S. J. Roche ◽

M. T. Kennedy ◽

A. J. Butt ◽

K. Kaar

Keyword(s):

Shoulder Pain ◽

Impingement Syndrome ◽

Coracoid Impingement ◽

Anterior Shoulder Pain

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Coracoid syndrome: a neglected cause of anterior shoulder pain

Joints ◽

10.11138/jts/2016.4.1.031 ◽

2016 ◽

Vol 04 (01) ◽

pp. 031-038

Author(s):

Antonio Gigante ◽

Carlo Bottegoni ◽

Pamela Barbadoro

Keyword(s):

Shoulder Pain ◽

Repeated Measures ◽

Trigger Point ◽

Biceps Tendon ◽

Case Series ◽

Coracoid Process ◽

Level Of Evidence ◽

Simple Shoulder Test ◽

Anterior Shoulder Pain ◽

Eq Vas

Purpose: the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. Methods: patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the italian version of the Simple Shoulder Test (SST). Results: between January 1 and December 31 2010, we treated 15 patients aged 26-66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. Conclusions: the present study documents the existence, and characteristics, of a “coracoid syndrome” characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in order to avoid inappropriate conservative or surgical treatment. Level of evidence: Level IV, therapeutic case series.

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Biceps

10.1093/med/9780199550647.003.004004 ◽

2011 ◽

Author(s):

Philip M. Ahrens

Keyword(s):

Rotator Cuff ◽

Diagnostic Imaging ◽

Shoulder Pain ◽

Clinical Evaluation ◽

Anterior Shoulder Pain

♦ LHB pathology is a commonn cause of anterior shoulder pain♦ Clinical evaluation and diagnostic imaging are both imprecise♦ Isolated biceps pathology may be present in the younger athlete♦ Degenerative biceps pathology is often associated with rotator cuff pathology♦ Failure to treat concomitant LHB pathology is a cause for surgical failures in many other shoulder conditions

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Acromion, coracoid and glenoid processes of scapula: an anatomical study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200237 ◽

2020 ◽

Vol 8 (2) ◽

pp. 570 ◽

Cited By ~ 1

Author(s):

Gyanaranjan Nayak ◽

Sitansu K. Panda ◽

Prafulla K. Chinara

Keyword(s):

Rotator Cuff ◽

Surgical Procedures ◽

Shoulder Joint ◽

Orthopaedic Surgery ◽

Anatomical Study ◽

Coracoid Process ◽

Impingement Syndrome ◽

Shoulder Prosthesis ◽

Shoulder Replacement ◽

Total Shoulder Replacement

Background: Acromion morphology has an important role in impingement syndrome and pathogenesis of rotator cuff diseases. Coracoid process is involved in many surgical procedures of shoulder joint. Dimensions of glenoid process are essential in designing glenoid components for total shoulder replacement. Aim of the study was to measure the various dimensions and note the morphology of acromion, coracoid and glenoid processes of scapula.Methods: Fourty two scapulae (24 right, 18 left) were used and the dimensions of the three processes were measured with digital Vernier calipers.Results: The findings were as follows- length of acromion- 43.57±5.13 mm; width of acromion- 25.03±3.57 mm; acromio-coracoid distance- 33.09±7.02 mm; acromio-glenoid distance- 25.24±4.05 mm; height of coraco-acromial arch- 15.17±3.8 mm; length of coracoid- 38.73±3.72 mm; width of coracoid- 14.28±2.36 mm; tip thickness of coracoid- 8.61±1.89 mm; height of base coracoid- 12.91±2.88 mm; width of base of coracoid- 22.31±3.54 mm; height of glenoid- 34.18±3.53 mm; superior antero-posterior glenoid length- 15.35±2.35 mm and inferior antero-posterior glenoid length- 23.9±2.52 mm.Conclusions: The results will be highly relevant in orthopaedic surgery and manufacturing shoulder prosthesis.

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