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Hussain S, Khan Z, Akhtar N, Jeys L, Parry M, Grimer RJ. Anatomical distribution, the incidence of malignancy and diagnostic workup in the pathological lesions of the clavicle: a review of 410 cases. Arch Orthop Trauma Surg 2022; 143:2981-2987. [PMID: 35778528 DOI: 10.1007/s00402-022-04511-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The clavicle poses a diagnostic dilemma of the pathological lesions due to the wide range of pathologies seen at this site. This study aimed to identify and stratify various pathologies seen in the clavicle and to guide ways of investigation for diagnosis based on age, site and investigation findings. MATERIALS AND METHODS Four hundred and ten cases with clavicle lesions were identified in our database. Data were collected about the patient's medical history, previous investigation, inflammatory markers radiological investigations and biopsy. All patients were worked up and managed after discussion in a multidisciplinary team meeting (MDT). RESULTS Non-malignant lesions accounted for 79% of cases. Infection was the most common diagnosis (39%) and the commonest diagnosis in those less than 20 years of age. 73% of the lesions were found at the medial end of the clavicle. Malignant tumours were 21%, while primary benign bone tumours accounted for only 14%. 50% of the malignant lesions were due to metastatic disease. The risk of malignancy increases with advancing age. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not sensitive as a diagnostic tool in cases of osteomyelitis confirmed by histology. Magnetic resonance imaging (MRI) was noted to have high sensitivity and specificity for identifying the nature of a lesion and diagnosis. CONCLUSION We have identified age as a positive predictor of a malignant cause in pathological lesions of the clavicle. MRI should be considered in all these cases. CRP and ESR have poor predictive values in diagnosing infection in the clavicle. Patients presenting with clavicle lesions should be discussed in a specialist MDT and undergo a systemic diagnostic workup, still in some cases, diagnosis can be speculated based on the patient's age, location of the lesion within the clavicle and the features seen on the MRI scan. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shakir Hussain
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK.
| | - Zeeshan Khan
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Naved Akhtar
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Lee Jeys
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Michael Parry
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Robert J Grimer
- The Oncology Department, The Orthopaedic Oncology Unit, The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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Song Y, Liu J, Cao L, Yu BH, Sun T, Shi L, Shi YH, Zhong ZW, Wu WJ, Gao BL. Clinical and imaging features of tumors in the scapula. Curr Med Imaging 2021; 18:674-683. [PMID: 34488589 DOI: 10.2174/1573405617666210901144924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Scapula is a small irregular-shaped flat bone, which may suffer from a variety of tumors or tumor-like lesions. Because the imaging manifestations are complex and changeable, correct imaging diagnosis is difficult. INTRODUCTION At present, there are few related radiology literatures, and it is necessary to fully analyze the imaging signs of different types of benign and malignant tumors in scapula to guide clinical treatment. This study was to investigate clinical and imaging presentations of tumors and tumor-like lesions in the scapula so as to increase the diagnostic accuracy of diseases in the scapula. METHODS Patients with scapular tumors confirmed by pathology were enrolled. The imaging and clinical data were analyzed. RESULT Among 108 patients, benign tumors were in 53 (49.1%) cases, intermediate in seven (6.5%), and malignant in 48 (44.4%) involving 16 diseases. Osteochondroma was the first benign tumors in 45 cases accounting for 84.9% of all benign scapular tumors followed by chondroma in four cases (7.5%). The intermediate tumors were mainly eosinophilic granuloma in four cases. Metastatic tumors were the commonest malignant tumor (27 cases or 56.2% of all malignant tumors), followed by chondrosarcoma (in 13 cases). Except for the one case of chondroblastoma in which the lesion involved the glenoid cavity, all the other cartilaginous tumors were located in the scapular body and processes. The type of lesions in the bony processes is the same as in the scapular body, the common lesions in the central area of body were malignant tumors, and the commonest lesions in the glenoid area were metastasis. Common imaging features of malignant scapular tumors were ill-defined margins, cortical destruction and soft tissue involvement. The imaging features of chondrosarcoma lack specificity except calcification. Benign lesions usually had clear boundary and marginal sclerosis. CONCLUSION A wide variety of benign and malignant tumors may occur in the scapula with mostly cartilaginous and metastatic tumors, and the location and distribution of lesions are similar in the scapula to those in the long bones.
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Affiliation(s)
- Yan Song
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Jie Liu
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Lei Cao
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Bao-Hai Yu
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Tao Sun
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Liang Shi
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Yun-Heng Shi
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Zhi-Wei Zhong
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Wen-Juan Wu
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
| | - Bu-Lang Gao
- Department of Radiology, The Third Hospital of Hebei Medical University 139 Ziqiang Road Shijiazhuang, Hebei Province. China
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Elamin M, Yeluri V, Khatir H, O'Grady P, Bennani F. Subacromial impingement by a lipoma arborescens. SICOT J 2021; 7:12. [PMID: 33704057 PMCID: PMC7949903 DOI: 10.1051/sicotj/2021004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Subacromial impingement syndrome (SIS) is the leading cause of shoulder pain. A systemic approach for abnormal causes of SIS is recommended to avoid misdiagnosing rare or sinister pathologies. To our knowledge, only nine cases of subacromial lipoma arborescens associated with impingement syndrome have been reported in the literature. In this report, we briefly discuss histopathologic and radiological signs of an unusual case of impingement syndrome caused by subacromial "lipoma arborescens" and describe arthroscopic synovectomy after the failure of conservative management. The patient remains symptom-free five years after surgery.
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Affiliation(s)
- Mohamed Elamin
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Venkatramana Yeluri
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Hisham Khatir
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Paul O'Grady
- Department of Orthopaedics, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
| | - Fadel Bennani
- Department of Pathology, Mayo University Hospital, Castlebar, Co. Mayo, F23 H529, Ireland
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AlGhoozi D, Gomaa H, Awad R, Alkhalifa F. Osteoid osteoma of the base of the coracoid process – A case report. Int J Surg Case Rep 2020; 66:162-164. [PMID: 31862658 PMCID: PMC6928335 DOI: 10.1016/j.ijscr.2019.11.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/22/2019] [Accepted: 11/30/2019] [Indexed: 11/06/2022] Open
Abstract
Osteoid osteomas are benign bone tumors commonly found in long bones. Presence of osteoid osteomas elsewhere makes early diagnosis difficult. MRI and CT scans help detect osteoid osteomas early. Juxta-articular osteoid osteomas are best excised arthroscopically.
Introduction Osteoid osteomas (OO) are small, well-defined, benign bone tumors of the young that are commonly found in long bones. In rare circumstances, when present elsewhere, they can mimic the symptoms of other pathologies pertaining to that area. Presentation of case We present such case in which an "OO" of the coracoid process led to a 2-year delay in diagnosis and management of a young male due to the presenting symptoms resembling those of other shoulder pathologies. Ultimately, the use of advanced imaging modalities proved to be useful in detecting the "OO", which was consequently arthroscopically excised. Discussion Appropriate imaging modalities such as CT or MRI often visualize the characteristic nidus more clearly as opposed to an X-ray and should therefore be used early when conservative management of shoulder pain has not been proven to be useful. Conclusion A long history of shoulder pain that is not responsive to conservative management in young patients should raise the suspicion of an "OO", and physicians should be encouraged to use early advanced imaging modalities in order to confirm it.
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Kaiser CL, Yeung CM, Raskin K, Gebhardt MC, Anderson ME, Lozano-Calderón SA. Tumors of the scapula: A retrospective analysis identifying predictors of malignancy. Surg Oncol 2019; 32:18-22. [PMID: 31689646 DOI: 10.1016/j.suronc.2019.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/18/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Osseous tumors of the shoulder girdle occur most frequently in the proximal humerus, scapula and clavicle. Prior studies have determined that tumors occurring in the scapula have a higher risk of malignancy, but few have looked exclusively at tumors of this site to describe incidence, clinical features and potential predictors of malignancy. As imaging technologies for diagnosis have improved, it is important to re-evaluate if patterns of incidence have changed and if new imaging findings could potentially be predictors of malignancy. METHODS This retrospective analysis identified 173 patients from a pediatric and an adult hospital between 1990 and 2015. All patients with tumors of the scapula either of bony origin or with bony invasion were included. Diagnosis, tumor location, and patient demographics were collected. Bivariate and logistic regression analyses were performed to identify potential predictors of malignancy. RESULTS Chondrosarcoma and osteochondroma were the most common malignant and benign tumors, respectively. Benign tumors were more prevalent in the pediatric population. Tumors occurred most frequently in the body of the scapula. Risk for malignancy increased with age (OR 1.09, 95% CI 1.05-1.12), tumors invading multiple sites (OR 10.85, 95% CI 2.37-49.72) and tumors that were lucent (OR 7.02, 95% CI 1.14-43.21) or had a mixed radiographic appearance (OR 11.47, 95% CI 1.36-99.65). CONCLUSIONS Including neoplasia in the differential diagnosis for shoulder complaints is important because the scapula is a site of increased risk of malignancy. Patterns of incidence and prevalence have not changed in the last years with the use of more advance techniques of imaging studies. Older age, lucent or mixed imaging, and tumors that span multiple sites of the scapula were found to be predictors of malignancy. Additional cross-sectional anatomy studies may be warranted for further evaluation in patients presenting with these characteristics given the higher concern for malignant disease. LEVEL OF EVIDENCE Level IV, Prognostic Study.
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Affiliation(s)
- Courtney L Kaiser
- Massachusetts General Hospital, Harvard Medical School, Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, 55 Fruit St., Boston, MA, 02114, USA.
| | - Caleb M Yeung
- Massachusetts General Hospital, Harvard Medical School, Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, 55 Fruit St., Boston, MA, 02114, USA.
| | - Kevin Raskin
- Massachusetts General Hospital, Harvard Medical School, Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, 55 Fruit St., Boston, MA, 02114, USA.
| | - Mark C Gebhardt
- Boston Children's Hospital, Department of Orthopaedic Surgery, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Megan E Anderson
- Boston Children's Hospital, Department of Orthopaedic Surgery, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Santiago A Lozano-Calderón
- Massachusetts General Hospital, Harvard Medical School, Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, 55 Fruit St., Boston, MA, 02114, USA.
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Priemel MH, Erler JME, Zustin J, Luebke AM, Stiel N, Spiro AS. Histological, epidemiological and anatomical analysis of 193 bone tumours of the scapula. J Bone Oncol 2019; 18:100258. [PMID: 31497502 PMCID: PMC6722280 DOI: 10.1016/j.jbo.2019.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023] Open
Abstract
Backround This study aimed to determine the frequency and distribution of bone tumours of the scapula as well as the histological and anatomical characteristics of these rare lesions in a large case series. Methods The records of all lesions of the scapula collected from 1975 to 2018 in our bone tumour registry and institute of pathology were evaluated. During these 43 years, 223 cases were identified. Analysis included assessment of age, gender, side, imaging findings, tumour location, and histological evaluation with the assignment of each lesion to one of the bone tumours according to the World Health Organization (WHO) classification of bone tumours. Results Bone tumours of the scapula were found in 193 cases. Mean patient age was 38.4 years (2.6–82.4). Most of the lesions were of cartilage origin (47%). 59 bone tumours were benign (30.6%), 29 were intermediate (15.0%), and 105 were malignant (54.4%). The most commonly found bone tumour was Osteochondroma (23.3%), followed by Chondrosarcoma (17.6%), Bone metastases (16.6%), Ewing sarcoma (8.8%), and Osteosarcoma (7.8%). The percentage of malignant bone tumours increased with increasing age. In patients >50 years of age, 91% had a malignant lesion of the scapula. Conclusions Evaluation of 193 bone tumours of the scapula revealed a high incidence of malignancy in this series, while increased patient age was identified as a potential risk factor for the development of a malignant lesion of the scapula. These findings highlight the importance of early diagnosis and treatment of suspicious lesions of the scapula to improve patient outcome.
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Affiliation(s)
- Matthias H Priemel
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes M E Erler
- Department of Orthopaedic and Trauma Surgery, Paracelsus Hospital Henstedt-Ulzburg, Henstedt-Ulzburg, Germany
| | - Jozef Zustin
- Gemeinschaftspraxis für Pathologie, Dechbettender Straße 5, Regensburg, Germany
| | - Andreas M Luebke
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norbert Stiel
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Bleickenallee 37, 22763 Hamburg, Germany.,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander S Spiro
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Bleickenallee 37, 22763 Hamburg, Germany.,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li CH, Skalski MR, Matcuk GR, Patel DB, Gross JS, Tomasian A, White EA. Coracoid process fractures: anatomy, injury patterns, multimodality imaging, and approach to management. Emerg Radiol 2019; 26:449-458. [PMID: 30911959 DOI: 10.1007/s10140-019-01683-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/01/2019] [Indexed: 01/10/2023]
Abstract
The coracoid process of the scapula is in close proximity to major neurovascular structures, including the brachial plexus and the axillary artery and vein. In addition, it serves as a major site of attachment for multiple tendons and ligaments about the shoulder. Isolated coracoid fractures are rare; however, they can be easily overlooked on routine shoulder radiographs. Importantly, when these fractures go undiagnosed, they are at high risk for nonunion. In this paper, we will review the relevant anatomy of the coracoid process, classification schemes for coracoid fractures, mechanisms of injury how these fractures typically present, multimodality imaging findings, and associated injuries. Finally, we will briefly discuss the clinical management of these fractures.
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Affiliation(s)
- Charles H Li
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | | | - George R Matcuk
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dakshesh B Patel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan S Gross
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anderanik Tomasian
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric A White
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Redefining anterior shoulder impingement: a literature review. INTERNATIONAL ORTHOPAEDICS 2017; 42:359-366. [PMID: 28585076 DOI: 10.1007/s00264-017-3515-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Many different types of impingements have been described in the shoulder. Inasmuch as the term 'shoulder impingement' usually refers to subacromial impingement, anterior impingement usually refers to subcoracoid impingement. However, there are many different subtypes of anterior impingements in the shoulder, and awareness of their existence is critical as they vary in their nature and treatment. Recent advances in biomechanical research and arthroscopic exploration of the anterior structures of the shoulder have brought new insights on the various potential impingements, warranting a revision and update of the current definitions of anterior shoulder impingement. The purpose of this article is to propose a comprehensive review and classification of all different subtypes of anterior impingement in the shoulder, including newly described entities.
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Xu SF, Yu XC, Xu M, Hu YC, Liu XP. Functional Results and Emotional Acceptance after Scapulectomy for Malignant Shoulder Tumors. Orthop Surg 2017; 8:186-95. [PMID: 27384727 DOI: 10.1111/os.12248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To demonstrate the functional results and emotional acceptance after scapulectomy for various malignant shoulder tumors. METHODS Eight patients with malignant shoulder tumors who had undergone scapulectomy between April 2004 and March 2014 were retrospectively reviewed. They comprised seven men and one woman their mean age was 54 years (range, 24-69 years). All patients were diagnosed by pathological examination of biopsy specimens. The tumors were metastatic in four cases, having originated from a primary carcinoma of the liver in one patient, the lung in one patient and the kidney in two patients. The other four patients had primary malignant tumors in their scapulae, specifically, two scapular malignant fibrous histiocytomas, one scapular Ewing sarcoma and one soft tissue synovial sarcoma. The four patients with metastases were staged as III, and other four were staged as IIB. Six patients underwent total and two subtotal scapulectomy. The remaining soft tissues were sutured together directly in seven of the patients. The remaining patient, who had soft tissue synovial sarcoma, required transfer of a pedicle latissimus dorsi muscle flap. The functional results and emotional acceptance were evaluated by clinician using the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS The average duration of follow-up was 22.8 months. Four patients were continuously disease-free, three patients developed metastases and died of disease within 12 months of surgery and one patient with a scapular metastasis from the kidney survived with pulmonary nodules. No major complications, including infection or dislocation, occurred during or after surgery. The mean MSTS score was 16.3 (54%), which is similar to that previously reported in other studies of scapulectomy. There were no local tumor recurrences and only one patient developed pulmonary metastases. These outcomes are similar to those reported for scapular prostheses and there were fewer complications than in patients treated with allografts. The mean emotional acceptance score was 3.6 (72.5%). CONCLUSIONS Performing scapulectomies on patients with malignant shoulder tumors without prostheses or allograft reconstruction achieves good functional results and emotional acceptance with a low rate of complications.
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Affiliation(s)
- Song-Feng Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Yong-Cheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin Medical University, Tianjin, China
| | - Xiao-Ping Liu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
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Alilet M, Behr J, Nueffer JP, Barbier-Brion B, Aubry S. Multi-modal imaging of the subscapularis muscle. Insights Imaging 2016; 7:779-791. [PMID: 27752837 PMCID: PMC5110480 DOI: 10.1007/s13244-016-0526-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/06/2016] [Accepted: 09/28/2016] [Indexed: 12/23/2022] Open
Abstract
Abstract The subscapularis (SSC) muscle is the most powerful of the rotator cuff muscles, and plays an important role in shoulder motion and stabilization. SSC tendon tear is quite uncommon, compared to the supraspinatus (SSP) tendon, and, most of the time, part of a large rupture of the rotator cuff. Various complementary imaging techniques can be used to obtain an accurate diagnosis of SSC tendon lesions, as well as their extension and muscular impact. Pre-operative diagnosis by imaging is a key issue, since a lesion of the SSC tendon impacts on treatment, surgical approach, and post-operative functional prognosis of rotator cuff injuries. Radiologists should be aware of the SSC anatomy, variability in radiological presentation of muscle or tendon injury, and particular mechanisms that may lead to a SSC injury, such as coracoid impingement. Teaching Points • Isolated subscapularis (SSC) tendon tears are uncommon. • Classically, partial thickness SSC tendon tears start superomedially and progress inferolaterally. • Long head of biceps tendon medial dislocation can indirectly signify SSC tendon tears. • SSC tendon injury is associated with anterior shoulder instability. • Dynamic ultrasound study of the SSC helps to diagnose coracoid impingement.
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Affiliation(s)
- Mona Alilet
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France
| | - Julien Behr
- Anatomy Laboratory, University of Franche-Comte, Besançon, France
| | - Jean-Philippe Nueffer
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France
| | | | - Sébastien Aubry
- Department of Musculoskeletal Imaging, CHRU de Besançon, CHRU Jean Minjoz, Boulevard Fleming, 25030, Besançon Cedex, France.
- Nanomedicine and Imagery Laboratory, EA4662, University of Franche-Comte, Besançon, France.
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Mohammed H, Skalski MR, Patel DB, Tomasian A, Schein AJ, White EA, Hatch GFR, Matcuk GR. Coracoid Process: The Lighthouse of the Shoulder. Radiographics 2016; 36:2084-2101. [PMID: 27471875 DOI: 10.1148/rg.2016160039] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©RSNA, 2016.
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Affiliation(s)
- Hussan Mohammed
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Matthew R Skalski
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Dakshesh B Patel
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Anderanik Tomasian
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Aaron J Schein
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - Eric A White
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - George F Rick Hatch
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
| | - George R Matcuk
- From the Departments of Radiology (H.M., D.B.P., A.T., A.J.S., E.A.W., G.R.M.) and Orthopaedic Surgery (G.F.R.H.), Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033-5313; and Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.)
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Arockiaraj J, Balaji G G, Vidyasagar B, Ashok A. Osteoblastoma of the coracoid process: an unusual location. BMJ Case Rep 2015; 2015:bcr-2015-212070. [PMID: 26420699 DOI: 10.1136/bcr-2015-212070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bone tumours arising from the coracoid process of the scapula are very rare. We present a case of a 19-year-old man with left shoulder pain for 1 year, with associated infraclavicular swelling for 8 months. Examination revealed a tender, bony, hard swelling measuring 3×4 cm. Imaging revealed an expansile osteolytic lesion arising from the coracoid process with loss of corticomedullary differentiation. MRI showed altered signal in the adjacent soft tissues. The patient underwent en bloc resection of the lesion. Histology was suggestive of osteoblastoma. At the end of 2 years follow-up, the patient had no pain or recurrence of the lesion. We present this case for its rare location and have briefly discussed the difficulties in diagnosis of this condition.
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Affiliation(s)
- Justin Arockiaraj
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopisankar Balaji G
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Bandikala Vidyasagar
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anand Ashok
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
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Cuéllar A, Cuéllar R, Sánchez A, Cuéllar A, Ruiz-Ibán MA. Soft tissue tumour causing coracoid impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2015; 23:2635-8. [PMID: 24839038 DOI: 10.1007/s00167-014-3048-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
Coracoid impingement syndrome results from subscapularis tendon entrapment between the humerus and the coracoid. This syndrome is an uncommon cause of shoulder pain that has many different aetiologies. Although synovial cysts have been reported as cause of coracoid impingement at this level, solid tumoural lesions are a rare cause of symptoms in this location. Two cases of benign soft tissue solid tumours are presented. Both patients developed symptoms compatible with coracoid impingement syndrome. The lesions were fully resected under arthroscopic visualization. Both patients had complete resolution of the symptoms and are asymptomatic at 2-year follow-up. Arthroscopic removal of benign soft tissue tumours that cause coracoid impingement syndrome has good results.
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Affiliation(s)
- Adrián Cuéllar
- Department of Orthopaedic Surgery, Galdakao Unsansolo Hospital, Galdakao, Vizcaya, Spain
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Goyal S, Said HG. Osteoid osteoma (OO) of the coracoid: a case report of arthroscopic excision and review of literature. SICOT J 2015; 1:17. [PMID: 27163073 PMCID: PMC4849236 DOI: 10.1051/sicotj/2015016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Osteoid osteoma (OO) of the coracoid is a rare entity that may present with variable symptoms from shoulder leading to delay in diagnosis and treatment. We present the clinical and radiological findings and management of one such case along with a review of similar cases reported in the literature. There was a delay of 2 years in diagnosis, which was later confirmed by computed tomography in addition to magnetic resonance imaging (MRI). The lesion was accessed arthroscopically and excised by unroofing and curettage. "OO" should be included in the differential diagnosis of shoulder pain in young patients not responding to long-term conservative treatment. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery.
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Affiliation(s)
- Saumitra Goyal
- Assiut Arthroscopy & Sports Injuries Unit, Orthopaedic & Traumatology Department, Assiut University Assiut 71515 Egypt
| | - Hatem Galal Said
- Assiut Arthroscopy & Sports Injuries Unit, Orthopaedic & Traumatology Department, Assiut University Assiut 71515 Egypt
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Wu X, Wang W, Meng C, Duan D, Xu W, Liu X, Wang H, Yang S. Functional outcome of limb-salvage surgery with shoulder abduction brace for bone tumors around the shoulders. J Surg Oncol 2014; 109:714-20. [PMID: 24395023 DOI: 10.1002/jso.23555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/13/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND The current trend is toward salvage of the extremity after tumor excision without compromising the extent of resection for bone tumor around the shoulders. OBJECTIVES The aim of this study was to evaluate functional outcome of patients treated with limb-salvage surgeries combined with shoulder abduction braces. METHODS Thirty-six patients with bone tumors around the shoulders, who had limb-sparing resection and reconstruction performed with a shoulder abduction brace, were retrospectively reviewed. Allograft transplantation and rigid internal fixation was performed in 22 patients and artificial prosthetic replacement was performed in 14 patients. Functional evaluation was performed based on the Musculoskeletal Tumour Society (MSTS) scoring system. RESULTS The overall survival was 78.8% (26/33) at 2 years. The mean final functional score was (81.2 ± 19.6%). The MSTS of patients treated by allograft transplantation and prosthetic replacement were (79.4 ± 15.3%) and (81.9 ± 18.1%), respectively. The MSTS scores differed only slightly between these two groups (P > 0.05). All the patients regained good ROM of the shoulder joints. CONCLUSIONS Satisfactory functional outcomes can be obtained by limb-salvage surgery for bone tumor around the shoulder. Postoperatively shoulder crutches with shoulder abduction brace are encouraged as the aid of reconstruction of shoulder joint function.
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Affiliation(s)
- Xinghuo Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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