Anatomical and morphological study of the subcoracoacromial canal

Diagnosis and Management of Subcoracoid Impingement

Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Stenosis of the subcoracoid space between the lesser tuberosity and the coracoid process <6 mm can lead to anterior shoulder pain and associated rotator cuff and biceps pathology. Multiple imaging modalities are available to assess narrowing of the coracohumeral interval, each with its strengths and limitations. If the patient can be accurately diagnosed with subcoracoid impingement, both conservative and surgical management options are available. Despite earlier case series demonstrating promising results with arthroscopic treatment, comparative studies have yet to support these initial claims.

Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair

Objective

The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume.

Methods

We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46–71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12–25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses.

Results

The mean subacromial volume of the preoperative group was 2.95 cm³ (range; 1.53–4.23) and the postoperative group was 3.59 cm³ (range; 2.12–4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm³ (range; 2.77–5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515).

Conclusion

The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly.

Level of evidence

Level IV; Diagnostic Study.