Subcoracoid impingement after ossification of the subscapularis tendon

Arthroscopic management of lesser tuberosity osteochondroma causing impingement and subscapularis tear of the shoulder

Although the proximal humerus is a common site of osteochondroma, osteochondroma arising from the lesser tuberosity of the proximal humerus is rare. Because of the anatomy of the shoulder, mechanical impingement can occur via direct contact of the protruding lesser tuberosity against the glenoid rim or coracoid. In younger patients, this may cause isolated tearing of the subscapularis. In this study, is presented a rare case of osteochondroma on the lesser tuberosity that caused a subscapularis tear after shoulder impingement in a 34-year-old male. This case was managed using an arthroscopic approach. One year after the surgery, the patient had recovered a normal range of motion, with the resolution of impingement symptoms and the tearing of the subscapularis. Level of evidence IV.

Redefining anterior shoulder impingement: a literature review

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.

Idiopathic heterotopic ossification of bilateral subscapularis tendons: illustration of a rare entity and a concise literature review

Ossification of the subscapularis tendon is an extremely uncommon, poorly described lesion with little known about its etiopathogenesis and clinical significance. To the best of our knowledge, only three cases of this entity have been reported till now, which were all unilateral. The authors present first case of ossification of bilateral subscapularis tendons in a 57-year-old male and hope that with increase in the number of reported cases, proper guidelines for management of such cases can be formulated.

Unusual lesions mimicking impingement syndrome in the shoulder joint - Think medially

Impingement syndrome is usually caused by irritation of the rotator cuff within the sub acromial space and this includes the coraco-acromial arch (Acromion and Coraco-acromial ligament), the acromio-clavicular joint and occasionally the coracoid. Iatrogenic causes such as sutures, pins, plates or wires left from previous surgery can cause similar symptoms. We present a series of four cases mimicking “classical” impingement symptoms/signs in which the causal pathology was identified outside the sub-acromial space. Magnetic Resonance Imaging (MRI) showed lesions that were present in the supra-spinatus fossa but were causing pressure effects on the sub-acromial space, namely - a ganglion cyst in one case, lipomata in two other cases, and a glomus tumour. A ganglion cyst and glomus tumour mimicking impingement syndrome is a rare reported case to our knowledge.

These are unusual causes that should be considered when investigating classical impingement syndrome and particularly those who may have failed to respond to decompression surgery. They highlight the potential value of looking beyond the sub-acromial space for causal lesions and in these cases, at a time when limited ultrasound investigation has become increasingly popular; MRI has clearly played an important and was essential in planning surgery as these lesions would not have been identified on USS. Even though the symptoms were classical.

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Impingement syndrome is defined as impingement of the rotator cuff by the anterior one-third of the acromion, 1.

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Iatrogenic causes such as sutures, can cause similar symptoms.

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Symptoms and signs of impingement may be present can originate outside the sub-acromial space.

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MRI scan remains an important imaging tool.

Sonographic Findings in Subcoracoid Impingement Syndrome: A Case Report and Literature Review

Subcoracoid impingement syndrome is a rare and underrecognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology.

LEVEL OF EVIDENCE

V.

Subcoracoid impingement and subscapularis tendon: is there any truth?

Subcoracoid impingement and stenosis have been described related to anterior shoulder pain and subscapularis tendon tears, but the pathogenesis and related treatment of this condition has still not been explained properly. Variability of coracoid morphology has been described and both traumatic and iatrogenic factors can modify it. Some authors referred this to a primary narrow coracohumeral distance with different threshold values defined as increased risk factor for subscapularis and antero-superior RC tear; opposite theories stated that the stenosis is secondary to an anterosuperior translation of the humeral head toward the coracoid due to degenerative changes of the rotator cuff tendons. Limited coracoplasty can be performed when related risk factors are identified; however no clear consensus arises from specific literature review and extensive clinical and instrumental examination of the patient should be performed in order to identify specific risk factors for subscapularis tendon pathology and, subsequently, tailor the proper approach.

Coracoid impingement: current concepts

For many years, coracoid impingement has been a well-recognized cause of anterior shoulder pain. However, a precise diagnosis of coracoid impingement remains difficult in some cases due to the presence of multifactorial pathologies and a paucity of supporting evidence in the literature. This review provides an update on the current anatomical and biomechanical knowledge regarding this pathology, describes the diagnostic process, and discusses the possible treatment options, based on a systematic review of the literature. Level of evidence V.

Subscapularis tendon tears

Pathology of the subscapularis tendon is both infrequently identified and not commonly considered as a major source of shoulder pain and dysfunction. Subscapularis tendon pathology can present as isolated tears; partial-thickness tears; anterosuperior tears, also involving the supraspinatus tendon; complete rotator cuff avulsion; and rotator interval lesions, in which instability of the long head of the biceps tendon may dominate the clinical presentation. Although an accurate physical examination is paramount, modalities such as arthroscopy, magnetic resonance imaging, and ultrasound have advanced knowledge of the spectrum of abnormalities involving the subscapularis tendon. Nonsurgical management may be effective for most partial tears. Surgically, open repair is more frequent than use of arthroscopic techniques. Tears of the subscapularis tendon portend a different prognosis than do supraspinatus tendon tears, especially when the injury is acute and diagnosis is delayed.

Shoulder impingement syndromes: implications on physical therapy examination and intervention

A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed.