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Horowitz EH, Aibinder WR. Shoulder Impingement Syndrome. Phys Med Rehabil Clin N Am 2023; 34:311-334. [PMID: 37003655 DOI: 10.1016/j.pmr.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder impingement is the most common diagnosis for shoulder pain. Shoulder impingement syndrome has been scrutinized as a misleading "umbrella" term, due to its vague and nonspecific context. It is better subcategorized into subacromial, internal, and subcoracoid impingement. The evaluation and treatment algorithm for each is grossly similar. A thorough history, focused physical examination, and standard radiographs are the first steps. Advanced imaging with MRI or ultrasound may be useful. The mainstay of treatment includes physical therapy, anti-inflammatory medications, and injections. Surgical treatment is reserved for refractory cases, and includes decompression, debridement, and/or repair of injured structures.
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Affiliation(s)
- Evan H Horowitz
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY 11203, USA. https://twitter.com/EvanHorowitzMD
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.
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El-Amin SF, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears. J Clin Med 2022; 11:2661. [PMID: 35566785 PMCID: PMC9100979 DOI: 10.3390/jcm11092661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study describes measurements between the coracoid, glenoid, and humerus; characterizes coracoid shape, rotator cuff fatty infiltration, and quantitatively evaluates coracoid impingement and its association with anterosuperior rotator cuff tears (ASCT). 193 shoulder magnetic resonance imaging (MRI) scans demonstrating: rotator cuff tear; isolated tear of the supraspinatus; tear of supraspinatus and subscapularis, were included. MRI measurements included coracohumeral interval (CHI), coracoid overlap (CO), coracoid recess (CR), coracoglenoid angle (CGA), and coracoglenoid interval (CGI) on axial slices; acromiohumeral interval (AHI) on coronal slices; and coracohumeral interval (CHI) and coracoacromial ligament (CAL) thickness on sagittal slices. The coracoid shape was classified as flat, curved, or hooked. An Independent T-test was used to compare the MRI measurements and the different rotator cuff tear groups. In 79% of the patients with ASCT tears, the coracoid was curved. Axial CHI, CGA, sagittal CHI, and AHI were decreased in ASCT when compared to no tears and isolated supraspinatus tears (p < 0.05). CO was increased in ASCT compared to no tears and isolated supraspinatus tears (p < 0.05). Patients with an ASCT had a significantly increased subscapularis and supraspinatus Goutallier fatty infiltration score when compared to no tear and isolated supraspinatus tears (p < 0.05). These quantitative measurements may be useful in identifying patients at risk for ASCT. Level of Evidence III.
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Affiliation(s)
- Saadiq F. El-Amin
- El-Amin Orthopaedic and Sports Medicine Institute, Lawrenceville, GA 30043, USA
- Regenerative Sports Medicine, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA;
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084 Fisciano, Italy;
- San Giovanni di Dio e Ruggi D’Aragona Hospital “Clinica Orthopedica” Department, Hospital of Salerno, 84124 Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent ST5 5BG, UK
| | - Matthew C. Mai
- Florida Bone & Joint Specialists, Gulf Breeze, FL 32561, USA;
| | - Hugo C. Rodriguez
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, USA; (H.C.R.); (D.C.)
- Larkin Community Hospital, South Miami, FL 33143, USA
| | - Victoria Jaso
- Ross University School of Medicine, Miramar, FL 33156, USA;
| | - Dylan Cannon
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, USA; (H.C.R.); (D.C.)
| | - Ashim Gupta
- BioIntegrate, Lawrenceville, GA 30043, USA;
- Future Biologics, Lawrenceville, GA 30043, USA
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Veterans in Pain (V.I.P.), Valencia, CA 91354, USA
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Anatomy of the coracoid process in thais: Cadaveric study and clinical implications. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kucukciloglu Y, Aydın D. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. Clin Orthop Surg 2022; 14:441-449. [PMID: 36061841 PMCID: PMC9393267 DOI: 10.4055/cios21261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background The value of radiological measurements of subcoracoid impingement such as the coracohumeral interval in predicting subscapularis tendon injuries is controversial. We aimed to assess the relationship between radiological measurements of subcoracoid impingement and subscapularis tendon lesions in young and middle-aged adults. Methods This study was designed as a retrospective cohort study. Patients between the ages of 18–55 years without a history of shoulder surgery or major trauma were included and patients with arthritis, instability, or retracted rotator cuff tears were excluded from the study. Magnetic resonance images were evaluated and patients were grouped into two according to the subscapularis tendon condition: normal or pathologic. Glenoid version, axial coracohumeral distance, coracoglenoid angle, coracoid index, sagittal coracoid-glenoid tubercule distance, and axial coracoacromial inclination-glenoid version difference were measured for all patients. Measurement findings were compared between the groups. Correlation analysis was performed for age and radiologic measurements. A p < 0.05 was considered statistically significant for all tests. Results A total of 298 patients, 107 women (35.1%) and 191 men (64.9%), with a mean age of 34.46 ± 10.10 years (range, 18–55 years) were examined in the study. Subscapularis tendon pathology was noted in 85 patients (28.5%). The diagnosed pathologies were tendinosis in 48 patients (56.5%), partial tears in 28 (32.9%), and full thickness tears in 9 (10.6%). A significant relationship was observed between increasing age and subscapularis tendon lesions (p = 0.001). There was no statistically significant relationship between subscapularis pathology and calculated measurements. Axial coracohumeral distance and coracoglenoid angle measurements showed a statistically significantly negative correlation with age. A positive correlation was found between axial coracohumeral distance and coracoglenoid angle measurements (p < 0.001) and also between glenoid version and coracoid index measurements (p = 0.004). Axial coracohumeral distance and coracoglenoid angle measurements showed a negative correlation with glenoid version and coracoid index measurements (p < 0.05). Conclusions In this study, the coracohumeral distance and coracoglenoid angle decreased and the incidence of subscapularis tendon lesions increased as the age progressed. However, no relationship was found between radiological measurements and subscapularis tendon lesions.
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Affiliation(s)
- Yasemin Kucukciloglu
- Department of Orthopedics and Traumatology, Near East University Medical Faculty, Nicosia, Cyprus
| | - Deniz Aydın
- Department of Orthopedics and Traumatology, Near East University Medical Faculty, Nicosia, Cyprus
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Subcoracoid Impingement in a Dragon Boat Racer. Am J Phys Med Rehabil 2020; 99:e152-e153. [DOI: 10.1097/phm.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Asal N, Şahan MH. Radiological Variabilities in Subcoracoid Impingement: Coracoid Morphology, Coracohumeral Distance, Coracoglenoid Angle, and Coracohumeral Angle. Med Sci Monit 2018; 24:8678-8684. [PMID: 30500807 PMCID: PMC6284362 DOI: 10.12659/msm.911470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development using magnetic resonance imaging (MRI). MATERIAL AND METHODS A total of 200 patients (87 males with mean age of 51.1±15.2 years and 113 females with mean age of 52.6±10.7 years) undergoing shoulder MRI were included in this retrospective study. All MRI studies were performed with standard positioning. Coracoid morphology and subscapularis tendon were evaluated. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. One-way ANOVA was used to assess the difference between the groups. For binary comparisons, Tukey post hoc analysis was done. Pearson correlation analysis was performed between variables. RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). There was a negative correlation between coracohumeral distance and coracohumeral angle (R=-0.668 P=0.000) and between coracoglenoid angle and coracohumeral angle (R=-0.605 P=0.000). CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. A statistically insignificant increase in coracohumeral angle was noted.
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Abdrabou AM, Shalaby MH. Narrowed coraco-humeral distance on MRI: Association with subscapularis tendon tear. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hatta T, Yamamoto N, Sano H, Omori Y, Sugamoto K, Suzuki K, Itoi E. Three-Dimensional Morphometric Analysis of the Coracohumeral Distance Using Magnetic Resonance Imaging. Orthop Rev (Pavia) 2017; 9:6999. [PMID: 28458785 PMCID: PMC5391515 DOI: 10.4081/or.2017.6999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022] Open
Abstract
There have been no studies investigating three-dimensional (3D) alteration of the coracohumeral distance (CHD) associated with shoulder motion. The aim of this study was to investigate the change of 3D-CHD with the arm in flexion/internal rotation and horizontal adduction. Six intact shoulders of four healthy volunteers were obtained for this study. MRI was taken in four arm positions: with the arm in internal rotation at 0°, 45°, and 90° of flexion, and 90° of flexion with maximum horizontal adduction. Using a motion analysis system, 3D models of the coracoid process and proximal humerus were created from MRI data. The CHD among the four positions were compared, and the closest part of coracoid process to the proximal humerus was also assessed. 3D-CHD significantly decreased with the arm in 90° of flexion and in 90° of flexion with horizontal adduction comparing with that in 0° flexion (P<0.05). In all subjects, lateral part of the coracoid process was the closest to the proximal humerus in these positions. In vivo quasi-static motion analysis revealed that the 3D-CHD was narrower in the arm position of flexion with horizontal abduction than that in 0° flexion. The lateral part on the coracoid process should be considered to be closest to the proximal humerus during the motion.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Sendai
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Sendai
| | - Hirotaka Sano
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Sendai
| | - Yasushi Omori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Sendai
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Osaka
| | - Kenji Suzuki
- Kansei Fukushi Research Institute, Tohoku Fukushi University, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Tohoku University, Sendai
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Hay-Man WK, Wai-hung LC, Nin-yuan P, Yuen-yi C, Hung-lit C, Lam CW, Cheung WW. Magnetic Resonance Imaging of the Subcoracoid Region and Its Relationship with Subscapularis Lesions in the Chinese Population. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2016. [DOI: 10.1016/j.jotr.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Introduction Coracoid impingement is considered a known yet frequently overlooked cause of anterior shoulder pain. Subcoracoid stenosis has been shown to be related to subscapularis tear. Studies have shown that patients with coracoid impingement have a shorter coracohumeral distance (CHD) and a larger coracoid overlap (CO) but these are based on data from Western populations. The aim of our study was to provide a local database on the MRI measurement of these parameters in our Chinese population and raise the awareness of this disease entity. Methods All the shoulder MRI films taken in our hospital in 2011 were retrospectively reviewed and classified into two cohorts. The control group consisted of patients who had no subscapularis lesion. The subscapularis lesion group consisted of patients with complete tear, partial tear or abnormal signal over the subscapularis tendon. The CHD and CO were measured. Results We reviewed 133 sets of shoulder MRI obtained in our hospital during 2011. Thirteen patients were noted to have subscapularis lesion. The CHD in the subscapularis lesion group was 6.24 ± 2.18 mm. The CHD in the control group was 9.95 ± 3.9 mm. Women had shorter CHD (8.18 ± 2.57 mm) than men (11.0 ± 4.54 mm). We failed to notice any statistically significant difference with regards to CO, coracoid process and lesser tuberosity morphology between the two groups of patients. Conclusion MRI assessment of CHD can be useful in identifying patients at risk of having subscapularis lesion and coracoids impingement.
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Affiliation(s)
- Wan Keith Hay-Man
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Lie Chester Wai-hung
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Pan Nin-yuan
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Cheuk Yuen-yi
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Chow Hung-lit
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Chan Wai Lam
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Kowloon, Hong Kong, China
| | - Wong Wing Cheung
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Kowloon, Hong Kong, China
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Porter NA, Singh J, Tins BJ, Lalam RK, Tyrrell PNM, Cassar-Pullicino VN. A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography. Skeletal Radiol 2015; 44:1309-16. [PMID: 25975185 DOI: 10.1007/s00256-015-2166-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/21/2015] [Accepted: 05/03/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Orthopaedic surgical studies have shown that variations in the vertical distance between the tip of the coracoid process and the supra-glenoid tubercle alter the shape of the subcoracoid outlet. Our objective was to measure the vertical distance between the coracoid tip and the supra-glenoid tubercle (CTGT) on MR and to assess whether this showed better correlation with rotator cuff pathology compared with the axial coraco-humeral distance. MATERIALS AND METHODS A retrospective review was performed of 100 consecutive shoulder MR arthrograms. Vertical distance between the coracoid tip and the supraglenoid tubercle was measured in the sagittal oblique plane. Separate assessment was then made of tendon pathology of the subscapularis, supraspinatus and long head of biceps tendons. Axial coraco-humeral distance was then measured. Correlation between tendon abnormalities and the two measurements was then made. RESULTS Of the 100 cases, 42 had subscapularis tendon lesions, 21 had lesions of the long head of biceps and 53 had supraspinatus tendon lesions. Mean vertical distance from the coracoid tip to supraglenoid tubercle was greater in those with lesions of any of these tendons and was statistically significant for the supraspinatus group (P = 0.005). Reduced axial coraco-humeral distance was also seen in patients with tendinopathy, although with less statistically significant difference (p = 0.059). CONCLUSION Our results support orthopaedic studies that have shown that the vertical distance between the coracoid tip and the supraglenoid tubercle increases the incidence and risk of rotator cuff disease by altering the shape of the subcoracoid outlet.
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Affiliation(s)
- N A Porter
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, UK
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Aktas E, Sahin B, Arikan M, Ciledag N, Buyukcam F, Tokgoz O, Caglar E, Aribas BK. MRI analysis of coracohumeral interval width and its relation to rotator cuff tear. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:281-6. [PMID: 24894445 DOI: 10.1007/s00590-014-1490-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/21/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Coracoid impingement is an uncommon cause of the shoulder pain. It is stimulated by adduction, internal rotation and forward flexion. These positions decrease the width of the coracohumeral interval. Owing to restriction of movement, rotator cuff tendons may be overloaded. Thus, in this study, we aimed to determine whether coracoid impingement increase the tendency of rotator cuff tears. MATERIALS AND METHODS Routine clinical MRI sequences of 117 shoulders were reviewed, and axial coracohumeral interval measurements were taken. Rotator cuff tendon integrity was evaluated. Relation between rotator cuff tear and coracohumeral interval width was commented statically. RESULTS Seventy-nine of the patients were women, 38 of them men. The average age was 44.8 ± 14.2 (14-75). The mean age of patients with rotator cuff tear was significantly higher than patients without tear (p = 0.001). The mean value of coracohumeral interval width was 8.853 ± 2.491 mm (min: 2.9-max: 15.8). There were no significant differences between coracohumeral interval width of women and men (p = 0.139). The mean value of coracohumeral interval width with rotator cuff tear was 8.362 ± 2.382, and without tear was 9.351 ± 2.520. There was a significant differences between them (p = 0.031). CONCLUSION According to our study, there was a relationship between coracohumeral interval width and rotator cuff tear, so decreasing coracohumeral interval width may increase tendency of rotator cuff tear.
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Affiliation(s)
- Elif Aktas
- Department of Radiology, Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Caddesi, Yenimahalle, Ankara, Turkey,
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Osti L, Soldati F, Del Buono A, Massari L. Subcoracoid impingement and subscapularis tendon: is there any truth? Muscles Ligaments Tendons J 2013; 3:101-5. [PMID: 23888292 DOI: 10.11138/mltj/2013.3.2.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
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Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. Coracohumeral Distances and Correlation to Arm Rotation: An In Vivo 3-Dimensional Biplane Fluoroscopy Study. Orthop J Sports Med 2013; 1:2325967113496059. [PMID: 26535235 PMCID: PMC4555485 DOI: 10.1177/2325967113496059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears. Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation. Study Design: Descriptive laboratory study. Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured. Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index. Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices. Clinical Relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.
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Affiliation(s)
- John P Brunkhorst
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - J Erik Giphart
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA
| | - Peter J Millett
- Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA. ; The Steadman Clinic, Vail, Colorado, USA
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Perdikakis E, Drakonaki E, Maris T, Karantanas A. MR arthrography of the shoulder: tolerance evaluation of four different injection techniques. Skeletal Radiol 2013; 42:99-105. [PMID: 23064511 DOI: 10.1007/s00256-012-1526-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/30/2012] [Accepted: 09/17/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. MATERIALS AND METHODS A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n(1) = 37), with CT guidance using an anterior (n(2) = 29) or a posterior approach (n(3) = 32) and with ultrasound guidance (n(4) = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = "no pain", 10 = "intolerable pain"), technical success of the method used, and reason for referral were recorded. RESULTS The technical success rate was 100% for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 ± 1.24, CT anterior guidance demonstrated a mean pain of 3.87 ± 0.95, CT posterior guidance showed a mean pain of 1.59 ± 0.81, and ultrasound guidance a mean pain of 3.63 ± 1.12. A significant difference (p < .05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients. CONCLUSIONS No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient.
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Affiliation(s)
- Evangelos Perdikakis
- Department of Medical Imaging, University Hospital, Heraklion, 71110, Crete, Greece
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MRI of selected abnormalities at the anterior superior aspect of the shoulder: potential pitfalls and subtle diagnoses. AJR Am J Roentgenol 2012; 199:534-45. [PMID: 22915393 DOI: 10.2214/ajr.12.8789] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE MRI has proven to be a helpful tool in the detection and description of pathologic changes of the rotator cuff, biceps tendon, and glenoid labrum and has thus become a mainstay in the evaluation of patients with shoulder pain. This review seeks to illustrate some of the more subtle abnormalities that can be detected on shoulder MRI and to highlight some normal anatomic variants that may mimic pathologic processes, concentrating on structures at the anterior superior aspect of the shoulder. CONCLUSION Shoulder MRI can provide a very accurate evaluation of shoulder pathologic processes and can assist in elucidating abnormalities that can be difficult to diagnose clinically. Awareness of the known anatomic variants and the sometimes subtle potential pain generators at the anterior superior aspect of the shoulder will allow a more accurate interpretation and can therefore increase the diagnostic yield of shoulder MRI.
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Coracoid impingement: current concepts. Knee Surg Sports Traumatol Arthrosc 2012; 20:2148-55. [PMID: 22527418 DOI: 10.1007/s00167-012-2013-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
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.
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