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Leite M, Pinho A, Sá M, Relvas M, Torres J, Madeira M, Pereira P. Anterior shoulder anatomy and subcoracoid impingement: An anatomical study. Morphologie 2020; 104:221-227. [PMID: 32571664 DOI: 10.1016/j.morpho.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of our study was to describe the anatomy of the anterior shoulder, specifically structures potentially involved in subscapularis tears pathophysiology and also to identify structures at risk during surgical approaches of this area. MATERIALS AND METHODS We designed an observational, experimental study based on cadaveric models. Dissection was performed and several structures of the anterior shoulder were characterized including the subscapularis, coracoid morphology, the coracoacromial ligament, coraco-humeral distance, and the axillary and musculocutaneous nerves. RESULTS Our sample included 16 shoulders. The coracoacromial ligament presented two bands in 37.5%, and these variants were significantly wider and thinner, and were associated with inferior coraco-humeral distance in internal rotation. The subscapularis footprint was longer and the coracoid process was bigger in male specimens, and the median coracoid angle was 122°, corresponding to a Leite-Torres type I. The Subscapularis showed a median thickness of 0.7cm, while the coraco-humeral distance in our sample ranged from 0.30cm in internal rotation to 0.85cm in external rotation. Neurologic relevant structures were at least more than 2.55cm from the coracoid tip. CONCLUSIONS This is the first paper to explore the eventual relationship between the presence of a double band coracoacromial ligament variant and subcoracoid impingement. Also, to our knowledge, this is the first cadaveric model study to postulate a possible anatomic base for subcoracoid impingement, as the SS myotendinous junction thickness was found to be greater than the coraco-humeral distance in neutral position and in IR.
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Affiliation(s)
- M Leite
- Serviço de Ortopedia e Traumatologia, São João University Hospital, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - A Pinho
- Serviço de Ortopedia e Traumatologia, São João University Hospital, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Porto Medical School, Porto University, Center for Health Technology and Services Research (CINTESIS), Alameda Prof. Hernâni Monteiro, Porto, Portugal; Porto Medical School, Porto University, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - M Sá
- Primary Health Care Unit Saúde em Família, R. Angola 172, Pedrouços, Portugal
| | - M Relvas
- Serviço de Ortopedia e Traumatologia, São João University Hospital, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - J Torres
- Serviço de Ortopedia e Traumatologia, São João University Hospital, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Porto Medical School, Porto University, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - M Madeira
- Unit of Anatomy, Department of Biomedicine, Porto Medical School, Porto University, Center for Health Technology and Services Research (CINTESIS), Alameda Prof. Hernâni Monteiro, Porto, Portugal; Porto Medical School, Porto University, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - P Pereira
- Unit of Anatomy, Department of Biomedicine, Porto Medical School, Porto University, Center for Health Technology and Services Research (CINTESIS), Alameda Prof. Hernâni Monteiro, Porto, Portugal; Porto Medical School, Porto University, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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