Subcoracoid impingement and subscapularis tendon: is there any truth?

Osti, Leonardo; Soldati, Francesco; Buono, Angelo Del; Massari, Leo

doi:10.11138/mltj/2013.3.2.101

Cited by 22 publications

(28 citation statements)

References 37 publications

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“…Some studies have reported that a short coracohumeral distance contributes to subscapularis tendon pathologies (14–17). In our study, the coracohumeral distance was significantly narrower in patients who had a cyst within the lesser tuberosity, which likely resulted in subscapularis tendon pathologies being more frequent in this group.…”

Section: Discussionmentioning

confidence: 99%

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders

et al. 2014

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“…Subcoracoid impingement has been implicated as a rare cause of anterior shoulder pain and abnormalities. 1 , 7 - 9 , 14 , 20 , 22 - 24 Gerber et al 8 provided the first comprehensive description of subcoracoid impingement. These authors described the clinical syndrome of subcoracoid impingement and helped to delineate the anatomy of this entity using computed tomography.…”

mentioning

confidence: 99%

Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

Dugarte

Davis

Lynch

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears.Purpose/Hypothesis:The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space.Study Design:Descriptive laboratory study.Methods:In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes.Results:The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively.Conclusion:The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders.Clinical Relevance:Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.

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“…Previous studies indicated that the impingement could be caused between the proximal humerus and the coracoid process, particularly in the shoulder motion of flexion with internal rotation. 3 , 10 In addition, passive maneuver of flexion with horizontal abduction has been clinically used as the provocative test for subcoracoid impingement, namely coracoid impingement test 5 or modified Kennedy-Hawkins test. 21 The present study clearly demonstrated that 3DCHD significantly altered in association with shoulder flexion with horizontal adduction, which simulated the coracoid impingement test.…”

Section: Discussionmentioning

confidence: 99%

“…There might be some differences in CHD between the supine position and the upright position with the shoulder loaded by gravity or the weight of the arm. 3 , 17 Second, we analyzed the movement patterns estimated under sequential static conditions: it may not completely reflect the shortest CHD during dynamic motion. From this perspective, 2D-3D registration technique using fluoroscopy might be more precisely evaluated than our method using MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Subcoracoid impingement has been considered as a potential cause of anterior shoulder pain since the first description by Goldthwait. 1 Although several authors indicated that subcoracoid impingement was an uncommon pathology caused by the contact of the coracoid process with the lesser tuberosity, 2 , 3 its clinical entity has not yet been fully established.…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional morphometric analysis of the coracohumeral distance using magnetic resonance imaging

Hatta¹,

Yamamoto²,

Sano³

et al. 2017

Orthop Rev (Pavia)

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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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Subcoracoid impingement and subscapularis tendon: is there any truth?

Cited by 22 publications

References 37 publications

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders

Locations of lesser tuberosity cysts and their association with subscapularis, supraspinatus, and long head of the biceps tendon disorders

Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

Three-dimensional morphometric analysis of the coracohumeral distance using magnetic resonance imaging

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