Coracoid impingement syndrome: a treatable cause of anterior shoulder pain

The painful shoulder: shoulder impingement syndrome

Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care.

The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition.

Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases.

A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible.

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.

Prevalence of the association of subacromial impingement with subcoracoid impingement and their clinical effects

OBJECTIVES

A prospective study to determine how commonly chronic subacromial impingement is associated with subcoracoid impingement and to evaluate clinical outcome after arthroscopic subacromial decompression (ASD).

METHODS

Subacromial and coracohumeral distances were evaluated in patients with chronic shoulder pain before and after ASD, using magnetic resonance imaging and the University of California at Los Angeles (UCLA) shoulder scale and Constant-Murley shoulder assessment.

RESULTS

A total of 40 patients were included in the study; patients were followed up for a mean of 27.3 months. Before ASD, 14 (35%) patients with chronic subacromial impingement also had subcoracoid impingement. In these patients, the mean coracohumeral distance was 7.18 mm (range 5.00 - 11.00 mm). After ASD, no patient had subcoracoid impingement, and the mean coracohumeral distance was significantly longer than pre-ASD, 12.85 mm (range 11.00 - 15.00 mm). The Constant-Murley shoulder assessment and UCLA shoulder scale both showed improvement after ASD.

CONCLUSIONS

Chronic subacromial impingement occurred together with subcoracoid impingement in 35% of patients presenting with chronic shoulder pain. Following ASD, the coracohumeral distance increased with remission from pain.

Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors

Subcoracoid impingement syndrome represents a rare cause of shoulder pain. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. There were 4 men and 9 women with a mean age of 45 years (range, 23-58 years). The diagnosis of subcoracoid impingement was carried out on the basis of clinical examination and magnetic resonance imaging finding. Arthroscopic surgery consisted of a coracoplasty alone in 2 patients, coracoplasty and acromioplasty in 2 patients, coracoplasty and subscapularis tendon repair in 4 patients, and in the last 5 patients no coracoplasty was done and surgery consisted in treating a minor shoulder instability. Patients were reviewed at a mean follow-up of 2.4 ± 0.7 years. We evaluated the difference between preoperative and final postoperative range of motion, VAS, UCLA, SST and Constant score using a Student's t test. At follow-up, we observed a significant improvement in range of motion and shoulder scores; moreover, clinical findings of subcoracoid impingement were negative in all patients. Different pathological shoulder conditions can be responsible for a subcoracoid impingement that can be primary or secondary to factors different from mechanic attrition against the coracoid because of its morphology. In case of primary impingement, coracoplasty is a good treatment to relieve clinical symptoms. In patients suffering from an associated minor shoulder instability with MGHL capsulolabral lesion, surgical treatment of this lesion without coracoplasty led to the improvement in symptoms.

Technique and safety aspects of resistance exercises: a systematic review of the literature

A systematic review of the scientific literature was conducted to identify the optimal ranges of motion for preventing injury in the main joints of the body during resistance exercise performance. These ranges of motion are independent of the type in which the resistance exercises could be applied (ie, adults, elderly, athletes, recreational exercisers), and the regions examined include the shoulder, spine, and knee, which are injured most often. It can be concluded that during the performance of any resistance exercise, it is possible to put anatomical structures at risk with certain body positions; therefore, it is necessary to understand these movements so injury can be avoided.

Coracoid impingement syndrome: a literature review

Coracoid impingement syndrome is a less common cause of shoulder pain. Symptoms are presumed to occur when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. Coracoid impingement should be included in the differential diagnosis when evaluating a patient with activity-related anterior shoulder pain. It is not thought to be as common as subacromial impingement, and the possibility of the coexistence of the two conditions must be taken into consideration before treatment of either as an isolated process. If nonoperative treatment fails to relieve symptoms, surgical decompression can be offered as an option.