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MUSCULOSKELETAL SURGERY

, Volume 95, Supplement 1, pp 25–29 | Cite as

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

  • Raffaele GarofaloEmail author
  • Marco Conti
  • Giuseppe Massazza
  • Eugenio Cesari
  • Enzo Vinci
  • Alessandro Castagna
Article

Abstract

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.

Keywords

Subcoracoid Impingement Minor instability Shoulder Coracoplasty 

Notes

Conflict of interest

Authors declare that they have no conflict of interest related to the publication of this article.

References

  1. 1.
    Goldthwait JE (1909) An anatomic and mechanical study of the shoulder-joint, explaining many cases of painful shoulder, many of the recurrent dislocations, and many of the cases of brachial neuralgias or neuritis. Am J Orthop Surg 6:579–606Google Scholar
  2. 2.
    Gerber C, Terrier F, Ganz R (1985) The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg Br 67:703–708PubMedGoogle Scholar
  3. 3.
    Kragh J, Doukas WC, Basamania CJ (2004) Primary coracoid impingement syndrome. Am J Orthop 33(5):229–232PubMedGoogle Scholar
  4. 4.
    Lo YK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and tuff lesions of the subscapularis. Arthroscopy 19(10):1142–1150PubMedCrossRefGoogle Scholar
  5. 5.
    Ferreira Neto AA, Almeida AM, Maiorino R, Zoppi Filho A, Benegas E (2006) An anatomical study of the subcoracoid space. Clinics 61(5):467–472PubMedCrossRefGoogle Scholar
  6. 6.
    Castagna A, Nordenson U, Garofalo R, Karlsson J (2007) Level V evidence. Minor shoulder instability. Arthroscopy 23(2):211–215PubMedCrossRefGoogle Scholar
  7. 7.
    Russo R, Togo F (1991) The subcoracoid impingement syndrome: clinical, semeiologic, and therapeutic considerations. Ital J Orthop Traumatol 17(3):351–358PubMedGoogle Scholar
  8. 8.
    Lo IK, Parten PM, Burkhart SS (2003) Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: an arthroscopic approach. Arthroscopy 19(10):1068–1078PubMedCrossRefGoogle Scholar
  9. 9.
    Greis PE, Kuhn JE, Schultheis J, Hintermeister R, Hawkins S (1996) Validation of the lift-off test and analysis of subscapularis activity during maximal internal rotation. Am J Sports Med 24:589–593PubMedCrossRefGoogle Scholar
  10. 10.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164PubMedGoogle Scholar
  11. 11.
    Rockwood CA, Matsen FA (2000) The shoulder, vol 2. Saunders Company, Philadelphia, pp 1034–1036Google Scholar
  12. 12.
    Dines DM, Warren RF, Inglis AE, Pavlov H (1990) The coracoid impingement syndrome. J Bone Joint Surg Br 72:314–316PubMedGoogle Scholar
  13. 13.
    Arrigoni P, Brady PC, Burkhart S (2006) Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Arthroscopy 22(10):1139.e1–1139.e3Google Scholar
  14. 14.
    Franceschi F, Longo UG, Ruzzino L, Rizzello G, Denaro V (2007) Arthroscopic management of calcific tendinitis of the subscapularis tendon. Knee Surg Sports Traumatol Arthrosc 15(12):1582–1585CrossRefGoogle Scholar
  15. 15.
    Kleist K, Freehill M, Hamilton L, Buss D, Fritts H (2007) Computed tomography analysis of the coracli process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaver study. J Should Elbow Surg 16:245–250CrossRefGoogle Scholar
  16. 16.
    Dumontier C, Sautet A, Gagey O, Apoil A (1997) Rotator interval lesions and their relation to coracli impingement syndrome. J Should Elbow Surg 8:130–135CrossRefGoogle Scholar
  17. 17.
    Roche SJ, Kennedy MT, Butt AJ, Kaar K (2006) Coracoid impingement syndrome: a treatable cause of anterior shoulder pain. Ir J Med Sci 175(3):57–61PubMedGoogle Scholar
  18. 18.
    Patte D (1990) The subcoracoid impingement. Clin Orthop 254:55–59PubMedGoogle Scholar
  19. 19.
    Patte D (1987) Diagnosis of painful shoulder think of the subcoracoid impingement syndrome. J Traumatol Sports 4:92–95Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Raffaele Garofalo
    • 1
    • 4
    Email author
  • Marco Conti
    • 2
  • Giuseppe Massazza
    • 2
  • Eugenio Cesari
    • 3
  • Enzo Vinci
    • 3
  • Alessandro Castagna
    • 2
  1. 1.Orthopedic and Traumatologic UnitRegional Hospital F. MiulliAcquaviva delle fontiItaly
  2. 2.Shoulder UnitIRCCS Humanitas InstituteRozzanoItaly
  3. 3.Shoulder Unit, Humanitas GavazzeniBergamoItaly
  4. 4.Santeramo in ColleItaly

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