Summary
Seventeen patients with a painful arc syndrome and tenderness over the coracoacromial ligament were selected to demonstrate the changes in the coracoacromial ligament in the impingement syndrome. Plain X-ray examination was normal and a preoperative subacromial bursogram demonstrated impingement in only three out of 17 patients. However, at operation the subacromial space under the coracoacromial ligament, which normally admits the tip of the little finger, appeared unusually tight and barely accessible in 15 out of 17 patients. Histological examination of the biopsied ligament showed degenerative changes but no increase in fibrous tissue. We conclude that in the absence of bony overgrowth the initial change is an increased volume of the soft tissues in the subacromial space. Consequently, the space is compromised by the swelling of its contents, which exert abnormal pressure on the overlying coracoacromial ligament and cause degenerative changes in the ligament. The symptoms of impingement appear because of the unyielding nature of the coracoacromial ligament. Subacromial bursography may not be a reliable test when the coracoacromial ligament is the site of impingement.
Résumé
Dans le but de mieux connaître les modifications du ligament acromio-coracoïdien chez les malades souffrant d'un conflit sous-acromial, nous avons étudié 17 patients. Il n'y avait aucune évidence de compression par des lésions osseuses ou articulaires. La bursographie préopératoire ne montrait un pincement que dans trois cas. Durant l'intervention on a constaté que l'espace sous-acromial au dessous du ligament acromio-coracoïdien était serré chez 15 patients. Ni l'inspection, ni la palpatione permettait de constater un épaississement ligamentaire. Histologiquement nous avons observé des changements dégénératifs, mais aucune augmentation de la composante fibreuse n'a été constatée. A notre avis, en l'absence d'une excroissance osseuse, le conflit est dû à une augmentation en volume des tissus mous occupant l'espace sous-acromial. Ces tissus gonflés exercent une pression contre le ligament acromio-coracoïdien et causent une dégénérescence. Les symptômes proviennent de la nature ferme du ligament. De plus nos résultats semblent mettre en doute la valeur de la bursographie dans le conflit sous-acromial, en ce qui concerne le ligament acromio-coracoïdien.
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Uhthoff, H.K., Hammond, D.I., Sarkar, K. et al. The role of the coracoacromial ligament in the impingement syndrome. International Orthopaedics 12, 97–104 (1988). https://doi.org/10.1007/BF00266972
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DOI: https://doi.org/10.1007/BF00266972