Clinical and radiological outcomes of arthroscopic subcoracoid decompression for idiopathic coracoid impingement, a stepped approach

<p class="abstract"><strong>Background:</strong> Idiopathic subcoracoid impingement is considered now as a well-established cause of anterior shoulder pain. There are multiple techniques reported for management of subcoracoid impingement. Open decompression and reattachment of conjoint tendon as well as arthroscopic resection of coracoid tip. The aim of this study was to evaluate the results of arthroscopic stepwise approach for management of idiopathic coracoid impingment.</p><p class="abstract"><strong>Methods:</strong> This prospective therapeutic case series study included 26 consecutive patients suffering from anterior shoulder pain and were diagnosed as subcoracoid impingement. All cases were evaluated preoperatively and followed up for 12 months after surgery both clinically and radiologically. Arthroscopic subcoracoid decompression, coracoplasty and arthroscopic repair of partial subscapularis tear if present were done for all cases.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age at the time of surgery was 45.3±5.4years. At the final follow up, the mean VAS score improved significantly to 0.8±0.8points postoperatively (p&lt;0.01). The mean Constant score improved significantly to 87.8±7.8 at the final follow-up (p&lt;0.001). The mean UCLA score improved significantly to 32.1±2.4 at the end of follow-up (P&lt;0.001)</p><p class="abstract"><strong>Conclusions:</strong> Coracoid impingement should be in mind when evaluating any patient with anterior shoulder pain. The arthroscopic management in form of bone, bursal and tendon procedures (triple attack) is a good treatment to relieve clinical symptoms with excellent patient reported outcomes.</p><p class="abstract"> </p>

Decreased axial coracoid inclination angle is associated with rotator cuff tears

Purpose: Coracoid morphology has been related to coracoid impingement mainly resulting in anterior shoulder pain aggravated by forward flexion and internal rotation. However, the coracoid process morphology can also affect the inclination of the coracoacromial ligament and subsequently the subacromial space in the same way that acromial slope does. The purpose of this study was to evaluate the influence of the coracoid body–glenoid surface, coracoid tip–glenoid surface, and coracoid body–coracoid tip angles (coracoid inclination angles) on rotator cuff tears (RCTs). Methods: Fifty patients with documented RCT and 50 patients with normal rotator cuff (control) were included. The coracoid inclination angles were determined in both groups by measuring on computed tomography scans the angle created by the coracoid body and the glenoid surface (A1), the angle created by the coracoid tip and the glenoid surface (A2), and the angle created by the coracoid body and the coracoid tip (A3). Results: All angles were significantly lower in the RCT group compared to the control group: mean A1 angle of 49.7° and 54.61°, respectively ( p = 0.011); mean A2 angle of 76.45° and 93.6°, respectively ( p < 0.001); and mean A3 angle of 132.33° and 144.34°, respectively ( p < 0.001). Conclusions: Decreased coracoid body–glenoid surface, coracoid tip–glenoid surface, and coracoid body–coracoid tip angles are associated with RCT. Decreased angles may reduce subacromial space by projecting the coracoacromial ligament more vertically.

Coracoid Impingement Treated with Corrective Osteotomy. A Case Report

Coracoid impingement syndrome is a rare cause of anterior shoulder pain. It is mainly a diagnosis of exclusion after considering the more common subacromial impingement. We describe a case of coracoid impingement and a novel approach to its management: coracoid osteotomy as opposed to the more commonly used technique of coracoplasty. A review of the literature is also presented in relation to this condition. Coracoid osteotomy with internal fixation allows good stability with reliable direct bone-to-bone healing. Coracoid osteotomy is a reliable and a satisfactory alternative to the more commonly-used technique of coracoplasty for the treatment of idiopathic coracoid impingement syndrome.