Prevalence and Morphology of the Coracoclavicular Joint: An Osteological Study of 2,724 Subjects Using Univariable and Multivariable Logistic Regression Analyses

Background: The coracoclavicular joint (CCJ) is an anomalous articulation between the surfaces of the inferior clavicle and superior coracoid and its etiology is controversial. Reportedly, symptomatic patients demonstrate significant functional limitations including shoulder abduction loss and potential for brachial plexus compression and impingement.Purpose: To determine the prevalence of CCJ across age, gender and ethnicity, and to identify clinically useful morphological characteristics.Methods: 2,724 subjects with intact clavicles and scapulae from the Hamann-Todd Osteological Collection were evaluated for the presence of CCJ. Logistic regression was used to determine the effect of age, height, gender, and race on prevalence of CCJ. 354 clavicles with CCJ were measured for size and location of the CCJ facet.Results: CCJ was observed in 9% of subjects. CCJ was more prevalent in African-Americans (12%) than Caucasian-Americans (6%) (p < 0.001) and more prevalent in females (11%) than males (8%) (p = 0.055). Facet location along clavicle length was consistent (average 25%, range 15–35%). But, facet location along clavicle width varied (average 60%, range 10–90%), with males having a more posterior location. For every 10-year increase in age, facet elevation (p = 0.001) and surface area (p < 0.001) increased.Conclusions: CCJ prevalence was 9% in our large osseous population, found more commonly in African-Americans and females. Facet location is predictable with respect to clavicle length, but less so along clavicle width. The clavicular facet may develop at some point in life and continue to grow in size after its appearance.Clinical Relevance: Presence of a CCJ represents a potential overlooked source of anterior shoulder pain and supracoracoid impingement. Epidemiologic and morphological characteristics presented in our study can aid in the identification, clinical understanding, and surgical excision of a symptomatic CCJ. Level of Evidence: Level IV.

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>

Subcoracoid Impingement – A Global View

Modifications in joint anatomy on both soft and bony tissue level play a key role in subcoracoid impingement syndrome. The diagnostic is primarily clinical and is based on patient history and functional tests. Imaging tests support, but do not establish the diagnostic. Approach can take the form of targeted exercises with progressive load, or that of invasive surgery. Shoulder pain has a diverse etiology which derives from the complex local anatomy which includes the clavicle, acromion, coracoid process and humeral head, the soft tissues surrounding this area, in particular the rotator cuff, but can also be unrelated to all of the above and be a reflection of a pathology located in the neck, arm or trunk, or adjacent visceral organs. More often, it is the manifestation of a traumatic episode or an anatomical anomaly, or it can be secondary to inflammation, tumors, or surgery. It is the third most common musculoskeletal complaint presenting to physiotherapy, and largely impacts both an individual’s quality of life and the public health system. Coracoid impingement syndrome can present itself as a cause of rotator cuff disease, but its role is not fully established yet. It is less prevalent than subacromial impingement, can coexist with it, and therefore should be considered into the differential diagnosis of anterior shoulder pain when a patient presents themselves with activity related anterior shoulder pain.