Pearson correlation analysis was performed between variables. If the patients palm is placed below the outer part of the gluteal muscle on the same side, the movement factor may also be inhibited. One-way ANOVA was used to assess the difference between the groups. Gerber et al. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. However, to the best of our knowledge, there is no study evaluating the relationship between the coracohumeral angle and subcoracoid impingement. Varying incidence of communication between the subcoracoid and subacromial bursae on the basis of MRI findings have been reported as 23% 5 and 55% 4, much higher than the 11% based on an early anatomic study3. There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). Illustration by Dr. Michael Stadnick. ( B ) Osteophyte at the tip of, Coracohumeral distance, in axial T2-weighted. Dugarte AJ, Davis RJ, Lynch TS, et al. Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the coracoid types are shown in Table 2. J Clin Imaging Sci 2011: 1:22, Bureau N, Dussault R, Keats T. Imaging of bursae around the shoulder joint. For subscapularis tendinosis and tear pathologies in the normal tendon of cases, we observed a narrowed coracohumeral distance and a decreased coracoglenoid angle, as well as an increase in coracohumeral angle. All MRI studies were static and used no special patient positioning technique. Bookshelf FOIA Find the code on the page and enter it above. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the subscapularis tendon pathologies are shown in Table 3. Federal government websites often end in .gov or .mil. Surgeons often refer to the coracoid process as the "lighthouse of the. [24] found a direct correlation between a narrowed coracohumeral distance and symptoms of subcoracoid impingement. 2013 Jul 9;3 (2):101-5. doi: 10.11138/mltj/2013.3.2.101. The subacromial bursa and the subscapularis recess are in close proximity; both track anterior to the subscapularis muscle and deep to the coracoid process, separated only by a thin fibrous band. 2021 Nov 25;6(3):447-453. doi: 10.1016/j.jseint.2021.10.007. Friedman et al. (12c) A more lateral sagittal image demonstrates the distended subcoracoid bursa (arrowheads). Epub 2018 Aug 29. There was a negative correlation between coracohumeral distance and coracohumeral angle (R=-0.668 P=0.000) and between coracoglenoid angle and coracohumeral angle (R=-0.605 P=0.000). Another common pathology of the rotator interval is adhesive capsulitis. (17a) A fat-suppressed proton density-weighted axial image reveals a degenerated and medially dislocated long biceps tendon (arrow), providing presumptive evidence of a rotator interval injury. A bursa is a synovial lined potential space which reduces friction at tendon-tendon and tendon-bone interfaces. 2013;1(2) 2325967113496059. For binary comparisons, Tukey post hoc analysis was done. The coracohumeral angle values increased, especially in type C coracoid, but the variability for coracohumeral angle values in coracoid and subscapularis tendon groups was less than 2 and no statistically significant difference was detected. When your hip functions normally, the femoral head glides in the hip socket. There was a negative correlation between coracohumeral distance and coracohumeral angle (R=0.668 P=0.000) and between coracoglenoid angle and coracohumeral angle (R=0.605 P=0.000). In the development of subcoracoid impingement, studies on the variabilities of coracoid morphology, coracohumeral distance, and coracoglenoid angle have been published [1,37,9,10]. Hekimoglu B, Aydn H, Kzlgz V, et al. CONCLUSION. Clipboard, Search History, and several other advanced features are temporarily unavailable. Yu JF, Xie P, Liu KF, Sun Y, Zhang J, Zhu H, Chen YH. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [ 1 - 3 ]. A statistically insignificant increase in coracohumeral angle was noted. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. P value=0.02 according to chi square analysis. Before Diagnosis certain Diagnosis certain . Muscles Ligaments Tendons J. Richards DP, Burkhart SS, Campbell SE. The discrepancy between these numbers has not been explained, but it has been speculated that significant bursal distension may disrupt normal barriers between the bursae5. The fat-suppressed coronal T2-weighted image (sensitive to fluid but not Gadolinium) demonstrates fluid in the joint (asterisk) and within the subacromial bursa (arrowheads). Fluid within the subacromial bursa is a well-established sign of a full thickness rotator cuff tear, so in cases where a communication between the subacromial and subcoracoid bursae exists, a full thickness supraspinatus tendon tear would result in fluid within both bursae. Imaging of the Bursae. (16a) The sagittal T2-weighted image confirms the same loose body (arrow) within the distended biceps tendon sheath. It is not uncommon for radiologists to confuse a distended subscapularis recess with the subcoracoid bursa. Unable to process the form. Type C coracoid was more frequent in the tendinosis and tendon tear groups. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. The PMC legacy view will also be available for a limited time. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-22581. For binary comparisons, Tukey post hoc analysis was done. A statistically insignificant increase in coracohumeral angle was noted. The five bursae that are found about the shoulder are the subacromial/subdeltoid (SbA/SD), subscapularis (SS), subcoracoid (SC), coracoclavicular (CC), and supra-acromial (SpA). 2 article In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. This could be explained in cases with communication with the subacromial bursa, which would allow for the ongoing decompression of glenohumeral joint fluid through the tear into the subacromial bursa and the subcoracoid bursa. Direct MR visualization of rotator interval tears is acknowledged to be difficult5 and published illustrations are rare 13,14, but subcoracoid effusions have been reported in association with rotator interval tears5. The site is secure. Figure 18 demonstrates findings commonly associated with adhesive capsulitis, together with a distended subcoracoid bursa. (15a) An axial fat suppressed proton density-weighted image reveals loose bodies within the axillary recess (short arrow) and within the biceps tendon sheath (long arrow). The results of the rates of coracoid types in subscapularis tendon pathologies are shown in Table 1. Distension of the subcoracoid bursa can be an isolated finding, but more frequently it is a marker of significant pathology elsewhere in the shoulder. Please enable it to take advantage of the complete set of features! Epub 2016 Apr 2. All patients who were selected in this study were having shoulder MRI. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [17]. The ePub format uses eBook readers, which have several "ease of reading" features Coracohumeral angle, in axial T2- weighted FFE images ( white*; coracoid distal tip). The clinical significance of fluid within the subcoracoid bursa is variable, but multiple studies have demonstrated its association with significant pathology, indicating that it is not to be considered a normal finding. Coracoid morphology and subscapularis tendon were evaluated; coracohumeral distance, coracoglenoid angle, and coracohumeral angle were measured in all subjects. Tendons, ligaments, and capsule of the rotator cuff: gross and microscopic anatom. Kim TK, Rauh PB, McFarland EG. The middle glenohumeral ligament (small arrow) and subscapularis tendon (SSc) are also indicated. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). This can damage the cartilage that . P<0.05 was considered statistically significant. But if there's abnormal contact between the femoral head and the rim of the hip socket, we call that hip impingement (also known as femoral acetabular impingement or FAI). The results are expressed as meanstandard deviation (SD); CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. 2022 May 9;11(9):2661. doi: 10.3390/jcm11092661. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Figure 13 demonstrates a distended subcoracoid bursa, narrowing of the coracohumeral distance to 3mm, and a partial thickness subscapularis tendon tear. -, Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Nevertheless, the results of our study are meaningful. We are experimenting with display styles that make it easier to read articles in PMC. MATERIAL AND METHODS A total of 200 patients (87 males with mean age of 51.115.2 years and 113 females with mean age of 52.610.7 years) undergoing shoulder MRI were included in this retrospective study. Since most arthrograms these days are performed in conjunction with MRI, this is not usually a significant problem, as MRI will reveal the status of the rotator cuff. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Otherwise, findings of subcoracoid impingement such as shoulder pain, subscapularis tear, shoulder impingement, and limitation of movement were present in the registered orthopedic examination findings in subscapularis tendon pathologies subjects. 50816 cases. This site needs JavaScript to work properly. 2021 Dec;29(6):367-375. doi: 10.1080/10669817.2021.1950300. Radas CB, Pieper HG. Curr Rev Musculoskelet Med. Report problem with Case; Contact user; In contrast, Richards et al. An early anatomic study identified the subcoracoid bursa in nearly 90% of gross specimens, and in 11% of those, there was a normal communication between the subcoracoid bursa and the subacromial/subdeltoid bursa 3. MeSH terms Adult Aged Coracoid Process / diagnostic imaging Female Humans A 10.7% incidence of bursal communication was identified in a study using subacromial bursography6. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. In subscapularis normal tendon subjects, orthopedic examination results were selected from those with no evidence of subcoracoid impingement. Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study. In this study, MRI was performed in the standard position; therefore, the inter-value angle variability was decreased. Skeletal Radiol.1996;25:5137, Horwitz T, Tocantins LM. Semin Musculoskelet Radiol 2014;18:436447, Demirhan M, Eralp L, Atalar AC. (13a) A fat-suppressed proton density-weighted axial image demonstrates a partial thickness subscapularis tendon tear (arrow), and a narrowed coracohumeral distance (dotted line, measuring 3mm). Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. Distention of the subcoracoid bursa in the absence of rotator cuff tear or communication with the subcoracoid bursa is less frequently seen, and more difficult to explain. In our study, there was a significant difference only between type A and C coracoid in coracoid types for coracohumeral angle. There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). [10] used a coracoglenoid angle measurement on different planes and found a positive correlation between the coracohumeral distance and the coracoglenoid angle. PMC The adjacent sagittal image demonstrates contrast within the joint and subscapularis recess (asterisk), and the subcoracoid bursa (arrowheads). Coracoglenoid angle, in axial T2-weighted FFE images ( white*; coracoid distal tip). 2018;70(7):116468. CONCLUSION. AJR Am J Roentgenol. Case Discussion The findings in this case are consistent with subcoracoid impingement. Subcoracoid impingement syndrome represents a rare cause of shoulder pain. One possibility is that the rotator cuff tear has altered the joint space, resulting in new patterns of impingement. By continuing to browse the site you are agreeing to our use of cookies. The adjacent distended subcoracoid bursa (arrowheads) is apparent. BACKGROUND The aim of this study was to investigate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development using magnetic resonance imaging (MRI). Shoulder disorders are very common in clinical practice. Isolated subacromial bursitis should be considered a diagnosis of exclusion after all other associated pathology has been ruled out. already built in. Subcoracoid impingement, characterized by narrowing of the space between the coracoid process and the humerus, is a rarely recognized cause of shoulder pain [1]. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. HHS Vulnerability Disclosure, Help Pearson correlation analysis was performed between variables. Internal impingement is a condition that occurs in athletes in which the shoulder is put in extreme abduction and external rotation during overhead movements. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. 16179 articles. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. (A) Flat coracoid. Involvement of the subacromial bursa with calcific bursitis or synovial chondromatosis has also been described2,9,12. Anatomic study of subcoracoid morphology in 418 shoulders: Potential implications for subcoracoid impingement. However, variabilities of coracoglenoid angle and coracohumeral angle between coracoid and subscapularis tendon groups are valuable for future studies. The supra-acromial and coracoclavicular bursae have been described as locations of calcific tendonitis 2, but are not as frequently identified as sources of pathology on MRI as the other bursae, which are more intimately related to the rotator cuff. J Radiol Sci 2013; 38: 111-118. The JRCERT is located at 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606, Phone: (312) 704-5300, Fax: (312)-704-5304. All MRI examinations were performed using surface coils by 1.5 Tesla (T) MRI systems (Philips MRI Systems, Achiava Release 3,2 Level 2013-10-21, Philips Medical Systems Nederland B.V.). The new PMC design is here! Distention of the subcoracoid bursa has also been recognized in subcoracoid impingement and rotator interval tears, and may be associated with other pathology of the rotator interval such as adhesive capsulitis. Chris Mallac explores the anatomy and biomechanics of subcoracoid impingement syndrome, including how clinicians can diagnose and most effectively manage this condition. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the subscapularis tendon pathologies. For the flat coracoid, the axis of the coracoid was generally straight from base to tip [9] (Figure 1A). Epub 2016 Dec 8. ADVERTISEMENT: Supporters see fewer/no ads. In the present study, was observed a statistically significant difference between coracoid types and subscapularis tendon pathologies. This site uses cookies. Subcoracoid impingement has also been suggested as a cause of subcoracoid bursal distention5,7. Although relatively rare, an isolated full thickness subscapularis tendon tear also results in fluid within the subcoracoid bursa, allowing fluid to freely decompress from the subscapularis recess into the subcoracoid bursa (figure 14). AJR Am J Roentgenol 1999;172(6): 15671571, Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. Measurement of Coracohumeral Distance in 3 Shoulder Positions Using Dynamic Ultrasonography: Correlation With Subscapularis Tear. Although loculated, this distended subscapularis recess (asterisk) clearly demonstrates communication with the joint and the typical saddlebag appearance, and does not extend as far caudally as a subcoracoid bursa. These results may vary depending on the different imaging methods and patient positioning used in the studies [6]. subscapularis tearing secondary to impingement technique resect posterolateral coracoid to create 7 mm clearance between coracoid and subscapularis if significant subscapularis tendon tear then repair open coracoplasty indications symptoms refractory to conservative treatment subscapularis tearing secondary to impingement technique Type A coracoid was the most frequent type, and type C coracoid was less frequent in the normal tendon group. Fluid is evident within a distended subcoracoid bursa (arrowheads). Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Hirji Z, Junjun JS, Choudur HN. Radiologists often mistake a distended subscapularis recess for a distended subcoracoid bursa. The routine shoulder MRI protocol for the 1.5-T MR machine at Krkkale University Hospital was as follows: T2-weighted FFE images in axial plane (TR/TE interval, 26003000/2030 ms), T2-weighted SPAIR images in sagittal plane (TR/TE interval, 26003000/2030 ms), and T2-weighted images fat-suppressed proton density-weighted images in coronal oblique plane (TR/TE interval, 26003000/2030 ms). [16]. Ethics Committee approval was obtained from Kirikkale University Faculty of Medicine (date: 08.05.2018, number: 10/02). Kleist KD, Freehill MQ, Hamilton L, et al. Radiopaedia's mission is to create the best radiology reference the world has ever seen and to make it available for free, for ever, for all. Categorical variables such as sex were compared between groups with the chi-square test. There was no rotator cuff tear, and although very mild subacromial bursitis was present, there was no visible communication between the subacromial bursa and the subcoracoid bursa. 2013;3(2):1015. The subcoracoid bursa is located between the anterior surface of the subscapularis and the coracoid process. Numerous authors have described the frequency of the subscapularis tears to be higher than previously thought, so subscapularis tears have lately become a focus of clinical practice and research [5,1315]. However, there was only a difference of less than 1 between the tendinosis and the tear groups in the angle values and no statistically significant difference was detected. Also note the fluid collection in the subcoracoid bursa, an obvious sign of bursitis. Print 2013 Apr. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance. Given the location of the subcoracoid bursa just caudal to the rotator interval, it is possible that bursal distention could be due to localized trauma, chronic inflammation, or altered biomechanics resulting in increased local friction. Adhesive capsulitis of the shoulder: MR arthrography. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [10]. RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. El-Amin SF 3rd, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. J Clin Med. View larger version (45K) All measurements were calculated T2-weighted FFE-weighted sequences on axial plane by an expert musculoskeletal radiologist with at least 10 years of experience (NA). Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. eCollection 2022 May. What are the findings? We predict that type C coracoid from coracoid types is an especially effective factor in subcoracoid impingement. Case of the Day. Subcoracoid impingement, which is defined as narrowing of the space between the coracoid process and the humerus, is an uncommon and infrequently recognized cause of shoulder pain. Correctly identifying the subcoracoid bursa and its relationship to other bursae in the shoulder should prompt the MRI radiologist to search for specific associated abnormalities. There was a significant difference between normal and tendinosis groups (P=0.006) and between normal and tear groups (P=0.000) for coracoglenoid angle values. Subcoracoid impingement and subscapularis tendon: is there any truth? Orthopedics 1998;21(5): 545548, Jonathan TF, Jeffrey MT, Mark C, Diane D. Subcoracoid bursitis as an unusual cause of painful anterior shoulder snapping in a weight lifter. Coracoglenoid angle, in axial T2-weighted FFE images (white*; coracoid distal tip). MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). Orthop J Sports Med. Neither the subcoracoid bursa nor the subacromial bursa should communicate with the glenohumeral joint when the rotator cuff is intact, but they may communicate with one another. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. The subacromial bursa and the subcoracoid bursa do not communicate with the joint under normal circumstances. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. There is no study on coracohumeral angle measurement in the literature. Anat Rec. Stenosis of the subcoracoid space between the lesser tuberosity and the . The results of the rates of coracoid types in subscapularis tendon pathologies. It is worth noting that bursal communication is much easier to confidently identify in cases with largely distended bursae, suggesting that MRI sensitivity for detecting bursal communication may be directly correlated with the degree of bursal distention. Garofalo R, Conti M, Massazza G, et al. Correlation analysis among coracohumeral distance, coracoglenoid angle and coracohumeral angle. Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. You may notice problems with Coracohumeral angle, in axial T2- weighted FFE images (white*; coracoid distal tip). Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders. Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. DMC Sinai-Grace Hospital is a 400-bed teaching hospital and offers a complete range . Magnetic resonance imaging based coracoid morphology and its associations with subscapularis tears: A new index. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. Clinical History: A 35 year-old female presents with shoulder pain after injuring her shoulder lifting a gate. This bursa does not normally communicate with the glenohumeral joint but may communicate with the subacromial bursa [ 1 ]. Ashoor MMA, Hamed WM, Alfarsi HM, et al. In their study, there was a decrease of axial coracoglenoid angle values in subscapularis tendon tears [10]. There was no significant difference between tendinosis and tear groups for coracohumeral distance and coracoglenoid angle values (P>0.05). Clinical presentation (18a) A sagittal T2-weighted image demonstrates a thickened coracohumeral ligament (arrow), infiltration of the subcoracoid fat triangle (short arrow), and a distended subcoracoid bursa (arrowheads). Neither the subacromial nor the subcoracoid bursa should communicate with the joint under normal circumstances. The amount of fluid within the subcoracoid bursa has not been directly correlated with degree of patients symptoms, but it has been suggested that larger amounts of fluid within the bursa correlate with the presence of a full thickness rotator cuff tear4. An anatomical study of the role of the long thoracic nerve and related scapular bursae in the pathogenesis of local paralysis of the serratus anterior muscle. For binary comparisons, Tukey post hoc analysis was done. Coracoid morphology and subscapularis tendon were evaluated. We work with you and your doctor to deliver the testing that is right for you. Med Sci Monit. Freehill MQ. The subcoracoid bursa is one of 5 bursae about the shoulder: the subacromial/subdeltoid bursa, the subscapularis recess/bursa, the subcoracoid bursa, the coracoclavicular bursa, and the supra-acromial bursa (figure 8). Coracoid impingement: Diagnosis and treatment. Coracohumeral distance values were 213.5 mm. BACKGROUND The aim of this study was to identify the diagnostic magnetic resonance imaging (MRI) findings in 47 shoulders with subcoracoid impingement syndrome by comparison with 100 normal shoulders. The coronal fat suppressed T1-weighted image reveals an intact supraspinatus tendon (arrowheads) with contrast in the joint (asterisk) and the biceps tendon sheath (small asterisk). Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [ 17 ]. Share Add to . The functionality is limited to basic scrolling. Int Orthop. There was no significant difference between the coracoid types and coracoglenoid angle values in our study. Wynell-Mayow W, Chong CC, Musbahi O, Ibrahim E. JSES Int. Coracohumeral distance, in axial T2-weighted FFE images (yellow*; coracoid distal tip). The presence of contrast filling the subcoracoid bursa has been described as an indirect sign of adhesive capsulitis on MR arthrography 15. In this study, a new approach used the coracohumeral angle to evaluate subcoracoid impingement. Kragh J, Jr, Doukas WC, Basamania CJ. One-way ANOVA was used to assess differences between the groups. Coracoglenoid angle values also decreased in the subscapularis tendon tendinosis and tear groups. Bethesda, MD 20894, Web Policies Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. The mechanism is increased with activities involving adduction, internal rotation, and forward flexion because the position decreases coracohumeral distance and impinges the intervening soft-tissue structures [46]. Charry FB, Martnez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. J Man Manip Ther. No communication between subcoracoid and subacromial bursae. What is the diagnosis? To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [13]. Subcoracoid impingement syndrome: A painful shoulder condition related to different pathologic factors. Nippon Seikeigeka Gakkai Zasshi 1979; 53:225-231, Yi-Hsuan Lee, Ginger H.F. Shu, Ching-Juei Yang, Wen-Sheng Tzeng, Clement Kuen-Huang Chen. All MRI studies were performed with standard positioning. The osteophyte at the end of the coracoid was defined as a more focused osteophyte at the distal end of the coracoid [9] (Figure 1B). Coracohumeral distance, in axial T2-weighted FFE images ( yellow*; coracoid distal tip). Giaroli EL, Major NM, Lemley DE et-al. [ 15 ] determined that positioning of the shoulder to 90-100 forward flexion and internal rotation significantly decreases the distance between the coracoid and the humeral head (8.7 vs 6.8 mm). MeSH Two sequential medial to lateral sagittal fat-suppressed T2 weighted images demonstrate the saddlebag appearance of the subscapularis recess (asterisks), draping over the subscapularis tendon (SSc) and communicating with the joint. Subcoracoid impingement syndrome is defined as impingement of the anterior soft tissues of the shoulder between the coracoid process and the lesser tuberosity, which causes fiber failure and damage, then partial or complete tearing of the subscapularis tendon, resulting in anterior shoulder pain [ 1 - 10 ]. -, Kleist KD, Freehill MQ, Hamilton L, et al. You may switch to Article in classic view. There were 87 males with a mean age of 51.115.2 years (range, 1880 years) and 113 females with a mean age of 52.610.7 years (range, 2374 years) in the study group. Authors Leonardo Osti 1 , Francesco Soldati , Angelo Del Buono , Leo Massari Affiliation 1 Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy. 2007;16(2):24550. During this motion, the posterior fibers of the supraspinatus tendon, anterior fibers of the infraspinatus tendon, or both can get impinged between the humeral head and the posterior glenoid. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [ 10 ]. Clinical conditions that may cause changes in measurements of shoulder joints, such as tumors, shoulder surgery, osteoarthritis, inflammatory joint disease, hemophilic arthritis, pyrophosphate disease, and significant trauma (including fractures, dislocations and falling down), were excluded from the study. This communication between the subacromial and subcoracoid bursae is a well known pitfall in the diagnosis of rotator cuff tears based on arthrography alone. Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the subscapularis tendon pathologies. There is a notable absence of loose bodies in a distended non-communicating subcoracoid bursa (figure 16b). Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. Clinico-radiological correlation of subcoracoid impingement with reduced coracohumeral interval and its relation to subscapularis tears in Indian patients. Subscapularis medial and lateral head coracohumeral ligament insertion anatomy: Arthroscopic appearance and incidence of hidden rotator interval lesions. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). Statistical analyses were performed using SPSS version 20 software (SPSS, Chicago, IL, U.S.A). The findings in this case are consistent withsubcoracoid impingement. [16] described an increased subcoracoid area after decompression surgery in symptomatic patients. Additional abnormalities as outlined in the study findings section. Arrigoni P, Brady PC, Burkhart SS. Let our care team know if you or your child have special needs or concerns, so we can make . Check for errors and try again. Determining the coracoid type is important for subcoracoid impingement due to the narrowing of the coracohumeral space [1,6,9,10]. In the subscapularis tendon tears, the coracohumeral distance narrowed and the mean value was 6 mm. An official website of the United States government. government site. The normal coracohumeral distance measures > 10 mm in asymptomatic patients. Disclaimer, National Library of Medicine Our results suggest that type C coracoid is an especially important predisposing factor in subcoracoid impingement development. However, the increased coracohumeral angle was accompanied a narrowed coracohumeral distance and a decreased coracoglenoid angle. The biceps tendon is indicated (LHBT). Radiological Variabilities in Subcoracoid Impingement: Coracoid Morphology, Coracohumeral Distance, Coracoglenoid Angle, and Coracohumeral Angle, Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey. Pearson correlation analysis was performed for coracohumeral distance and coracoglenoid angle, coracohumeral distance and coracohumeral angle, and coracoglenoid angle and coracohumeral angle. Careers. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the coracoid types. (12a) A fat-suppressed T2-weighted coronal image reveals a full thickness supraspinatus tendon tear, with fluid tracking from the joint into the subacromial bursa (arrowheads). Subcoracoid Bursa: Imaging Diagnosis and Significance. 2009;2 (1): 51-5. -. Illustration by Dr. Michael Stadnick. (12b) Communicating fluid is seen to extend from the subacromial bursa into the subcoracoid bursa (arrowheads) on the corresponding T2-weighted sagittal view. One-way ANOVA was used to assess the difference between the groups. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible . J Korean Radiol Soc 2001; 45(1):55-59. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U. Arthroscopy. The Egyptian Journal of Hospital Medicine. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. Third, no correlation analysis was performed regarding MR arthrography of tendon tears. International Scientific Literature, Ltd. Clin Orthop Surg. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. The patient also had subacromial impingement with severe tendinosis of the supra and infraspinatus tendons. Figure 17 demonstrates a lesion of the biceps pulley with medial dislocation of the biceps tendon (see Radsource web clinic February 2014), and an associated subcoracoid bursal effusion. Quantitative measurement of humero-acromial, humero-coracoid, and coracoclavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint. This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (, Magnetic Resonance Imaging, Rotator Cuff, Shoulder Impingement Syndrome, Coracohumeral distance, in axial T2-weighted FFE images (, Coracoglenoid angle, in axial T2-weighted FFE images (, Coracohumeral angle, in axial T2- weighted FFE images (, Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. Additional comprehensive studies are required that involve evaluations on different plans and that include dynamic imaging and correlation of MRI arthrography. Watson et al. sharing sensitive information, make sure youre on a federal MRI subcoracoid impingement diagnoses were falsely positive. There was a statistically significant difference in coracohumeral distance (P=0.016), but there was no significant difference in coracoglenoid angle (P=0.08) or coracohumeral angle (P=0.2). Garavaglia G, Ufenast H, Taverna E. The frequency of subscapularis tears in arthroscopic rotator cuff repairs: A retrospective study comparing magnetic resonance imaging and arthroscopic findings. 1998;21(5):54548. When this interbursal communication exists, subcoracoid bursal distention can be a sign of a full thickness rotator cuff tear. The coracohumeral distance may be narrowed due to anatomic variations of the humerus and scapula, specifically lesser tuberosity protrusion and coracoid shape [7,9]. Radiology 2005; 235: 1, Petchprapal CN, Beltran LS, Lath M, et al.. In the subscapularis tendon pathologies, 198 of the tears (99%) were partial tears and there were only 2 full-thickness tears. Second, no radiological comparison of results with measurements in different plans was performed. There was no significant difference among subscapularis tendon groups for coracohumeral angle. Radiology care teams at Ascension sites of care provide convenient imaging tests and quickly share results with you and your doctor. The https:// ensures that you are connecting to the Learn more about navigating our updated article layout. A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders. Measurement of coracohumeral distance in 3 shoulder positions using dynamic ultrasonography: Correlation with subscapularis tear. Subcoracoid impingement syndrome is the cause of anterior shoulder pain, first reported by Gerber et al. For coracoid morphology, the shape of the coracoid was determined according to whether it was straight or not, any osteophyte included, and whether it was curved. In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [10,1821]. and transmitted securely. Am J Sports Med 2010; 38: 1687-1692, Meraj S, Bencardino JT, Steinbach L. Imaging of Cysts and Bursae about the Shoulder. The subscapularis tendon was evaluated as normal, tendinosis, or tear in the 3 groups. Would you like email updates of new search results? However, there was no statistically significant difference between tendinosis and tear groups due to less than 1 mm difference in coracohumeral distance values. Involvement of the various spaces of the shoulder with synovitis or loose bodies will also follow known normal anatomic patterns, and any departure from this should prompt a search for further pathology. The role of local anatomy in the etiology of tears of the subscapularis tendon is very important. In cases where there is no communication between the subcoracoid bursa and the subacromial bursa, fluid within the subcoracoid bursa cannot be explained simply by the presence of a supraspinatus tendon tear. The low significance of differences in the values in the subscapularis tendinosis and tear pathologies may be due to the similarity in the process of formation of these pathologies and the fact that the imaging was performed in the standard position. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: A literature review. (13b) A fat-suppressed proton density-weighted axial image demonstrates a partial thickness subscapularis tendon tear (arrow), and a narrowed coracohumeral distance (dotted line, measuring 3mm). However, given the wide range of pathology with which a distended subcoracoid bursa may be associated, isolated subcoracoid bursitis is best considered a diagnosis of exclusion, after all other associated pathology has been ruled out. Subcoracoid impingement is an unusual form of shoulder impingement and results from narrowing of the coracohumeral interval (space between the tip of the coracoid and the humerus). 1938; 71:375-386, Schraner AB, Major NM. 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