An Anatomical Study of the Subcoracoid Space

Neto, Arnaldo Amado Ferreira; Almeida, Arací Malagodi de; Maiorino, Renzo; Filho, Américo Zoppi; Benegas, Eduardo

doi:10.1590/s1807-59322006000500015

Cited by 24 publications

(14 citation statements)

References 13 publications

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“…Synovitis within the rotator interval is debrided and the coracohumeral interval is examined. If the interval is less than 8mm in females or less than 10mm in males, [ 22 , 23 ] coracoplasty is performed to reestablish the dimensions of the interval by anteriorizing, medializing, and superiorizing the margins of the coracoid with an arthroscopic bur. When coracoplasty is necessary, the subscapularis tendon is critically scrutinized and addressed as indicated, as it is often pathologically involved with a stenotic coracohumeral interval [ 23 ].…”

Section: Surgical Techniquementioning

confidence: 99%

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

Mook¹,

Greenspoon²,

Millett³

2016

TOORTHJ

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Background:Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row.Methods:The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results:The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion:Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

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Section: Surgical Techniquementioning

confidence: 99%

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

Mook¹,

Greenspoon²,

Millett³

2016

TOORTHJ

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“… 5 , 12 Bhatia et al 2 performed a large-scale anatomic study of 101 human scapulae and found significant differences in several anatomic parameters between male and female specimens. Ferreira Neto et al 5 confirmed these sex-based differences in the subcoracoid space. Specifically, there was a smaller distance between the coracoid apex and the lesser tuberosity in female specimens compared to male specimens.…”

mentioning

confidence: 99%

“…Specifically, there was a smaller distance between the coracoid apex and the lesser tuberosity in female specimens compared to male specimens. 5 Gumina et al 12 also characterized the shape of the coracoglenoid space in 204 scapulae. No study to date has demonstrated an association between age and the anatomy of the coracoid process and the subcoracoid space.…”

mentioning

confidence: 99%

Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

Dugarte

Davis

Lynch

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears.Purpose/Hypothesis:The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space.Study Design:Descriptive laboratory study.Methods:In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes.Results:The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively.Conclusion:The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders.Clinical Relevance:Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.

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“…Some studies have reported smaller coracohumeral distances in women, 13 , 37 while others reported no differences in coracohumeral distance or incidence of subcoracoid impingement between sexes. 7 , 12 , 34 , 38 While it is unclear whether differences exist between sexes, our data only reflect the male population. Secondly, biplane fluoroscopy and CT imaging do not depict the soft tissue structures within the coracohumeral interval (articular cartilage, articular capsule, subscapularis muscle and tendon, and subcoracoid bursa).…”

Section: Discussionmentioning

confidence: 89%

“…Subcoracoid impingement, while relatively uncommon in clinical incidence when compared to subacromial impingement, has been increasingly diagnosed in patients with anterior shoulder pain and tenderness. 7 – 9 , 11 , 27 However, studies have suggested that subcoracoid impingement may not be as rare as once thought. 6 , 8 , 12 , 22 , 26 , 33 In fact, one study reported that 19% of patients with combined subscapularis, supraspinatus, and infraspinatus tears had subcoracoid impingement, 26 and another reported subcoracoid impingement as a postoperative complication in 5.1% of patients following rotator cuff repair and anterior acromioplasty.…”

mentioning

confidence: 99%

Coracohumeral Distances and Correlation to Arm Rotation

Brunkhorst

Giphart

LaPrade

et al. 2013

Orthopaedic Journal of Sports Medicine

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Background:Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.Purpose:To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.Study Design:Descriptive laboratory study.Methods:A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.Results:The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index.Conclusion:Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.Clinical Relevance:This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.

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An Anatomical Study of the Subcoracoid Space

Cited by 24 publications

References 13 publications

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

Coracohumeral Distances and Correlation to Arm Rotation

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