Ultrasound of the coracoacromial ligament in asymptomatic volunteers and patients with shoulder impingement

Dietrich, Tobias Johannes; Jonczy, Maciej; Buck, Florian M.; Sutter, Reto; Puskás, Gábor J.; Pfirrmann, Christian W. A.

doi:10.1177/0284185115610930

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…This led them to theorize that increased stiffness of the CAL may raise contact pressures between the CAL and rotator cuff, resulting in pathologic degeneration. 8 Dietrich et al 10 recently compared CAL morphology in patients aged 20 to 60 years with and without shoulder pain due to subacromial impingement. Ultrasound evaluation showed that an anteriorly convex shape of the superficial contour of the CAL was more frequently seen in symptomatic patients.…”

Section: Pathologic Conditionsmentioning

confidence: 99%

See 1 more Smart Citation

The Coracoacromial Ligament: Anatomy, Function, and Clinical Significance

Rothenberg

Gasbarro

Chlebeck

et al. 2017

Orthopaedic Journal of Sports Medicine

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The coracoacromial ligament (CAL) was first described as a pain generator by Dr Charles Neer in the early 1970s. Since that time, considerable controversy regarding CAL management during acromioplasty has persisted. This review aims to better understand the role of the CAL in shoulder physiology and pathology. Sixty-six articles from 1958 to 2016 were identified using an electronic search of PubMed, Cochrane Library, AccessMedicine, and MD Consult for case series as well as cohort and prospective studies. The authors used “coracoacromial ligament” and “coracoacromial veil” as medical subject headings (MeSH). In addition, reference lists from all identified articles were reviewed for studies that the search terms may have omitted. The CAL plays an important role in shoulder biomechanics, joint stability, and proprioception. Morphological variance of the CAL is evident throughout the literature. Age-dependent changes due to chronic stress and cellular degradation cause thickening and stiffening of the CAL that may contribute to a spectrum of shoulder pathology from capsular tightness to rotator cuff tear arthropathy and impingement syndrome. The CAL is an integral component of the coracoacromial arch. CAL release during acromioplasty remains controversial. Future clinical outcomes research should endeavor to advance the understanding of the CAL to refine clinical and intraoperative decision making regarding its management.

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Section: Pathologic Conditionsmentioning

confidence: 99%

“…Ultrasound evaluation showed that an anteriorly convex shape of the superficial contour of the CAL was more frequently seen in symptomatic patients. 10 …”

Section: Pathologic Conditionsmentioning

confidence: 99%

The Coracoacromial Ligament: Anatomy, Function, and Clinical Significance

Rothenberg

Gasbarro

Chlebeck

et al. 2017

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

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“…Tendon rupture (17,25,26) was classified as full or partial thickness. Subacromial conflict was assessed (28)(29)(30)(31).…”

Section: Measurementsmentioning

confidence: 99%

Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain

et al. 2021

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Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints.Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant.Results: A total of 202 participants were enrolled (median age 56 years, range 18–70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample.Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.

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“…The dynamic evaluation of subacromial space impingement is assessed during progressive abduction and internal rotation of the arm by aligning the probe beneath the end of the acromion, in the long-axis of the supraspinatus tendon and, more anteriorly, at the level of the coracoacromial arch to visualize the supraspinatus as it glides underneath the coracoacromial ligament. In individuals with subacromial space impingement, the incomplete gliding of the supraspinatus tendon and the bursa with some pooling of bursal fluid and synovium squeezed against the lateral edge of the acromion, and the coracoacromial ligament can be appreciated during shoulder abduction and internal rotation [72].…”

Section: Shouldermentioning

confidence: 99%