(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). (C) Hooked coracoid in axial T2-weighted FFE images. 2022 Sep;14(3):441-449. doi: 10.4055/cios21261. (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). We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. In such cases it is useful to note that one study has demonstrated that even an inadvertent subcoracoid bursagram can be used to demonstrate a full thickness rotator cuff tear, since delayed post exercise imaging can reveal retrograde filling of the joint through the rotator cuff tear 6. This can damage the cartilage that . Am J Sports Med 2010; 38: 1687-1692, Meraj S, Bencardino JT, Steinbach L. Imaging of Cysts and Bursae about the Shoulder. 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). [16] described an increased subcoracoid area after decompression surgery in symptomatic patients. Figure 18 demonstrates findings commonly associated with adhesive capsulitis, together with a distended subcoracoid bursa. (12b) Communicating fluid is seen to extend from the subacromial bursa into the subcoracoid bursa (arrowheads) on the corresponding T2-weighted sagittal view. View larger version (45K) 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. However, to the best of our knowledge, there is no study evaluating the relationship between the coracohumeral angle and subcoracoid impingement. Coracohumeral angle, in axial T2- weighted FFE images ( white*; coracoid distal tip). There was a significant difference between normal and tendinosis groups (P=0.021) and between normal and tear groups (P=0.000) for coracohumeral distance values. Measurement of coracohumeral distance in 3 shoulder positions using dynamic ultrasonography: Correlation with subscapularis tear. We are experimenting with display styles that make it easier to read articles in PMC. 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. All patients who were selected in this study were having shoulder MRI. 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]. [16]. (B) Osteophyte at the tip of the coracoid. 8600 Rockville Pike Report problem with Case; Contact user; Our results suggest that type C coracoid is an especially important predisposing factor in subcoracoid impingement development. The Egyptian Journal of Hospital Medicine. In this study, a new approach used the coracohumeral angle to evaluate subcoracoid impingement. 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. Quantitative measurement of humero-acromial, humero-coracoid, and coracoclavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint. Additional abnormalities as outlined in the study findings section. You may notice problems with 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. Skeletal Radiol.1996;25:5137, Horwitz T, Tocantins LM. 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. Int Orthop. The Egyptian Journal of Hospital Medicine. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. sharing sensitive information, make sure youre on a federal Correlation analysis among coracohumeral distance, coracoglenoid angle and coracohumeral angle. These results may vary depending on the different imaging methods and patient positioning used in the studies [6]. Third, no correlation analysis was performed regarding MR arthrography of tendon tears. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). The medially retracted supraspinatus tendon is evident (arrow). [ 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). Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. The coracoid impingement of the subscapularis tendon: A cadaver study. 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. 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. 2013;1(2) 2325967113496059. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the coracoid types are shown in Table 2. [4] used dynamic MRI to evaluate coracohumeral distance, reporting an 11-mm mean coracohumeral distance in asymptomatic patients and 5.5 mm in symptomatic patients [4]. However, variabilities of coracoglenoid angle and coracohumeral angle between coracoid and subscapularis tendon groups are valuable for future studies. With the subscapularis muscle partially removed, this anterior oblique 3D representation depicts the subscapularis bursa (SS) deep to the subscapularis muscle and tendon protruding anterosuperiorly (asterisk) over the superior edge of the subscapularis tendon. Charry FB, Martnez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. J Man Manip Ther. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). 2013 Jul 9;3 (2):101-5. doi: 10.11138/mltj/2013.3.2.101. 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. First, there was no dynamic imaging involving provocative maneuvers. 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). The only other such structure communicating normally with the joint is the biceps tendon sheath. Clinico-radiological correlation of subcoracoid impingement with reduced coracohumeral interval and its relation to subscapularis tears in Indian patients. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [ 17 ]. Images from an MR arthrogram are presented. In our study, the narrowed coracohumeral distance was accompanied by decreased coracoglenoid angle and there was a positive correlation, similar to the report by Watson et al. Find the code on the page and enter it above. A bursa is a synovial lined potential space which reduces friction at tendon-tendon and tendon-bone interfaces. Find out more. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Surgeons often refer to the coracoid process as the "lighthouse of the. For binary comparisons, Tukey post hoc analysis was done. CONCLUSION. 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. Tears of the subscapularis tendon constitute 3137% of all repaired rotator cuff tendons [1012]. The presence of contrast filling the subcoracoid bursa has been described as an indirect sign of adhesive capsulitis on MR arthrography 15. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). Friedman et al. Measurement of Coracohumeral Distance in 3 Shoulder Positions Using Dynamic Ultrasonography: Correlation With Subscapularis Tear. 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. Group categorization was performed according to coracoid morphology: type A was flat coracoid, type B was osteophyte at the tip of the coracoid, and type C was hooked coracoid. 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). For binary comparisons, Tukey post hoc analysis was done. Type C coracoid was seen more frequently in the tendinosis and tear groups. 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. CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. The findings in this case are consistent withsubcoracoid impingement. The ePub format uses eBook readers, which have several "ease of reading" features 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). Intact rotator cuff, mild subacromial bursitis, inadvertent injection of subcoracoid bursa during anterior injection of joint. The results are expressed as meanstandard deviation (SD); CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. government site. Radiology care teams at Ascension sites of care provide convenient imaging tests and quickly share results with you and your doctor. 2017 Apr;33(4):734-742. doi: 10.1016/j.arthro.2016.09.003. Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U. Arthroscopy. 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. Received 2018 Jun 1; Accepted 2018 Aug 1. Disclaimer, National Library of Medicine Coracohumeral distances and correlation to arm rotation: An. Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. MRI appears to be more sensitive than CT for diagnosis of coracoid impingement [17]. Learn more about navigating our updated article layout. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . The most lateral sagittal fat suppressed T1-weighted MR arthrogram image demonstrates contrast within the joint and subscapularis recess (asterisk), fluid within the subcoracoid bursa (arrowhead), and the subscapularis tendon (SSc). MRI subcoracoid impingement diagnoses were falsely positive. Giaroli et al. The patient also had subacromial impingement with severe tendinosis of the supra and infraspinatus tendons. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. Semin Musculoskelet Radiol 2014;18:436447, Demirhan M, Eralp L, Atalar AC. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. The subcoracoid bursa is located between the anterior surface of the subscapularis and the coracoid process. Ashoor MMA, Hamed WM, Alfarsi HM, et al. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [13]. Illustration by Dr. Michael Stadnick. Three sagittal fat-suppressed T1-weighted images extending lateral to medial (1a, 1b, 1c), a coronal fat suppressed T1-weighted image (2a), and a coronal fat suppressed T2-weighted image (2b) are provided. Authors Leonardo Osti 1 , Francesco Soldati , Angelo Del Buono , Leo Massari Affiliation 1 Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy. There are studies in the literature that evaluated the effect of dynamic imaging on the subcoracoid impingement [5,6,8,10,22]. 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. One possibility is that the rotator cuff tear has altered the joint space, resulting in new patterns of impingement. Unable to process the form. Second, no radiological comparison of results with measurements in different plans was performed. Bookshelf Bennett WF. The coracohumeral distance may be narrowed due to anatomic variations of the humerus and scapula, specifically lesser tuberosity protrusion and coracoid shape [7,9]. J Shoulder Elbow Surg. The normal coracohumeral distance measures > 10 mm in asymptomatic patients. Clinical presentation The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. Richards DP, Burkhart SS, Campbell SE. Pearson correlation analysis was performed for coracohumeral distance and coracoglenoid angle, coracohumeral distance and coracohumeral angle, and coracoglenoid angle and coracohumeral angle. 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. No communication between subcoracoid and subacromial bursae. 1938; 71:375-386, Schraner AB, Major NM. The groups showed normal distribution and the variances were homogeneous. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the coracoid types. The subcoracoid bursa lies deep to the conjoined tendons of the coracobrachialis and short biceps tendons, and superficial to the subscapularis tendon. MeSH terms Adult Aged Coracoid Process / diagnostic imaging Female Humans The results of the rates of coracoid types in subscapularis tendon pathologies. The middle glenohumeral ligament (small arrow) and subscapularis tendon (SSc) are also indicated. Narrow coracohumeral distance measures 6.5 mm (Normal > 10 mm).The subscapularis tendon is thickened and displays abnormal intrasubstance bright signal in T2WI most likely partial tear. 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). 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). The adjacent distended subcoracoid bursa (arrowheads) is apparent. Let our care team know if you or your child have special needs or concerns, so we can make . Venous vascular malformation - thigh. There was no significant difference between tendinosis and tear groups for coracohumeral distance and coracoglenoid angle values (P>0.05). Diagnosis certain Diagnosis certain . Yu JF, Xie P, Liu KF, Sun Y, Zhang J, Zhu H, Chen YH. 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 coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Primary coracoid impingement syndrome. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance. Involvement of the subacromial bursa with calcific bursitis or synovial chondromatosis has also been described2,9,12. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. The functionality is limited to basic scrolling. What are the findings? Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the subscapularis tendon pathologies. Internal impingement is a condition that occurs in athletes in which the shoulder is put in extreme abduction and external rotation during overhead movements. 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. MRI subcoracoid impingement diagnoses were falsely positive. All MRI studies were static and used no special patient positioning technique. Imaging of the Bursae. Pearson correlation analysis was performed between variables. (18b) The coronal fat suppressed T2-weighted image demonstrates thickening and edema of the inferior glenohumeral ligament typical for adhesive capsulitis. This communication between the subacromial and subcoracoid bursae is a well known pitfall in the diagnosis of rotator cuff tears based on arthrography alone. (14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. 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. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: A statistical analysis of sixty cases. The PMC legacy view will also be available for a limited time. 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. Clinical History: A 35 year-old female presents with shoulder pain after injuring her shoulder lifting a gate. Subcoracoid impingement Last revised by Dr Henry Knipe on 15 Mar 2022 Edit article Citation, DOI & article data 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 ). Kim TK, Rauh PB, McFarland EG. CONCLUSION. If your doctor recommends a radiology test, Ascension sites of care provide convenient imaging services, close to home. -, Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Orthopedics. The coracohumeral angle was measured as an angle between the line tangential to the lateral surface of the humerus head from the coracoid tip and the line tangential to the medial surface of the humerus head from coracoid tip on the axial images (Figure 4). 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. 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. Ethics Committee approval was obtained from Kirikkale University Faculty of Medicine (date: 08.05.2018, number: 10/02). A new approach uses coracohumeral angle to evaluate subcoracoid impingement. [6] reported that the measurement of coracohumeral distance had poor predictive value for subcoracoid impingement diagnosis. Radas CB, Pieper HG. PMC In our study, there was a significant difference only between type A and C coracoid in coracoid types for coracohumeral angle. 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. 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). Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Federal government websites often end in .gov or .mil. One-way ANOVA was used to assess the difference between the groups. MATERIAL AND METHODS The subcoracoid impingement syndrome group consisted of 47 shoulders with subc 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. Arthroscopy. In this study, MRI was performed in the standard position; therefore, the inter-value angle variability was decreased. 2013;3(2):1015. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the subscapularis tendon pathologies are shown in Table 3. Accessibility Also note the fluid collection in the subcoracoid bursa, an obvious sign of bursitis. Figures 15 and 16 demonstrate loose bodies within the subscapularis recess and biceps tendon sheath, which communicate with the shoulder joint normally. Relationship between narrowed coracohumeral distance and subscapularis tears. A total of 200 shoulder MRIs in adult over age 18 years were examined retrospectively between January 2017 and March 2018 from a digital radiology database at Kirikkale University. Although in our test case the injection into the subcoracoid bursa was recognized and the needle was advanced further into the joint, inadvertent injection of contrast into the subcoracoid bursa can lead to a false positive diagnosis of rotator cuff tear. 2021 Nov 25;6(3):447-453. doi: 10.1016/j.jseint.2021.10.007. Figure 12 demonstrates a full thickness supraspinatus tendon tear in a patient with communicating subacromial and subdeltoid bursae. Coracoid impingement: Diagnosis and treatment. (16a) The sagittal T2-weighted image confirms the same loose body (arrow) within the distended biceps tendon sheath. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. 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. Coracohumeral distances and correlation to arm rotation: An in vivo 3-dimensional biplane fluoroscopy study. This occurs when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. Coracoglenoid angle, in axial T2-weighted FFE images (white*; coracoid distal tip). Our radiology care team at Ascension St. John Hospital Imaging is dedicated to making your experience as comfortable as possible. To learn more about Sinai-Grace's School of Radiologic Technology: call (313) 966-6866, or email Liz Oras, Program Director, at MOras@dmc.org. In shoulders where a normal communication between the subacromial and subcoracoid bursa exists, the resultant filling of the subacromial bursa may lead the radiologist to assume that contrast is extending from the joint though a full thickness rotator cuff tear into the subacromial bursa . Coracohumeral angle, in axial T2- weighted FFE images (white*; coracoid distal tip). There were [24] found a direct correlation between a narrowed coracohumeral distance and symptoms of subcoracoid impingement. 1998;21(5):54548. 2 article However, if subcoracoid im-pingement was the referring di agnosis, prospective MRI evalua tion more often was correct (n = 7 [three true-negatives, two true-positives, two false-negatives]). A 10.7% incidence of bursal communication was identified in a study using subacromial bursography6. 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). Coracoid morphology and subscapularis tendon were evaluated. -. Kleist KD, Freehill MQ, Hamilton L, et al. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-22581. Even in the absence of directly visualized rotator interval tears, effusions of the subcoracoid bursa can be seen in association with pathology of the rotator interval. 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. 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]. Shoulder disorders are very common in clinical practice. There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). One-way ANOVA was used to assess the difference between the groups. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. The JRCERT is located at 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606, Phone: (312) 704-5300, Fax: (312)-704-5304. There was no statistically significant difference between the values of the coracohumeral angle and the changes in the subscapularis tendon pathologies (P>0.05), but we observed higher coracohumeral angle values of tendinosis and tear pathologies (P=0.074 and P=0.073, respectively). Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. This bursa does not normally communicate with the glenohumeral joint but may communicate with the subacromial bursa [ 1 ]. Subcoracoid impingement syndrome is the cause of anterior shoulder pain, first reported by Gerber et al. ADVERTISEMENT: Supporters see fewer/no ads. Epub 2016 Apr 2. Epub 2021 Jul 14. However, there was no statistically significant difference between tendinosis and tear groups due to less than 1 mm difference in coracohumeral distance values. We explain what to expect and whether there are any dietary restrictions before coming in for your imaging test or procedure. Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears. ( B ) Osteophyte at the tip of, Coracohumeral distance, in axial T2-weighted. The subscapularis tendon is thickened and displays abnormal intrasubstance bright signal in T2WI most likely partial tear. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [10]. J Korean Radiol Soc 2001; 45(1):55-59. Magnetic resonance imaging based coracoid morphology and its associations with subscapularis tears: A new index. 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). The subscapularis recess can be loculated, and when markedly distended it can drape even further inferiorly along the anterior border of the subscapularis tendon (figure 11), but should not be confused with the subcoracoid bursa which extends significantly more caudally along the anterior border of the subscapularis tendon. 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. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. Imaging parameters were as follows: field of view, 1820 cm; matrix, 256182 pixels; slice thickness, 4 mm; section gap, 0.3 mm. official website and that any information you provide is encrypted [10] used a coracoglenoid angle measurement on different planes and found a positive correlation between the coracohumeral distance and the coracoglenoid angle. A statistically insignificant increase in coracohumeral angle was noted. Narasimhan R, Shamse K, Nash C, et al. The ePub format is best viewed in the iBooks reader. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. The subcoracoid bursa (SC) is separate and lies anterior to the subscapularis muscle and deep to the origins of the short head of the biceps tendon (SHB) and coracobrachialis (CB) muscles. See this image and copyright information in PMC. The small subacromial fluid collection (arrowheads) did not communicate with the subcoracoid bursa, and there was no full thickness rotator cuff tear. Coracoglenoid angle, in axial T2-weighted. (A) Flat coracoid. the display of certain parts of an article in other eReaders. Oh JH, Song BW, Choi JA, Lee GY, Kim SH, Kim DH. 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. The compression of the soft tissue between the lesser tuberosity of the humerus and the coracoid tip is defined as the roller-wringer effect and was reported to cause progressive degeneration and injury to the rotator cuff, especially subscapularis tendon tears [1,68]. 2009;2 (1): 51-5. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [ 10, 18 - 21 ]. There was no statistically significant difference among coracoid types for coracoglenoid angle or coracohumeral angle values (P>0.05). There is no study on coracohumeral angle measurement in the literature. 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). In many studies, a coracohumeral distance below 6 mm is considered to be significant for subcoracoid impingement in partial and full-thickness tears of subscapularis tendon [8]. Before Print 2013 Apr. The role of local anatomy in the etiology of tears of the subscapularis tendon is very important. There was a statistically significant difference between coracoid types and subscapularis tendon pathologies (P=0.02). Kragh J, Jr, Doukas WC, Basamania CJ. 16179 articles. AJR Am J Roentgenol 1999;172(6): 15671571, Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. Subcoracoid impingement is caused by entrapment of a portion of the rotator cuff between the coracoid process and the head of the humerus . 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. Pearson correlation analysis was performed between variables. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). DMC Sinai-Grace Hospital is a 400-bed teaching hospital and offers a complete range . There is a notable absence of loose bodies in a distended non-communicating subcoracoid bursa (figure 16b). In the present study, was observed a statistically significant difference between coracoid types and subscapularis tendon pathologies. Subcoracoid impingement syndrome represents a rare cause of shoulder pain. A communicating bursa is one that normally communicates with the joint 1; in the shoulder only the subscapularis bursa communicates with the joint. In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. Case Discussion The findings in this case are consistent with subcoracoid impingement. The most valuable data of this study was the narrowed coracohumeral distance measurement. 1999;23:358-360, Morag Y, Jacombson A, Shields G et al. Relation between narrowed coracohumeral distance and subscapularis tears. Wynell-Mayow W, Chong CC, Musbahi O, Ibrahim E. JSES Int. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the subscapularis tendon pathologies. (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). 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. Case contributed by Dr Roberto Schubert. Muscles Ligaments Tendons J. In contrast, there was a significant difference in coracoglenoid angle between the tendinosis-tear pathologies and the tendon normal groups. Nair AV, Rao SN, Kumaran CK, Kochukunju BV. Subcoracoid effusions are not infrequently seen in association with thickening of the rotator interval capsule and coracohumeral ligament, and infiltration of the subcoracoid fat triangle, all findings described in the MRI diagnosis of adhesive capsulitis14. 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. Arthroscopic management of calcific tendinitis of the subscapularis tendon. Arrigoni P, Brady PC, Burkhart SS. Ashoor MMA, Hamed WM, Alfarsi HM, et al. MR imaging of the subcoracoid bursa. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [17]. 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. Clark, JM, Harryman DT. Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study. Hekimoglu B, Aydn H, Kzlgz V, et al. P<0.05 was considered statistically significant. already built in. A coronal fat suppressed T1-weighted image (2a), and a coronal fat suppressed T2-weighted image (2b). The present study used MRI to evaluate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development. For binary comparisons, Tukey post hoc analysis was done. 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. Subcoracoid impingement. We found a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). It extends caudal to the tendon of the coracobrachialis and the short head of the biceps. In the present study, narrowed coracohumeral distance, decreased coracoglenoid angle, and increased coracohumeral angle were observed in type B and C coracoid, especially in type C coracoid. Clinical presentation Patients present with anterior shoulder p. Nevertheless, the results of our study are meaningful. Subcoracoid impingement, characterized by narrowing of the space between the coracoid process and the humerus, is a rarely recognized cause of shoulder pain [1]. Share Add to . Each patient was examined in the supine position, with slight external rotation position of the arm. Int Orthop. Orthop J Sports Med. 14a 14b Figure 14:(14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. Fourth, interobserver variability could not be determined because the measurements were performed by a single radiologist. The subacromial bursa and the subcoracoid bursa do not communicate with the joint under normal circumstances. Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders. -, Kleist KD, Freehill MQ, Hamilton L, et al. Adhesive capsulitis of the shoulder: MR arthrography. Coracohumeral distance, in axial T2-weighted FFE images ( yellow*; coracoid distal tip). Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. An official website of the United States government. 2007;16(2):24550. Bethesda, MD 20894, Web Policies MeSH ( A ) Flat coracoid. In the subscapularis tendon tears, the coracohumeral distance narrowed and the mean value was 6 mm. 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 ]. Gerber et al. The https:// ensures that you are connecting to the Subcoracoid impingement and subscapularis tendon: is there any truth? Figure 13 demonstrates a distended subcoracoid bursa, narrowing of the coracohumeral distance to 3mm, and a partial thickness subscapularis tendon tear. Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. A normal coracohumeral distance measures 8-11mm, with an average value of 5.5mm in symptomatic individuals 8,9. While the variability in the coracohumeral distance values between coracoid types was more prominent, there was no statistically significant difference due to less variability for coracoglenoid angle and coracohumeral angle values. Additional comprehensive studies are required that involve evaluations on different plans and that include dynamic imaging and correlation of MRI arthrography. It is not uncommon for radiologists to confuse a distended subscapularis recess with the subcoracoid bursa. The femoral head, or the ball portion of the joint. 2022 May 9;11(9):2661. doi: 10.3390/jcm11092661. A statistically insignificant increase in coracohumeral angle was noted. Coracohumeral distance, in axial T2-weighted FFE images (yellow*; coracoid distal tip). Another common pathology of the rotator interval is adhesive capsulitis. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. 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. Author(s), Article title, Publication (year), DOI. Giaroli EL, Major NM, Lemley DE et-al. 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. All MRI studies were performed with standard positioning. 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). International Scientific Literature, Ltd. Clin Orthop Surg. The subscapularis tendon was evaluated as normal, tendinosis, or tear in the 3 groups. 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). Med Sci Monit. For the flat coracoid, the axis of the coracoid was generally straight from base to tip [9] (Figure 1A). Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the types of coracoids. Determining the coracoid type is important for subcoracoid impingement due to the narrowing of the coracohumeral space [1,6,9,10]. Unable to load your collection due to an error, Unable to load your delegates due to an error, Coracohumeral distance, in axial T2-weighted FFE images (, Coracoglenoid angle, in axial T2-weighted FFE images (, Coracohumeral angle, in axial T2- weighted FFE images (. This site uses cookies. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Features of subcoracoid impingement with narrowing of the coracohumeral distance (6mm), subcoracoid bursitis and severe tendinopathy of the subscapularis with partial tear of its superior fibers and subluxation of a moderately tendinopathic long head of biceps tendon. doi: 10.12659/MSM.936703. Several authors have used roentgen, computed tomography (CT), or MRI to evaluate coracoid morphology, coracohumeral distance, and coracoglenoid angle [1,3,7,10,16]. The coracohumeral distance was measured at the narrowest point between the coracoid and the humerus on the axial images [10] (Figure 2). The separate subcoracoid bursa (arrowheads) has an elongated configuration tracking inferior to the subscapularis recess, along the anterior inferior margin of the subscapularis tendon and deep to the coracobrachialis muscle and tendon (CB). Freehill MQ. Coracoid morphology and subscapularis tendon were evaluated; coracohumeral distance, coracoglenoid angle, and coracohumeral angle were measured in all subjects. A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [ 1 - 3 ]. Chris Mallac explores the anatomy and biomechanics of subcoracoid impingement syndrome, including how clinicians can diagnose and most effectively manage this condition. In the subscapularis tendon pathologies, 198 of the tears (99%) were partial tears and there were only 2 full-thickness tears. 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). 2022 Aug 1;28:e936703. (16b) A more medial sagittal T2-weighted image demonstrates a loose body within the subscapularis recess (arrow) and the distended subcoracoid bursa (arrowheads) with a notable absence of loose bodies in the latter. However, if subcoracoid im-pingement was the referring di agnosis, prospective MRI evalua tion more often was correct (n = 7 [three true-negatives, two true-positives, two false-negatives]). Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. [1] found that the coracohumeral distance decreased by 16% during internal rotation, and they also suggested evaluating internal rotation in terms of subcoracoid impingement [1]. Indeed this bursa is actually a recess of the joint, alternatively referred to as the subscapularis recess. 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. Coracoglenoid angle, in axial T2-weighted FFE images ( white*; coracoid distal tip). Franceschi F, Longo UG, Ruzzino L, et al. The coracoglenoid angle was measured as an angle between a line along the plane of the glenoid face and a line projecting from the anterior edge of the glenoid to the lateral edge of the coracoid on the axial images [10] (Figure 3). Radiologists often mistake a distended subscapularis recess for a distended subcoracoid bursa. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . 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. We work with you and your doctor to deliver the testing that is right for you. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. J Clin Imaging Sci 2011: 1:22, Bureau N, Dussault R, Keats T. Imaging of bursae around the shoulder joint. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [ 10 ]. Signs of subscapularis tendinosis, medial dislocation of the long head biceps tendon, which also seems to be involved in the impingement. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). MR Arthrography of Rotator Interval, Long head of the biceps brachii and biceps pulley of the shoulder. The results of correlation analysis of coracohumeral distance, coracoglenoid angle, and coracohumeral angle are shown in Table 4. Oh JH, Song BW, Choi JA, et al. 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. What is the diagnosis? Epub 2018 Aug 29. El-Amin SF 3rd, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. J Clin Med. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. P value=0.02 according to chi square analysis. (15b) A coronal fat suppressed T2-weighted image redemonstrates the loose body (arrow) within the distended biceps tendon sheath. Contributed by Mourad Kerdjoudj. 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). Muscles Ligaments Tendons J. AJR Am J Roentgenol. Subcoracoid Bursa: Imaging Diagnosis and Significance. The most frequently reported and well-established pathology associated with a distended subcoracoid bursa is a full thickness tear of the rotator cuff, specifically the anterior rotator cuff, or supraspinatus tendon 4, 5. There was no significant difference between the coracoid types and coracoglenoid angle values in our study. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: A literature review. We predict that type C coracoid from coracoid types is an especially effective factor in subcoracoid impingement. 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. Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? 2016 Aug;32(8):1502-8. doi: 10.1016/j.arthro.2016.01.029. and transmitted securely. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). 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.). (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. Subcoracoid impingement has also been suggested as a cause of subcoracoid bursal distention5,7. Distension of the subcoracoid bursa can be an isolated finding, but more frequently it is a marker of significant pathology elsewhere in the shoulder. J Bone Joint Surg [Am} 1992, 74: 713-725. 2018 Regis Prograis is hit by a punch from Terry Flanagan Credit: Stephen Lew-USA TODAY Sports Sub-coracoid impingement (SCI) syndromes are an uncommon cause of anterior shoulder pain in the athlete; the prevalence in the . Epub 2016 Dec 8. In subscapularis normal tendon subjects, orthopedic examination results were selected from those with no evidence of subcoracoid impingement. 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. The adjacent sagittal image demonstrates contrast within the joint and subscapularis recess (asterisk), and the subcoracoid bursa (arrowheads). Case of the Day. [23] found a significant relationship between narrowed coracohumeral distance and subscapularis tendon pathologies. Check for errors and try again. 2018;70(7):116468. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. Dugarte AJ, Davis RJ, Lynch TS, et al. Generating an ePub file may take a long time, please be patient. 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). Coracoglenoid angle values decreased in type C coracoid but the variability was not more than 2 and no statistically significant difference was observed. In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [10,1821]. However, the increased coracohumeral angle was accompanied a narrowed coracohumeral distance and a decreased coracoglenoid angle. Would you like email updates of new search results? A small amount of fluid within the subscapularis recess is indicated (asterisk). Watson et al. Coracohumeral distance values were 213.5 mm. When your hip functions normally, the femoral head glides in the hip socket. 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. 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. The .gov means its official. Hekimoglu et al. Curr Rev Musculoskelet Med. Data are expressed as mean standard deviation (SD) or median (range). It is essential to properly distinguish these two potential spaces about the shoulder, since fluid within the subcoracoid bursa is considered pathologic, while the fluid in the subscapularis recess is due to a normal communication with the glenohumeral joint. No contrast is present in the subacromial bursa. Subscapularis medial and lateral head coracohumeral ligament insertion anatomy: Arthroscopic appearance and incidence of hidden rotator interval lesions. By continuing to browse the site you are agreeing to our use of cookies. eCollection 2022 May. AJR Am J Roentgenol 2000;174(5):13771380, Mikasa M. Subacromial bursography. Statistical analyses were performed using SPSS version 20 software (SPSS, Chicago, IL, U.S.A). Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. J Radiol Sci 2013; 38: 111-118. The biceps tendon is indicated (LHBT). At the level of the glenoid, the next sagittal image demonstrates contrast within the subscapularis recess (asterisk) and the subcoracoid bursa (arrowheads) outlining the superior portion of the subscapularis musculotendinous junction (SSc). (12c) A more lateral sagittal image demonstrates the distended subcoracoid bursa (arrowheads). (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). Fluid is evident within a distended subcoracoid bursa (arrowheads). But in those few patients who may be unable to undergo MRI, the shoulder arthrogram alone is still a useful tool for assessing the status of the rotator cuff. (17b) The distended subcoracoid bursa (arrowheads) is confirmed on the T2-weighted sagittal view. FOIA Watson AC, Jamieson RP, Mattin AC, Page RS. Radiology 2005; 235: 1, Petchprapal CN, Beltran LS, Lath M, et al.. You may switch to Article in classic view. Synovial chondromatosis of the subcoracoid bursa. Gerber et al. 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 [ 4 - 6 ]. American Journal of Roentgenology 2010;195: 567-576, Kim HJ, Han TI, Lee KW, et al. Brukhorst et al. Tendons, ligaments, and capsule of the rotator cuff: gross and microscopic anatom. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. Use the menu to find downloaded articles. 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]. Neither the subacromial nor the subcoracoid bursa should communicate with the joint under normal circumstances. The new PMC design is here! (1a, 1b, 1c) Three sagittal fat-suppressed T1-weighted images extending lateral to medial. 50816 cases. Type A coracoid was the most frequent type, and type C coracoid was less frequent in the normal tendon group. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. Coracoglenoid angle values also decreased in the subscapularis tendon tendinosis and tear groups. 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. In their study, there was a decrease of axial coracoglenoid angle values in subscapularis tendon tears [10]. Relation between narrowed coracohumeral distance and subscapularis tears. 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 contrast, Richards et al. 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. There was a significant difference between type A and C coracoid for coracohumeral distance values (P=0.012), but no significant difference was found between other coracoid groups (P>0.05). There was a statistically significant difference in coracohumeral distance (P=0.000) and coracoglenoid angle (P=0.000), but there was no significant difference in coracohumeral angle (P=0.06). It is an important entity to be aware of because it has been identified as a cause of persistent postoperative shoulder pain after rotator cuff repair [ 1 ]. 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. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible . 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 site needs JavaScript to work properly. The site is secure. Type C coracoid was more frequent in the tendinosis and tendon tear groups. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. 2021 Dec;29(6):367-375. doi: 10.1080/10669817.2021.1950300. Limitations of the study are as follow. The results of the rates of coracoid types in subscapularis tendon pathologies are shown in Table 1. Anat Rec. Illustration by Dr. Michael Stadnick. (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). Anatomic study of subcoracoid morphology in 418 shoulders: Potential implications for subcoracoid impingement. You can use Radiopaedia cases in a variety of ways to help you learn and teach. [10]. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Abdrabou A, Subcoracoid impingement. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. Tap on the below button when you are Online. A statistically insignificant increase in coracohumeral angle was noted. Some authors have suggested that distention of the subcoracoid bursa alone may produce symptoms4,10, characterized clinically by anterior shoulder pain inferior to the coracoid process 11. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. (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). 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. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. Careers. -, Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? 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