| Introduction |
- Defined as subscapularis impingement between the coracoid and lesser tuberosity
- position of maximal impingement is arm adduction, flexion, and internal rotation
- Associated with combined subscapularis, supraspinatus, and infraspinatus tears
- Increased risk with
- patients with a long or excessively lateral coracoid process
- following surgery that caused posterior capsular tightening and loss of internal rotation
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| Presentation |
- Symptoms
- pain in anterior shoulder worsened by various degrees of flexion , adduction, and rotation
- Physical Exam
- tenderness over anterior coracoid
- position of maximal pain is 120-130° of arm flexion and internal rotation
- local anesthetic will eliminate symptoms
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| Imaging |
- Radiographs
- may show a decreased coracohumeral distance
- CT scan
- a CT obtained with the arms crossed on chest is helpful to make the diagnosis
- a coracohumeral distance of < 6 mm is considered abnormal (normal is 8.7 mm in the adducted arm 6.7 mm in the flexed arm)
- MRI
- evaulate degree of rotator cuff pathology
- axial view also effective to look for a decreased coracohumeral distance
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| Treatment |
- Nonoperative
- Operative
- arthroscopic coracoplasty
- resect posterolateral coracoid to create 7 mm clearence between coracoid and subscapularis
- if significant subscapularis tendon tear then repair
- open coracoplasty
- resect lateral aspect of coracoid process and reattach the conjoined tendon to the remaining coracoid
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