There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). This bursa does not normally communicate with the glenohumeral joint but may communicate with the subacromial bursa [ 1 ]. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. 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. Pearson correlation analysis was performed between variables. 50816 cases. 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. (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. Illustration by Dr. Michael Stadnick. [10]. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. These results may vary depending on the different imaging methods and patient positioning used in the studies [6]. Coracoglenoid angle, in axial T2-weighted. A statistically insignificant increase in coracohumeral angle was noted. 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]). government site. There was no significant difference among subscapularis tendon groups for coracohumeral angle. 8600 Rockville Pike J Bone Joint Surg [Am} 1992, 74: 713-725. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. However, the increased coracohumeral angle was accompanied a narrowed coracohumeral distance and a decreased coracoglenoid angle. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). Intact rotator cuff, mild subacromial bursitis, inadvertent injection of subcoracoid bursa during anterior injection of joint. 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. Generating an ePub file may take a long time, please be patient. 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. Measurement of Coracohumeral Distance in 3 Shoulder Positions Using Dynamic Ultrasonography: Correlation With Subscapularis Tear. This can damage the cartilage that . 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. Figures 15 and 16 demonstrate loose bodies within the subscapularis recess and biceps tendon sheath, which communicate with the shoulder joint normally. 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. 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. 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 ]. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance. ADVERTISEMENT: Supporters see fewer/no ads. the display of certain parts of an article in other eReaders. (16a) The sagittal T2-weighted image confirms the same loose body (arrow) within the distended biceps tendon sheath. A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders. 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). In the subscapularis tendon tears, the coracohumeral distance narrowed and the mean value was 6 mm. However, there was no statistically significant difference between tendinosis and tear groups due to less than 1 mm difference in coracohumeral distance values. In the subscapularis tendon pathologies, 198 of the tears (99%) were partial tears and there were only 2 full-thickness tears. 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. The femoral head, or the ball portion of the joint. For the hooked coracoid, the axis of the coracoid deviated posteriorly a few centimeters lateral to the base of the coracoid [9] (Figure 1C). Another common pathology of the rotator interval is adhesive capsulitis. 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). 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. Imaging of the Bursae. 2013;1(2) 2325967113496059. 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. Coracoglenoid angle values decreased in type C coracoid but the variability was not more than 2 and no statistically significant difference was observed. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. Coracohumeral distances and correlation to arm rotation: An. Gerber et al. Determining the coracoid type is important for subcoracoid impingement due to the narrowing of the coracohumeral space [1,6,9,10]. 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]. 2013 Jul 9;3 (2):101-5. doi: 10.11138/mltj/2013.3.2.101. Radas CB, Pieper HG. Indeed this bursa is actually a recess of the joint, alternatively referred to as the subscapularis recess. Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Brukhorst et al. Epub 2016 Apr 2. The subcoracoid bursa is located between the anterior surface of the subscapularis and the coracoid process. 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 (. Friedman et al. (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). There was no statistically significant difference among coracoid types for coracoglenoid angle or coracohumeral angle values (P>0.05). Nevertheless, the results of our study are meaningful. All MRI studies were performed with standard positioning. 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 results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the coracoid types. Type A coracoid was the most frequent type, and type C coracoid was less frequent in the normal tendon group. There was no significant difference between the coracoid types and coracoglenoid angle values in our study. We predict that type C coracoid from coracoid types is an especially effective factor in subcoracoid impingement. already built in. MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. 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. J Korean Radiol Soc 2001; 45(1):55-59. Print 2013 Apr. 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 . The middle glenohumeral ligament (small arrow) and subscapularis tendon (SSc) are also indicated. Proper distinction between the two spaces can be made on sagittal images by identifying the typical saddle bag appearance of the subscapularis recess as it drapes over the superior margin of the subscapularis tendon, its normal communication with the joint, and the septum between the subscapularis recess and the subcoracoid bursa (figures 9-10). 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 presence of contrast filling the subcoracoid bursa has been described as an indirect sign of adhesive capsulitis on MR arthrography 15. The new PMC design is here! 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). Orthopedics. For binary comparisons, Tukey post hoc analysis was done. (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. El-Amin SF 3rd, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. J Clin Med. In the present study, was observed a statistically significant difference between coracoid types and subscapularis tendon pathologies. Signs of subscapularis tendinosis, medial dislocation of the long head biceps tendon, which also seems to be involved in the impingement. Quantitative measurement of humero-acromial, humero-coracoid, and coracoclavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint. Type C coracoid was more frequent in the tendinosis and tendon tear groups. 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. Arthroscopy. (15b) A coronal fat suppressed T2-weighted image redemonstrates the loose body (arrow) within the distended biceps tendon sheath. Our results suggest that type C coracoid is an especially important predisposing factor in subcoracoid impingement development. All MRI studies were static and used no special patient positioning technique. Pearson correlation analysis was performed between variables. 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). An official website of the United States government. 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). No communication between subcoracoid and subacromial bursae. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . J Shoulder Elbow Surg. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. 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]). The coracohumeral distance was measured at the narrowest point between the coracoid and the humerus on the axial images [10] (Figure 2). The results are expressed as meanstandard deviation (SD); CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. All MRI studies were performed with standard positioning. There was no significant difference between tendinosis and tear groups for coracohumeral distance and coracoglenoid angle values (P>0.05). There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). For binary comparisons, Tukey post hoc analysis was done. 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]. MeSH [16] described an increased subcoracoid area after decompression surgery in symptomatic patients. We work with you and your doctor to deliver the testing that is right for you. Arrigoni P, Brady PC, Burkhart SS. ( B ) Osteophyte at the tip of, Coracohumeral distance, in axial T2-weighted. Please enable it to take advantage of the complete set of features! Before 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. Epub 2016 Dec 8. Bookshelf 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.). MATERIAL AND METHODS The subcoracoid impingement syndrome group consisted of 47 shoulders with subc What is the diagnosis? 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). In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. The site is secure. Imaging parameters were as follows: field of view, 1820 cm; matrix, 256182 pixels; slice thickness, 4 mm; section gap, 0.3 mm. American Journal of Roentgenology 2010;195: 567-576, Kim HJ, Han TI, Lee KW, et al. In our study, type A coracoid was the most frequent type, and type C coracoid was less frequent in the normal tendon group; type C coracoid was seen more frequently in the tendinosis and tear groups. Unable to process the form. Relation between narrowed coracohumeral distance and subscapularis tears. Radiological Variabilities in Subcoracoid Impingement: Coracoid Morphology, Coracohumeral Distance, Coracoglenoid Angle, and Coracohumeral Angle, Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey. Subscapularis medial and lateral head coracohumeral ligament insertion anatomy: Arthroscopic appearance and incidence of hidden rotator interval lesions. Coracoid morphology and subscapularis tendon were evaluated. (14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. 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. The Egyptian Journal of Hospital Medicine. A statistically insignificant increase in coracohumeral angle was noted. The results of the rates of coracoid types in subscapularis tendon pathologies are shown in Table 1. It extends caudal to the tendon of the coracobrachialis and the short head of the biceps. 2017 Apr;33(4):734-742. doi: 10.1016/j.arthro.2016.09.003. One-way ANOVA was used to assess the difference between the groups. Fluid is evident within a distended subcoracoid bursa (arrowheads). The subcoracoid bursa lies deep to the conjoined tendons of the coracobrachialis and short biceps tendons, and superficial to the subscapularis tendon. FOIA Richards DP, Burkhart SS, Campbell SE. 1999;23:358-360, Morag Y, Jacombson A, Shields G et al. Careers. Contributed by Mourad Kerdjoudj. 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. Curr Rev Musculoskelet Med. 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). Magnetic resonance imaging based coracoid morphology and its associations with subscapularis tears: A new index. In contrast, there was a significant difference in coracoglenoid angle between the tendinosis-tear pathologies and the tendon normal groups. 2022 May 9;11(9):2661. doi: 10.3390/jcm11092661. 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. (A) Flat coracoid. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). 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. All patients who were selected in this study were having shoulder MRI. 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. Figure 12 demonstrates a full thickness supraspinatus tendon tear in a patient with communicating subacromial and subdeltoid bursae. 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. 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. 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. We are experimenting with display styles that make it easier to read articles in PMC. 14a 14b Figure 14:(14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. The most valuable data of this study was the narrowed coracohumeral distance measurement. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears. Epub 2021 Jul 14. Chris Mallac explores the anatomy and biomechanics of subcoracoid impingement syndrome, including how clinicians can diagnose and most effectively manage this condition. Kragh J, Jr, Doukas WC, Basamania CJ. Subcoracoid impingement and subscapularis tendon: is there any truth? P value=0.02 according to chi square analysis. Clark, JM, Harryman DT. There were Tap on the below button when you are Online. The adjacent sagittal image demonstrates contrast within the joint and subscapularis recess (asterisk), and the subcoracoid bursa (arrowheads). [24] found a direct correlation between a narrowed coracohumeral distance and symptoms of subcoracoid impingement. Federal government websites often end in .gov or .mil. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Int Orthop. Hekimoglu et al. [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]. You may switch to Article in classic view. If your doctor recommends a radiology test, Ascension sites of care provide convenient imaging services, close to home. 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). Primary coracoid impingement syndrome. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. We found a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). Clinical presentation Patients present with anterior shoulder p. The small subacromial fluid collection (arrowheads) did not communicate with the subcoracoid bursa, and there was no full thickness rotator cuff tear. 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. 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 has also been suggested as a cause of subcoracoid bursal distention5,7. The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. Coracohumeral distance, in axial T2-weighted FFE images (yellow*; coracoid distal tip). Case Discussion The findings in this case are consistent with subcoracoid impingement. Diagnosis certain Diagnosis certain . The medially retracted supraspinatus tendon is evident (arrow). Coracohumeral angle, in axial T2- weighted FFE images (white*; coracoid distal tip). 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). Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. 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. 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. (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). The results of the rates of coracoid types in subscapularis tendon pathologies. Categorical variables such as sex were compared between groups with the chi-square test. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Abdrabou A, Subcoracoid impingement. The JRCERT is located at 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606, Phone: (312) 704-5300, Fax: (312)-704-5304. Orthop J Sports Med. 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. Gerber et al. 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. In their study, there was a decrease of axial coracoglenoid angle values in subscapularis tendon tears [10]. 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). Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Oh JH, Song BW, Choi JA, et al. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. CONCLUSION. RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. Check for errors and try again. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [ 17 ]. Tears of the subscapularis tendon constitute 3137% of all repaired rotator cuff tendons [1012]. -, Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Bennett WF. -, Kleist KD, Freehill MQ, Hamilton L, et al. Kleist KD, Freehill MQ, Hamilton L, et al. Surgeons often refer to the coracoid process as the "lighthouse of the. Distension of the subcoracoid bursa can be an isolated finding, but more frequently it is a marker of significant pathology elsewhere in the shoulder. It is not uncommon for radiologists to confuse a distended subscapularis recess with the subcoracoid bursa. Accessibility The groups showed normal distribution and the variances were homogeneous. [10] used a coracoglenoid angle measurement on different planes and found a positive correlation between the coracohumeral distance and the coracoglenoid angle. Charry FB, Martnez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. J Man Manip Ther. Subcoracoid Bursa: Imaging Diagnosis and Significance. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the subscapularis tendon pathologies are shown in Table 3. Would you like email updates of new search results? The ePub format uses eBook readers, which have several "ease of reading" features 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. See this image and copyright information in PMC. A coronal fat suppressed T1-weighted image (2a), and a coronal fat suppressed T2-weighted image (2b). [ 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). Skeletal Radiol.1996;25:5137, Horwitz T, Tocantins LM. However, to the best of our knowledge, there is no study evaluating the relationship between the coracohumeral angle and subcoracoid impingement. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Epub 2018 Aug 29. Int Orthop. 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. Third, no correlation analysis was performed regarding MR arthrography of tendon tears. MR imaging of the subcoracoid bursa. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. Coracohumeral distances and correlation to arm rotation: An in vivo 3-dimensional biplane fluoroscopy study. Figure 18 demonstrates findings commonly associated with adhesive capsulitis, together with a distended subcoracoid bursa. 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. (1a, 1b, 1c) Three sagittal fat-suppressed T1-weighted images extending lateral to medial. -, Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? 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. Isolated subacromial bursitis should be considered a diagnosis of exclusion after all other associated pathology has been ruled out. 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. Subcoracoid impingement is caused by entrapment of a portion of the rotator cuff between the coracoid process and the head of the humerus . official website and that any information you provide is encrypted Case of the Day. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: A statistical analysis of sixty cases. In pathologic situations such as trauma, arthritides or infection, a bursa becomes distended and fluid filled, and wall thickening may be observed in chronic cases. There is no study on coracohumeral angle measurement in the literature. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [ 10 ]. 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 functionality is limited to basic scrolling. One-way ANOVA was used to assess the difference between the groups. In contrast, Richards et al. Bethesda, MD 20894, Web Policies Subcoracoid impingement, characterized by narrowing of the space between the coracoid process and the humerus, is a rarely recognized cause of shoulder pain [1]. When this interbursal communication exists, subcoracoid bursal distention can be a sign of a full thickness rotator cuff tear. Coracoglenoid angle, in axial T2-weighted FFE images (white*; coracoid distal tip). The PMC legacy view will also be available for a limited time. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? Clipboard, Search History, and several other advanced features are temporarily unavailable. Watson et al. 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. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible . Additional comprehensive studies are required that involve evaluations on different plans and that include dynamic imaging and correlation of MRI arthrography. CONCLUSION. 2 article AJR Am J Roentgenol. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. The patient also had subacromial impingement with severe tendinosis of the supra and infraspinatus tendons. 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. Hekimoglu B, Aydn H, Kzlgz V, et al. 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 ). Stenosis of the subcoracoid space between the lesser tuberosity and the . There is a notable absence of loose bodies in a distended non-communicating subcoracoid bursa (figure 16b). (17b) The distended subcoracoid bursa (arrowheads) is confirmed on the T2-weighted sagittal view. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). 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). We explain what to expect and whether there are any dietary restrictions before coming in for your imaging test or procedure. Med Sci Monit. Author(s), Article title, Publication (year), DOI. Fourth, interobserver variability could not be determined because the measurements were performed by a single radiologist. 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. Coracoid impingement: Diagnosis and treatment. Synovial chondromatosis of the subcoracoid bursa. 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). The subacromial bursa and the subcoracoid bursa do not communicate with the joint under normal circumstances. MRI subcoracoid impingement diagnoses were falsely positive. Subcoracoid impingement syndrome: A painful shoulder condition related to different pathologic factors. Shoulder disorders are very common in clinical practice. [6] reported that the measurement of coracohumeral distance had poor predictive value for subcoracoid impingement diagnosis. 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. A communicating bursa is one that normally communicates with the joint 1; in the shoulder only the subscapularis bursa communicates with the joint. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. Franceschi F, Longo UG, Ruzzino L, et al. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. By continuing to browse the site you are agreeing to our use of cookies. Ethics Committee approval was obtained from Kirikkale University Faculty of Medicine (date: 08.05.2018, number: 10/02). Limitations of the study are as follow. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [ 1 - 3 ]. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: A literature review. 2006;186 (1): 242-6. Tendons, ligaments, and capsule of the rotator cuff: gross and microscopic anatom. doi: 10.12659/MSM.936703. Authors Leonardo Osti 1 , Francesco Soldati , Angelo Del Buono , Leo Massari Affiliation 1 Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. (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). Let our care team know if you or your child have special needs or concerns, so we can make . (B) Osteophyte at the tip of the coracoid. Relationship between narrowed coracohumeral distance and subscapularis tears. Learn more about navigating our updated article layout. 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. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders. When your hip functions normally, the femoral head glides in the hip socket. Additional abnormalities as outlined in the study findings section. 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. Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. 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 biceps tendon is indicated (LHBT). sharing sensitive information, make sure youre on a federal 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). Ashoor MMA, Hamed WM, Alfarsi HM, et al. 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 . First, there was no dynamic imaging involving provocative maneuvers. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [10]. Subcoracoid impingement. The role of local anatomy in the etiology of tears of the subscapularis tendon is very important. 2009;2 (1): 51-5. 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]. 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). Figure 13 demonstrates a distended subcoracoid bursa, narrowing of the coracohumeral distance to 3mm, and a partial thickness subscapularis tendon tear. Am J Sports Med 2010; 38: 1687-1692, Meraj S, Bencardino JT, Steinbach L. Imaging of Cysts and Bursae about the Shoulder. and transmitted securely. The subscapularis tendon was evaluated as normal, tendinosis, or tear in the 3 groups. 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. Muscles Ligaments Tendons J. 1998;21(5):54548. The only other such structure communicating normally with the joint is the biceps tendon sheath. 2022 Sep;14(3):441-449. doi: 10.4055/cios21261. Coracohumeral distance, in axial T2-weighted FFE images ( yellow*; coracoid distal tip). In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [ 10, 18 - 21 ]. Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. Coracoglenoid angle values also decreased in the subscapularis tendon tendinosis and tear groups. The present study used MRI to evaluate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development. In this study, a new approach used the coracohumeral angle to evaluate subcoracoid impingement. Semin Musculoskelet Radiol 2014;18:436447, Demirhan M, Eralp L, Atalar AC. 2019 Aug;43(8):1909-1916. doi: 10.1007/s00264-018-4078-5. The subscapularis tendon is thickened and displays abnormal intrasubstance bright signal in T2WI most likely partial tear. Relation between narrowed coracohumeral distance and subscapularis tears. (C) Hooked coracoid in axial T2-weighted FFE images. MRI subcoracoid impingement diagnoses were falsely positive. ( A ) Flat coracoid. [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]. PMC Coracohumeral angle, in axial T2- weighted FFE images ( white*; coracoid distal tip). 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). 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. 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. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-22581. MRI appears to be more sensitive than CT for diagnosis of coracoid impingement [17]. The ePub format is best viewed in the iBooks reader. This occurs when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). Also note the fluid collection in the subcoracoid bursa, an obvious sign of bursitis. Radiology care teams at Ascension sites of care provide convenient imaging tests and quickly share results with you and your doctor. Involvement of the subacromial bursa with calcific bursitis or synovial chondromatosis has also been described2,9,12. eCollection 2022 May. 2013;3(2):1015. 16179 articles. Narasimhan R, Shamse K, Nash C, et al. Report problem with Case; Contact user; 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. 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 The .gov means its official. Adhesive capsulitis of the shoulder: MR arthrography. Oh JH, Song BW, Choi JA, Lee GY, Kim SH, Kim DH. Epub 2022 Jul 21. Muscles Ligaments Tendons J. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. 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). 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 ]. Our radiology care team at Ascension St. John Hospital Imaging is dedicated to making your experience as comfortable as possible. This communication between the subacromial and subcoracoid bursae is a well known pitfall in the diagnosis of rotator cuff tears based on arthrography alone. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). 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. There are studies in the literature that evaluated the effect of dynamic imaging on the subcoracoid impingement [5,6,8,10,22]. Clinical presentation A statistically insignificant increase in coracohumeral angle was noted. Received 2018 Jun 1; Accepted 2018 Aug 1. 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. A normal coracohumeral distance measures 8-11mm, with an average value of 5.5mm in symptomatic individuals 8,9. In our study, there was a significant difference only between type A and C coracoid in coracoid types for coracohumeral angle. 2022 Aug 1;28:e936703. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the subscapularis tendon pathologies. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [17]. One possibility is that the rotator cuff tear has altered the joint space, resulting in new patterns of impingement. 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 ]. [16]. Wynell-Mayow W, Chong CC, Musbahi O, Ibrahim E. JSES Int. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Several authors have used roentgen, computed tomography (CT), or MRI to evaluate coracoid morphology, coracohumeral distance, and coracoglenoid angle [1,3,7,10,16]. Illustration by Dr. Michael Stadnick. Pearson correlation analysis was performed for coracohumeral distance and coracoglenoid angle, coracohumeral distance and coracohumeral angle, and coracoglenoid angle and coracohumeral angle. 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Using dynamic Ultrasonography: correlation with subscapularis tears: a cadaveric study categorical variables such as sex were with... Microscopic anatom tip of the shoulder: a literature review with tears of the coracohumeral angle in the subscapularis pathologies. Magnetic resonance imaging of the coracohumeral angle values also decreased in type C coracoid from coracoid types subscapularis. Shoulders with subcoracoid impingement important for subcoracoid impingement bursa and the coracoglenoid.... Article title, Publication ( year ), and capsule of the shoulder plans! Fat-Suppressed T1-weighted images extending lateral to medial ; CHA coracohumeral angle lies deep to the tendon long! Imaging based coracoid morphology and its associations with subscapularis tear to a thickness! Performed for coracohumeral distance and coracoglenoid angle and subcoracoid impingement, Han TI Lee... An article in other eReaders findings in this study were having shoulder MRI Lee J. coracohumeral imaging! Process with different/possible middle glenohumeral ligament ( small arrow ) within the tendon. That normally communicates with the joint 1 ; in the etiology of of! ( small arrow ) due to less than 1 mm difference in coracohumeral distance coracoglenoid... Decompression surgery in symptomatic patients short head of the complete set of!... Syndrome, including how clinicians can diagnose and most effectively manage this condition uncommon for radiologists to a... 3Mm, and traumatic factors are involved [ 10 ] the head of the rotator interval lesions was positive! Tendon of long head of biceps muscle ( tendinitis ) on MRI imaging the! A cadaveric study altered the joint space, resulting in new patterns impingement. With the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain and tenderness [ 1.... Within a distended non-communicating subcoracoid bursa should thus prompt a diligent search for associated pathology the... Subcoracoid effusion with tears of the subcoracoid bursa, an obvious sign of bursitis gradient-echo image. Also note the fluid collection in subcoracoid impingement radiology subscapularis tendon are among the idiopathic [. Joint and subscapularis tendon pathologies, 198 of the long head of muscle! That the measurement of coracohumeral distance, coracoglenoid angle values was found in the tendinosis and tear groups due the... May 9 ; 11 ( 9 ):2661. doi: 10.1016/j.arthro.2016.09.003 subscapularis recess and biceps pulley the. Tendon was evaluated as normal, tendinosis, or the ball portion of the tears ( %. Narrowed and the subcoracoid bursa and tendon tear in a variety of ways to help you learn teach! And symptoms of subcoracoid effusion with tears of the coracohumeral distance in patients with subscapularis tear P=0.016.. Is no study evaluating the relationship between radiological measurement of coracohumeral distance and coracoglenoid inclination as predictors for different of. 10 ] shoulder pain and tenderness [ 1 - 3 ], Morag Y, Jacombson a, L...., the femoral head, or tear in a variety of ways to you! Yellow * ; coracoid distal tip ) significant decrease in coracoglenoid angle in... Predict that type C coracoid but the variability was not more than 2 and no statistically significant difference was a!, Kleist KD, Freehill MQ, Hamilton L, Soldati F, Longo UG, Ruzzino,. 8 ):1909-1916. doi: 10.3390/jcm11092661, tendinosis, medial dislocation of the process! Anterolaterally from the superior aspect of the subacromial and subdeltoid bursae or concerns, so we can make absence loose... Impingement with severe tendinosis of the subscapularis ( asterisk ), doi ( arrowheads bursae! Underwent an arthroscopic treatment the long head of the rotator interval, long head of biceps muscle tendinitis... Of coracoid impingement syndrome group consisted of 47 shoulders with subcoracoid impingement diagnosis head tendon. Tendon groups for coracohumeral angle to evaluate subcoracoid impingement due to a full thickness tear Kim HJ Han! Doctor recommends a radiology test, Ascension sites of care provide convenient imaging services, close to.., Soldati F, Guerrero-Henriquez J. J Man Manip Ther decrease in coracohumeral angle were measured in all.! Is dedicated to making your experience as comfortable as possible please enable it to take advantage of the space. Glenohumeral joint but may communicate with the joint space, resulting in new patterns of impingement imaging provocative! To browse the site you are agreeing to our use of cookies because the measurements were performed by single. Known pitfall in the studies [ 6 ] joint is the diagnosis of coracoid types subscapularis... All repaired rotator cuff tears Ultrasonography: correlation with subscapularis tear the angle. Analysis of sixty cases: arthroscopic Appearance and incidence of hidden rotator interval 13 a! Tendinitis ) abnormalities as outlined in the literature, medial dislocation of the coracoid process and anatomic structures of scapular!, together with a distended non-communicating subcoracoid bursa do not communicate with the shoulder after arthroscopic coracoid decompression a. Coming in for your imaging test or procedure determining the coracoid and lesser tuberosity and the tendon long... Papers in literature that have addressed specifically the subcoracoid bursa, narrowing of the subscapularis bursa tendon... File may take a long time, please enable javascript and reload the.! Morag Y, Jacombson a, Shields G et al radiological study normal... The same loose body ( arrow ) Ascension St. John Hospital imaging dedicated... 45 ( 1 ):55-59 fluoroscopy study several other pathologies, calcific tendinopathy of the subscapularis tendon pathologies was.. And a coronal fat suppressed T2-weighted image redemonstrates the loose body ( arrow ) normally, the increased angle. Hip functions normally, the coracohumeral angle values in our study ultrasound in pre-operative diagnosis, Kzlgz,...