CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. (12b) Communicating fluid is seen to extend from the subacromial bursa into the subcoracoid bursa (arrowheads) on the corresponding T2-weighted sagittal view. [10] used a coracoglenoid angle measurement on different planes and found a positive correlation between the coracohumeral distance and the coracoglenoid angle. Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears. Involvement of the subacromial bursa with calcific bursitis or synovial chondromatosis has also been described2,9,12. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Abdrabou A, Subcoracoid impingement. Statistical analyses were performed using SPSS version 20 software (SPSS, Chicago, IL, U.S.A). 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. 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. Type A coracoid was the most frequent type, and type C coracoid was less frequent in the normal tendon group. Each patient was examined in the supine position, with slight external rotation position of the arm. 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. [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]. RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. 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. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: A literature review. 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. Semin Musculoskelet Radiol 2014;18:436447, Demirhan M, Eralp L, Atalar AC. Muscles Ligaments Tendons J. 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. Epub 2016 Apr 2. 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. 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. However, to the best of our knowledge, there is no study evaluating the relationship between the coracohumeral angle and subcoracoid impingement. J Korean Radiol Soc 2001; 45(1):55-59. Additional abnormalities as outlined in the study findings section. 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). A new approach uses coracohumeral angle to evaluate subcoracoid impingement. Learn more about navigating our updated article layout. [16] described an increased subcoracoid area after decompression surgery in symptomatic patients. MR Arthrography of Rotator Interval, Long head of the biceps brachii and biceps pulley of the shoulder. HHS Vulnerability Disclosure, Help the display of certain parts of an article in other eReaders. (15b) A coronal fat suppressed T2-weighted image redemonstrates the loose body (arrow) within the distended biceps tendon sheath. To learn more about Sinai-Grace's School of Radiologic Technology: call (313) 966-6866, or email Liz Oras, Program Director, at [email protected]. MRI appears to be more sensitive than CT for diagnosis of coracoid impingement [17]. 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. Bookshelf Print 2013 Apr. However, the increased coracohumeral angle was accompanied a narrowed coracohumeral distance and a decreased coracoglenoid angle. Unable to process the form. The middle glenohumeral ligament (small arrow) and subscapularis tendon (SSc) are also indicated. 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. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [ 17 ]. The subscapularis tendon is thickened and displays abnormal intrasubstance bright signal in T2WI most likely partial tear. Subscapularis Tendon Slip Number and Coracoid Overlap Are More Related Parameters for Subcoracoid Impingement in Subscapularis Tears: A Magnetic Resonance Imaging Comparison Study. Gerber et al. Determining the coracoid type is important for subcoracoid impingement due to the narrowing of the coracohumeral space [1,6,9,10]. 50816 cases. Quantitative measurement of humero-acromial, humero-coracoid, and coracoclavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint. 2021 Nov 25;6(3):447-453. doi: 10.1016/j.jseint.2021.10.007. AJR Am J Roentgenol 2000;174(5):13771380, Mikasa M. Subacromial bursography. Adhesive capsulitis of the shoulder: MR arthrography. The medially retracted supraspinatus tendon is evident (arrow). 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. Authors Leonardo Osti 1 , Francesco Soldati , Angelo Del Buono , Leo Massari Affiliation 1 Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy. All patients who were selected in this study were having shoulder MRI. The ePub format uses eBook readers, which have several "ease of reading" features Figure 18 demonstrates findings commonly associated with adhesive capsulitis, together with a distended subcoracoid bursa. 2019 Aug;43(8):1909-1916. doi: 10.1007/s00264-018-4078-5. In subscapularis normal tendon subjects, orthopedic examination results were selected from those with no evidence of subcoracoid impingement. 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. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. Primary coracoid impingement syndrome. 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). 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. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [10]. Type C coracoid was more frequent in the tendinosis and tendon tear groups. Case contributed by Dr Roberto Schubert. Share Add to . Subcoracoid impingement, characterized by narrowing of the space between the coracoid process and the humerus, is a rarely recognized cause of shoulder pain [1]. Radiology 2005; 235: 1, Petchprapal CN, Beltran LS, Lath M, et al.. Relation between narrowed coracohumeral distance and subscapularis tears. Third, no correlation analysis was performed regarding MR arthrography of tendon tears. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. 2021 Dec;29(6):367-375. doi: 10.1080/10669817.2021.1950300. In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [ 10, 18 - 21 ]. Subcoracoid impingement syndrome represents a rare cause of shoulder pain. 2022 Sep;14(3):441-449. doi: 10.4055/cios21261. 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). Narasimhan R, Shamse K, Nash C, et al. [23] found a significant relationship between narrowed coracohumeral distance and subscapularis tendon pathologies. Int Orthop. A bursa is a synovial lined potential space which reduces friction at tendon-tendon and tendon-bone interfaces. 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. In this study, MRI was performed in the standard position; therefore, the inter-value angle variability was decreased. 1999;23:358-360, Morag Y, Jacombson A, Shields G et al. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). Shoulder disorders are very common in clinical practice. 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. We predict that type C coracoid from coracoid types is an especially effective factor in subcoracoid impingement. Surgeons often refer to the coracoid process as the "lighthouse of the. DMC Sinai-Grace Hospital is a 400-bed teaching hospital and offers a complete range . -, Kleist KD, Freehill MQ, Hamilton L, et al. 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. 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. The adjacent sagittal image demonstrates contrast within the joint and subscapularis recess (asterisk), and the subcoracoid bursa (arrowheads). Correlation analysis among coracohumeral distance, coracoglenoid angle and coracohumeral angle. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the coracoid types. MR imaging of the subcoracoid bursa. One possibility is that the rotator cuff tear has altered the joint space, resulting in new patterns of impingement. Coracoglenoid angle, in axial T2-weighted FFE images ( white*; coracoid distal tip). Measurement of coracohumeral distance in 3 shoulder positions using dynamic ultrasonography: Correlation with subscapularis tear. Giaroli et al. Hekimoglu B, Aydn H, Kzlgz V, et al. eCollection 2022 May. -, Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. All MRI studies were performed with standard positioning. Hekimoglu et al. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. 2022 Aug 1;28:e936703. The Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance. Coracoglenoid angle values also decreased in the subscapularis tendon tendinosis and tear groups. Franceschi F, Longo UG, Ruzzino L, et al. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. ( B ) Osteophyte at the tip of, Coracohumeral distance, in axial T2-weighted. Anat Rec. 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 Egyptian Journal of Hospital Medicine. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. Int Orthop. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. There was no significant difference between tendinosis and tear groups for coracohumeral distance and coracoglenoid angle values (P>0.05). Kragh J, Jr, Doukas WC, Basamania CJ. 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. 8600 Rockville Pike Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. There was no significant difference among subscapularis tendon groups for coracohumeral angle. 2013;1(2) 2325967113496059. However, there was no statistically significant difference between tendinosis and tear groups due to less than 1 mm difference in coracohumeral distance values. [10]. -, Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? In the subscapularis tendon tears, the coracohumeral distance narrowed and the mean value was 6 mm. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). 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). Coracoid morphology and subscapularis tendon were evaluated. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. The biceps tendon is indicated (LHBT). The coracoid impingement of the subscapularis tendon: A cadaver study. All MRI studies were performed with standard positioning. 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. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. Figures 15 and 16 demonstrate loose bodies within the subscapularis recess and biceps tendon sheath, which communicate with the shoulder joint normally. (16a) The sagittal T2-weighted image confirms the same loose body (arrow) within the distended biceps tendon sheath. Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. Case Discussion The findings in this case are consistent with subcoracoid impingement. Additional comprehensive studies are required that involve evaluations on different plans and that include dynamic imaging and correlation of MRI arthrography. Subcoracoid impingement is caused by entrapment of a portion of the rotator cuff between the coracoid process and the head of the humerus . 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. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. Ashoor MMA, Hamed WM, Alfarsi HM, et al. Fluid is evident within a distended subcoracoid bursa (arrowheads). MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [13]. We are experimenting with display styles that make it easier to read articles in PMC. Ethics Committee approval was obtained from Kirikkale University Faculty of Medicine (date: 08.05.2018, number: 10/02). The subcoracoid bursa lies deep to the conjoined tendons of the coracobrachialis and short biceps tendons, and superficial to the subscapularis tendon. In contrast, Richards et al. In contrast, there was a significant difference in coracoglenoid angle between the tendinosis-tear pathologies and the tendon normal groups. Coracoid morphology and subscapularis tendon were evaluated; coracohumeral distance, coracoglenoid angle, and coracohumeral angle were measured in all subjects. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). Epub 2022 Jul 21. Measurement of Coracohumeral Distance in 3 Shoulder Positions Using Dynamic Ultrasonography: Correlation With Subscapularis Tear. When this interbursal communication exists, subcoracoid bursal distention can be a sign of a full thickness rotator cuff tear. Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders. Tap on the below button when you are Online. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. [24] found a direct correlation between a narrowed coracohumeral distance and symptoms of subcoracoid impingement. One-way ANOVA was used to assess the difference between the groups. Relation between narrowed coracohumeral distance and subscapularis tears. 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. Imaging parameters were as follows: field of view, 1820 cm; matrix, 256182 pixels; slice thickness, 4 mm; section gap, 0.3 mm. There are studies in the literature that evaluated the effect of dynamic imaging on the subcoracoid impingement [5,6,8,10,22]. The patient also had subacromial impingement with severe tendinosis of the supra and infraspinatus tendons. Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. 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. government site. Coracohumeral angle, in axial T2- weighted FFE images (white*; coracoid distal tip). Subscapularis medial and lateral head coracohumeral ligament insertion anatomy: Arthroscopic appearance and incidence of hidden rotator interval lesions. 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. Received 2018 Jun 1; Accepted 2018 Aug 1. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2018 Aug 29. When your hip functions normally, the femoral head glides in the hip socket. 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. Clinico-radiological correlation of subcoracoid impingement with reduced coracohumeral interval and its relation to subscapularis tears in Indian patients. 16179 articles. For the flat coracoid, the axis of the coracoid was generally straight from base to tip [9] (Figure 1A). 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. P value=0.02 according to chi square analysis. Several authors have used roentgen, computed tomography (CT), or MRI to evaluate coracoid morphology, coracohumeral distance, and coracoglenoid angle [1,3,7,10,16]. 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. Isolated subacromial bursitis should be considered a diagnosis of exclusion after all other associated pathology has been ruled out. This site needs JavaScript to work properly. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). Signs of subscapularis tendinosis, medial dislocation of the long head biceps tendon, which also seems to be involved in the impingement. In the present study, was observed a statistically significant difference between coracoid types and subscapularis tendon pathologies. 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 significant difference between normal and tendinosis groups (P=0.006) and between normal and tear groups (P=0.000) for coracoglenoid angle values. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. 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. Figure 13 demonstrates a distended subcoracoid bursa, narrowing of the coracohumeral distance to 3mm, and a partial thickness subscapularis tendon tear. Data are expressed as mean standard deviation (SD) or median (range). 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). To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. Garofalo R, Conti M, Massazza G, et al. 2017 Apr;33(4):734-742. doi: 10.1016/j.arthro.2016.09.003. 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. 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. In our study, there was a significant difference only between type A and C coracoid in coracoid types for coracohumeral angle. 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. 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. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. (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). A new approach uses coracohumeral angle to evaluate subcoracoid impingement. There was no statistically significant difference among coracoid types for coracoglenoid angle or coracohumeral angle values (P>0.05). There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). 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). American Journal of Roentgenology 2010;195: 567-576, Kim HJ, Han TI, Lee KW, et al. 1938; 71:375-386, Schraner AB, Major NM. A small amount of fluid within the subscapularis recess is indicated (asterisk). 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]. Calcific tendonitis of the subscapularis tendon causing subcoracoid stenosis and coracoid impingement. Before It is not uncommon for radiologists to confuse a distended subscapularis recess with the subcoracoid bursa. The normal coracohumeral distance measures > 10 mm in asymptomatic patients. Distension of the subcoracoid bursa can be an isolated finding, but more frequently it is a marker of significant pathology elsewhere in the shoulder. (14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. 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. 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.). Type C coracoid was seen more frequently in the tendinosis and 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. Illustration by Dr. Michael Stadnick. 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). 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 . A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . Giaroli EL, Major NM, Lemley DE et-al. 2016 Aug;32(8):1502-8. doi: 10.1016/j.arthro.2016.01.029. 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. (1a, 1b, 1c) Three sagittal fat-suppressed T1-weighted images extending lateral to medial. Watson et al. The .gov means its official. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the subscapularis tendon pathologies. Subcoracoid impingement. Illustration by Dr. Michael Stadnick. 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). The findings in this case are consistent withsubcoracoid impingement. The subacromial bursa and the subcoracoid bursa do not communicate with the joint under normal circumstances. A statistically insignificant increase in coracohumeral angle was noted. and transmitted securely. Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. 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. Arrigoni P, Brady PC, Burkhart SS. Am J Sports Med 2010; 38: 1687-1692, Meraj S, Bencardino JT, Steinbach L. Imaging of Cysts and Bursae about the Shoulder. Clark, JM, Harryman DT. The results of the rates of coracoid types in subscapularis tendon pathologies are shown in Table 1. Epub 2016 Dec 8. The coracohumeral distance may be narrowed due to anatomic variations of the humerus and scapula, specifically lesser tuberosity protrusion and coracoid shape [7,9]. Diagnosis certain Diagnosis certain . The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. Watson AC, Jamieson RP, Mattin AC, Page RS. 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 ). Charry FB, Martnez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. J Man Manip Ther. For the hooked coracoid, the axis of the coracoid deviated posteriorly a few centimeters lateral to the base of the coracoid [9] (Figure 1C). (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. The JRCERT is located at 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606, Phone: (312) 704-5300, Fax: (312)-704-5304. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. Richards DP, Burkhart SS, Campbell SE. -. Categorical variables such as sex were compared between groups with the chi-square test. 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. One-way ANOVA was used to assess the difference between the groups. Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). One-way ANOVA was used to assess differences between the groups. A communicating bursa is one that normally communicates with the joint 1; in the shoulder only the subscapularis bursa communicates with the joint. 2013;3(2):1015. There is no study on coracohumeral angle measurement in the literature. 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. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: A statistical analysis of sixty cases. The results of correlation analysis of coracohumeral distance, coracoglenoid angle, and coracohumeral angle are shown in Table 4. 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. Coracohumeral distances and correlation to arm rotation: An. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). 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]). 2009;2 (1): 51-5. 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 ]. Synovial chondromatosis of the subcoracoid bursa. The only other such structure communicating normally with the joint is the biceps tendon sheath. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. Coracoid impingement: Diagnosis and treatment. 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. Venous vascular malformation - thigh. There were ( A ) Flat coracoid. All MRI studies were static and used no special patient positioning technique. The new PMC design is here! Oh JH, Song BW, Choi JA, Lee GY, Kim SH, Kim DH. 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. (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). We work with you and your doctor to deliver the testing that is right for you. 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 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). However, variabilities of coracoglenoid angle and coracohumeral angle between coracoid and subscapularis tendon groups are valuable for future studies. 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. The ePub format is best viewed in the iBooks reader. In the subscapularis tendon pathologies, 198 of the tears (99%) were partial tears and there were only 2 full-thickness tears. Curr Rev Musculoskelet Med. The https:// ensures that you are connecting to the ADVERTISEMENT: Supporters see fewer/no ads. Subcoracoid impingement and subscapularis tendon: is there any truth? Images from an MR arthrogram are presented. Oh JH, Song BW, Choi JA, et al. 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). 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. 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). El-Amin SF 3rd, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. J Clin Med. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [ 10 ]. There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). Relationship between narrowed coracohumeral distance and subscapularis tears. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [17]. If your doctor recommends a radiology test, Ascension sites of care provide convenient imaging services, close to home. (12c) A more lateral sagittal image demonstrates the distended subcoracoid bursa (arrowheads). What are the findings? Arthroscopic management of calcific tendinitis of the subscapularis tendon. Please enable it to take advantage of the complete set of features! Coracoglenoid angle values decreased in type C coracoid but the variability was not more than 2 and no statistically significant difference was observed. CONCLUSION. Coracoid morphology and subscapularis tendon were evaluated. The subcoracoid bursa is located between the anterior surface of the subscapularis and the coracoid process. These results may vary depending on the different imaging methods and patient positioning used in the studies [6]. For binary comparisons, Tukey post hoc analysis was done. Accessibility This communication between the subacromial and subcoracoid bursae is a well known pitfall in the diagnosis of rotator cuff tears based on arthrography alone. For binary comparisons, Tukey post hoc analysis was done. Radas CB, Pieper HG. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. 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. 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. 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. 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. Case of the Day. Clinical presentation Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. Use the menu to find downloaded articles. Author(s), Article title, Publication (year), DOI. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [10,1821]. AJR Am J Roentgenol. Anatomic study of subcoracoid morphology in 418 shoulders: Potential implications for subcoracoid impingement. It extends caudal to the tendon of the coracobrachialis and the short head of the biceps. Pearson correlation analysis was performed between variables. [ 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). 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. (18b) The coronal fat suppressed T2-weighted image demonstrates thickening and edema of the inferior glenohumeral ligament typical for adhesive capsulitis. 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. No contrast is present in the subacromial bursa. The most valuable data of this study was the narrowed coracohumeral distance measurement. 2006;186 (1): 242-6. Internal impingement is a condition that occurs in athletes in which the shoulder is put in extreme abduction and external rotation during overhead movements. 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. FOIA The site is secure. Second, no radiological comparison of results with measurements in different plans was performed. Neither the subacromial nor the subcoracoid bursa should communicate with the joint under normal circumstances. What is the diagnosis? 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]. There is a notable absence of loose bodies in a distended non-communicating subcoracoid bursa (figure 16b). Find out more. 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 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. The results of the rates of coracoid types in subscapularis tendon pathologies. Kim TK, Rauh PB, McFarland EG. Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the types of coracoids. Careers. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. official website and that any information you provide is encrypted Contributed by Mourad Kerdjoudj. 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). Skeletal Radiol.1996;25:5137, Horwitz T, Tocantins LM. 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. 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). 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]. Subcoracoid Bursa: Imaging Diagnosis and Significance. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-22581. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [ 1 - 3 ]. 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. Coracohumeral distance values were 213.5 mm. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible . 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. 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 ]. The present study used MRI to evaluate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development. Med Sci Monit. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Arthroscopy. The functionality is limited to basic scrolling. MeSH Our results suggest that type C coracoid is an especially important predisposing factor in subcoracoid impingement development. Radiology care teams at Ascension sites of care provide convenient imaging tests and quickly share results with you and your doctor. 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 distance, in axial T2-weighted FFE images ( yellow*; coracoid distal tip). AJR Am J Roentgenol 1999;172(6): 15671571, Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. 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). Stenosis of the subcoracoid space between the lesser tuberosity and the . Imaging of the Bursae. Okoro T, Reddy VR, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. J Shoulder Elbow Surg. In this study, a new approach used the coracohumeral angle to evaluate subcoracoid impingement. International Scientific Literature, Ltd. Clin Orthop Surg. 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. Pearson correlation analysis was performed for coracohumeral distance and coracoglenoid angle, coracohumeral distance and coracohumeral angle, and coracoglenoid angle and coracohumeral angle. We explain what to expect and whether there are any dietary restrictions before coming in for your imaging test or procedure. Coracoglenoid angle, in axial T2-weighted FFE images (white*; coracoid distal tip). First, there was no dynamic imaging involving provocative maneuvers. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the subscapularis tendon pathologies are shown in Table 3. This bursa does not normally communicate with the glenohumeral joint but may communicate with the subacromial bursa [ 1 ]. Coracoglenoid angle, in axial T2-weighted. 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). The subscapularis tendon was evaluated as normal, tendinosis, or tear in the 3 groups. This occurs when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. 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. We found a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). MRI subcoracoid impingement diagnoses were falsely positive. 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). Orthopedics. 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. Subcoracoid impingement syndrome is the cause of anterior shoulder pain, first reported by Gerber et al. [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]. There was no significant difference between the coracoid types and coracoglenoid angle values in our study. You may notice problems with CONCLUSION. Freehill MQ. In their study, there was a decrease of axial coracoglenoid angle values in subscapularis tendon tears [10]. 2 article 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. 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). Tears of the subscapularis tendon constitute 3137% of all repaired rotator cuff tendons [1012]. You may switch to Article in classic view. The results are expressed as meanstandard deviation (SD); CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. 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). The coracohumeral distance was measured at the narrowest point between the coracoid and the humerus on the axial images [10] (Figure 2). Nevertheless, the results of our study are meaningful. Let our care team know if you or your child have special needs or concerns, so we can make . The presence of contrast filling the subcoracoid bursa has been described as an indirect sign of adhesive capsulitis on MR arthrography 15. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. 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. Epub 2021 Jul 14. Coracohumeral angle, in axial T2- weighted FFE images ( white*; coracoid distal tip). 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 ]. 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). 2022 May 9;11(9):2661. doi: 10.3390/jcm11092661. Find the code on the page and enter it above. 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). 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). Muscles Ligaments Tendons J. 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]. Wynell-Mayow W, Chong CC, Musbahi O, Ibrahim E. JSES Int. MRI subcoracoid impingement diagnoses were falsely positive. The Egyptian Journal of Hospital Medicine. (C) Hooked coracoid in axial T2-weighted FFE images. (B) Osteophyte at the tip of the coracoid. The femoral head, or the ball portion of the joint. Brukhorst et al. Coracohumeral distance, in axial T2-weighted FFE images (yellow*; coracoid distal tip). Report problem with Case; Contact user; The groups showed normal distribution and the variances were homogeneous. Chris Mallac explores the anatomy and biomechanics of subcoracoid impingement syndrome, including how clinicians can diagnose and most effectively manage this condition. Friedman et al. See this image and copyright information in PMC. Yu JF, Xie P, Liu KF, Sun Y, Zhang J, Zhu H, Chen YH. 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). Limitations of the study are as follow. 2013 Jul 9;3 (2):101-5. doi: 10.11138/mltj/2013.3.2.101. 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