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). Statistical analyses were performed using SPSS version 20 software (SPSS, Chicago, IL, U.S.A). 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). Arrigoni P, Brady PC, Burkhart SS. In the subscapularis tendon pathologies, 198 of the tears (99%) were partial tears and there were only 2 full-thickness tears. 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. 2022 Aug 1;28:e936703. We found a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). Coracoid morphology and subscapularis tendon were evaluated. 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. Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. 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 role of local anatomy in the etiology of tears of the subscapularis tendon is very important. Neither the subacromial nor the subcoracoid bursa should communicate with the joint under normal circumstances. [ 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). Subcoracoid impingement syndrome: A painful shoulder condition related to different pathologic factors. The Egyptian Journal of Hospital Medicine. 2016 Aug;32(8):1502-8. doi: 10.1016/j.arthro.2016.01.029. 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. 1999;23:358-360, Morag Y, Jacombson A, Shields G et al. Categorical variables such as sex were compared between groups with the chi-square test. 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 ]. The results are expressed as meanstandard deviation (SD); CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Abdrabou A, Subcoracoid impingement. The only other such structure communicating normally with the joint is the biceps tendon sheath. Radiology care teams at Ascension sites of care provide convenient imaging tests and quickly share results with you and your doctor. 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. 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. 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 ]. There was no rotator cuff tear, and although very mild subacromial bursitis was present, there was no visible communication between the subacromial bursa and the subcoracoid bursa. Pearson correlation analysis was performed for coracohumeral distance and coracoglenoid angle, coracohumeral distance and coracohumeral angle, and coracoglenoid angle and coracohumeral angle. Coracoglenoid angle values decreased in type C coracoid but the variability was not more than 2 and no statistically significant difference was observed. 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]. For coracoid morphology, the shape of the coracoid was determined according to whether it was straight or not, any osteophyte included, and whether it was curved. This site needs JavaScript to work properly. The https:// ensures that you are connecting to the Radas CB, Pieper HG. Garofalo R, Conti M, Massazza G, et al. 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). 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. Quantitative measurement of humero-acromial, humero-coracoid, and coracoclavicular intervals for the diagnosis of subacromial and subcoracoid impingement of shoulder joint. 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). Illustration by Dr. Michael Stadnick. Our radiology care team at Ascension St. John Hospital Imaging is dedicated to making your experience as comfortable as possible. 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. Coracoid morphology and subscapularis tendon were evaluated; coracohumeral distance, coracoglenoid angle, and coracohumeral angle were measured in all subjects. 2013 Jul 9;3 (2):101-5. doi: 10.11138/mltj/2013.3.2.101. A statistically insignificant increase in coracohumeral angle was noted. A communicating bursa is one that normally communicates with the joint 1; in the shoulder only the subscapularis bursa communicates with the joint. These results may vary depending on the different imaging methods and patient positioning used in the studies [6]. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Adhesive capsulitis of the shoulder: MR arthrography. Radiology 2005; 235: 1, Petchprapal CN, Beltran LS, Lath M, et al.. In our study, there was a significant difference only between type A and C coracoid in coracoid types for coracohumeral angle. Coracoid impingement: Diagnosis and treatment. -, Osti L, Soldati F, Del Buono A, Massari L. Subkorakoid impingement and subscapularis tendon: is there any truth? 2022 Sep;14(3):441-449. doi: 10.4055/cios21261. Ethics Committee approval was obtained from Kirikkale University Faculty of Medicine (date: 08.05.2018, number: 10/02). 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. This site uses cookies. For the flat coracoid, the axis of the coracoid was generally straight from base to tip [9] (Figure 1A). Among several other pathologies, calcific tendinopathy of the rotator cuff tendons is frequently observed during the ultrasound examination of patients with painful shoulder. 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 . (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. -. 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]). 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. (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). In the present study, was observed a statistically significant difference between coracoid types and subscapularis tendon pathologies. 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. Measurement of Coracohumeral Distance in 3 Shoulder Positions Using Dynamic Ultrasonography: Correlation With Subscapularis Tear. Coracohumeral angle, in axial T2- weighted FFE images ( white*; coracoid distal tip). 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. This occurs when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. The most valuable data of this study was the narrowed coracohumeral distance measurement. The coracoid impingement of the subscapularis tendon: A cadaver study. We predict that type C coracoid from coracoid types is an especially effective factor in subcoracoid impingement. Oh JH, Song BW, Choi JA, Lee GY, Kim SH, Kim DH. Author(s), Article title, Publication (year), DOI. Our results suggest that type C coracoid is an especially important predisposing factor in subcoracoid impingement development. View larger version (45K) 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). (14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. Imaging of the Bursae. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [13]. Arthroscopic management of calcific tendinitis of the subscapularis tendon. Prevalence of subscapularis tears and accuracy of shoulder ultrasound in pre-operative diagnosis. Oh JH, Song BW, Choi JA, et al. 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. -, Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Watson et al. Watson AC, Jamieson RP, Mattin AC, Page RS. There was a significant difference between type C coracoid and the other coracoid types for coracohumeral distance values (P=0.016). A statistically insignificant increase in coracohumeral angle was noted. 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. The results of the rates of coracoid types in subscapularis tendon pathologies are shown in Table 1. ADVERTISEMENT: Supporters see fewer/no ads. Freehill MQ. Shoulder disorders are very common in clinical practice. Figures 15 and 16 demonstrate loose bodies within the subscapularis recess and biceps tendon sheath, which communicate with the shoulder joint normally. Nair AV, Rao SN, Kumaran CK, Kochukunju BV. 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. A new approach uses coracohumeral angle to evaluate subcoracoid impingement. 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). Unable to process the form. 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 ). Chris Mallac explores the anatomy and biomechanics of subcoracoid impingement syndrome, including how clinicians can diagnose and most effectively manage this condition. 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. The coracohumeral distance may be narrowed due to anatomic variations of the humerus and scapula, specifically lesser tuberosity protrusion and coracoid shape [7,9]. eCollection 2022 May. We reviewed 13 consecutive patients suffering from this syndrome who underwent an arthroscopic treatment. A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although sta-tistically . Find out more. Coracoglenoid angle, in axial T2-weighted. You may notice problems with 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. The present study used MRI to evaluate the effects of coracoid morphology, coracohumeral distance, coracoglenoid angle, and coracohumeral angle variabilities on subcoracoid impingement development. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). Relation between narrowed coracohumeral distance and subscapularis tears. All MRI studies were performed with standard positioning. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the coracoid types. Coracoglenoid angle values also decreased in the subscapularis tendon tendinosis and tear groups. Pearson correlation analysis was performed between variables. However, to the best of our knowledge, there is no study evaluating the relationship between the coracohumeral angle and subcoracoid impingement. There was a statistically significant difference in coracohumeral distance (P=0.016), but there was no significant difference in coracoglenoid angle (P=0.08) or coracohumeral angle (P=0.2). The discrepancy between these numbers has not been explained, but it has been speculated that significant bursal distension may disrupt normal barriers between the bursae5. 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 Rotator Interval: A Review of Anatomy, Function, and Normal and Abnormal MRI Appearance. 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]. The results of measurement of coracohumeral distance, coracoglenoid angle, and coracohumeral angle in the subscapularis tendon pathologies are shown in Table 3. Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Illustration by Dr. Michael Stadnick. Please enable it to take advantage of the complete set of features! 8600 Rockville Pike 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. The small subacromial fluid collection (arrowheads) did not communicate with the subcoracoid bursa, and there was no full thickness rotator cuff tear. In their study, there was a decrease of axial coracoglenoid angle values in subscapularis tendon tears [10]. Additional comprehensive studies are required that involve evaluations on different plans and that include dynamic imaging and correlation of MRI arthrography. 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). The presence of contrast filling the subcoracoid bursa has been described as an indirect sign of adhesive capsulitis on MR arthrography 15. Figure 13 demonstrates a distended subcoracoid bursa, narrowing of the coracohumeral distance to 3mm, and a partial thickness subscapularis tendon tear. 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. Limitations of the study are as follow. Measurement of coracohumeral distance in 3 shoulder positions using dynamic ultrasonography: Correlation with subscapularis tear. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. 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). Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. 2021 Nov 25;6(3):447-453. doi: 10.1016/j.jseint.2021.10.007. [16]. HHS Vulnerability Disclosure, Help RESULTS Type C coracoid was more frequent in the tendinosis and tendon tear groups. 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). AJR Am J Roentgenol 2000;174(5):13771380, Mikasa M. Subacromial bursography. Type C coracoid was more frequent in the tendinosis and tendon tear groups. Gerber et al. There was a statistically significant difference between coracoid types and subscapularis tendon pathologies (P=0.02). sharing sensitive information, make sure youre on a federal 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. (12a) A fat-suppressed T2-weighted coronal image reveals a full thickness supraspinatus tendon tear, with fluid tracking from the joint into the subacromial bursa (arrowheads). A new approach uses coracohumeral angle to evaluate subcoracoid impingement. Anatomic study of subcoracoid morphology in 418 shoulders: Potential implications for subcoracoid impingement. The biceps tendon is indicated (LHBT). Med Sci Monit. (18b) The coronal fat suppressed T2-weighted image demonstrates thickening and edema of the inferior glenohumeral ligament typical for adhesive capsulitis. 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. Diagnosis certain Diagnosis certain . [16] described an increased subcoracoid area after decompression surgery in symptomatic patients. First, there was no dynamic imaging involving provocative maneuvers. One-way ANOVA was used to assess the difference between the groups. MR imaging of the subcoracoid bursa. J Bone Joint Surg [Am} 1992, 74: 713-725. 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. Federal government websites often end in .gov or .mil. Data are expressed as mean standard deviation (SD) or median (range). Contributed by Mourad Kerdjoudj. Check for errors and try again. There was no statistically significant difference among coracoid types for coracoglenoid angle or coracohumeral angle values (P>0.05). Epub 2016 Dec 8. Subcoracoid impingement has also been suggested as a cause of subcoracoid bursal distention5,7. 2009;2 (1): 51-5. CHD coracohumeral distance; CGA coracoglenoid angle; CHA coracohumeral angle. ( A ) Flat coracoid. 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. Nevertheless, the results of our study are meaningful. Tap on the below button when you are Online. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. Coracohumeral angle, in axial T2- weighted FFE images (white*; coracoid distal tip). (12c) A more lateral sagittal image demonstrates the distended subcoracoid bursa (arrowheads). Brukhorst et al. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: A statistical analysis of sixty cases. Curr Rev Musculoskelet Med. El-Amin SF 3rd, Maffulli N, Mai MC, Rodriguez HC, Jaso V, Cannon D, Gupta A. J Clin 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. (16a) The sagittal T2-weighted image confirms the same loose body (arrow) within the distended biceps tendon sheath. For binary comparisons, Tukey post hoc analysis was done. Subcoracoid impingement. Each patient was examined in the supine position, with slight external rotation position of the arm. Fluid is present within the subscapularis (asterisk) and the subcoracoid (arrowheads) bursae. (14b) A sagittal fat-suppressed image confirms the fluid in the subscapularis recess (asterisk) decompressing out into the subcoracoid bursa (arrowheads). CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. The subcoracoid bursa is located between the anterior surface of the subscapularis and the coracoid process. (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). official website and that any information you provide is encrypted 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. Radiologists often mistake a distended subscapularis recess for a distended subcoracoid bursa. Yu JF, Xie P, Liu KF, Sun Y, Zhang J, Zhu H, Chen YH. This communication between the subacromial and subcoracoid bursae is a well known pitfall in the diagnosis of rotator cuff tears based on arthrography alone. However, there was no statistically significant difference between tendinosis and tear groups due to less than 1 mm difference in coracohumeral distance values. 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. (1a, 1b, 1c) Three sagittal fat-suppressed T1-weighted images extending lateral to medial. 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. A statistically insignificant increase in coracohumeral angle values was found in the subscapularis tendon pathologies. When this interbursal communication exists, subcoracoid bursal distention can be a sign of a full thickness rotator cuff tear. 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). Hekimoglu B, Aydn H, Kzlgz V, et al. The .gov means its official. 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. J Korean Radiol Soc 2001; 45(1):55-59. 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. You can use Radiopaedia cases in a variety of ways to help you learn and teach. 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. 2019 Aug;43(8):1909-1916. doi: 10.1007/s00264-018-4078-5. Narasimhan R, Shamse K, Nash C, et al. MRI subcoracoid impingement diagnoses were falsely positive. 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. J Clin Imaging Sci 2011: 1:22, Bureau N, Dussault R, Keats T. Imaging of bursae around the shoulder joint. (C) Hooked coracoid in axial T2-weighted FFE images. AJR Am J Roentgenol 1999;172(6): 15671571, Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. It is not uncommon for radiologists to confuse a distended subscapularis recess with the subcoracoid bursa. Angled or elongated coracoid type and calcification of the subscapularis tendon are among the idiopathic causes [ 17 ]. In this study, MRI was performed in the standard position; therefore, the inter-value angle variability was decreased. No contrast is present in the subacromial bursa. Additional abnormalities as outlined in the study findings section. The middle glenohumeral ligament (small arrow) and subscapularis tendon (SSc) are also indicated. 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). Charry FB, Martnez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. J Man Manip Ther. The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. All MRI studies were performed with standard positioning. CONCLUSION. We explain what to expect and whether there are any dietary restrictions before coming in for your imaging test or procedure. 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). Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. 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. Coracohumeral distances and correlation to arm rotation: An. 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. AJR Am J Roentgenol. -, Kleist KD, Freehill MQ, Hamilton L, et al. This can damage the cartilage that . In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [10,1821]. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. MR Arthrography of Rotator Interval, Long head of the biceps brachii and biceps pulley of the shoulder. Determining the coracoid type is important for subcoracoid impingement due to the narrowing of the coracohumeral space [1,6,9,10]. J Radiol Sci 2013; 38: 111-118. Identification of Diagnostic Magnetic Resonance Imaging Findings in 47 Shoulders with Subcoracoid Impingement Syndrome by Comparison with 100 Normal Shoulders. the display of certain parts of an article in other eReaders. CONCLUSION. 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. Skeletal Radiol.1996;25:5137, Horwitz T, Tocantins LM. Coracohumeral distance, in axial T2-weighted FFE images ( yellow*; coracoid distal tip). The JRCERT is located at 20 N. Wacker Dr., Suite 2850, Chicago, IL 60606, Phone: (312) 704-5300, Fax: (312)-704-5304. There was no statistically significant difference between the values of the coracohumeral angle and the changes in the subscapularis tendon pathologies (P>0.05), but we observed higher coracohumeral angle values of tendinosis and tear pathologies (P=0.074 and P=0.073, respectively). Coracoglenoid angle, in axial T2-weighted FFE images (white*; coracoid distal tip). ( B ) Osteophyte at the tip of, Coracohumeral distance, in axial T2-weighted. Gerber et al. All MRI studies were static and used no special patient positioning technique. However, subcoracoid impingement is increasingly diagnosed in patients with anterior shoulder pain and tenderness [ 1 - 3 ]. 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). 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 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. 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. 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 (. The subacromial bursa and the subcoracoid bursa do not communicate with the joint under normal circumstances. Received 2018 Jun 1; Accepted 2018 Aug 1. The site is secure. Semin Musculoskelet Radiol 2014;18:436447, Demirhan M, Eralp L, Atalar AC. Clinical presentation Patients present with anterior shoulder p. Int Orthop. Imaging parameters were as follows: field of view, 1820 cm; matrix, 256182 pixels; slice thickness, 4 mm; section gap, 0.3 mm. Report problem with Case; Contact user; International Scientific Literature, Ltd. Clin Orthop Surg. The ePub format is best viewed in the iBooks reader. Print 2013 Apr. already built in. Kragh J, Jr, Doukas WC, Basamania CJ. MATERIAL AND METHODS The subcoracoid impingement syndrome group consisted of 47 shoulders with subc Ashoor MMA, Hamed WM, Alfarsi HM, et al. Franceschi F, Longo UG, Ruzzino L, et al. 2021 Dec;29(6):367-375. doi: 10.1080/10669817.2021.1950300. Disclaimer, National Library of Medicine Coracohumeral distance, in axial T2-weighted FFE images (yellow*; coracoid distal tip). Epub 2016 Apr 2. The ePub format uses eBook readers, which have several "ease of reading" features Kim TK, Rauh PB, McFarland EG. Find the code on the page and enter it above. Correlation analysis among coracohumeral distance, coracoglenoid angle and coracohumeral angle. [10] used a coracoglenoid angle measurement on different planes and found a positive correlation between the coracohumeral distance and the coracoglenoid angle. Signs of subscapularis tendinosis, medial dislocation of the long head biceps tendon, which also seems to be involved in the impingement. The subscapularis tendon was evaluated as normal, tendinosis, or tear in the 3 groups. Orthop J Sports Med. 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. However, the increased coracohumeral angle was accompanied a narrowed coracohumeral distance and a decreased coracoglenoid angle. Impingement of the subcoracoid space is a poorly understood pathologic cause of anterior shoulder pain. Kleist KD, Freehill MQ, Hamilton L, et al. and transmitted securely. MRI appears to be more sensitive than CT for diagnosis of coracoid impingement [17]. Clinical History: A 35 year-old female presents with shoulder pain after injuring her shoulder lifting a gate. MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. One-way ANOVA was used to assess differences between the groups. Coracohumeral distances and correlation to arm rotation: An in vivo 3-dimensional biplane fluoroscopy study. Bookshelf The coracohumeral distance was measured at the narrowest point between the coracoid and the humerus on the axial images [10] (Figure 2). The findings in this case are consistent withsubcoracoid impingement. Bethesda, MD 20894, Web Policies 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]. Richards DP, Burkhart SS, Campbell SE. Third, no correlation analysis was performed regarding MR arthrography of tendon tears. Fluid is evident within a distended subcoracoid bursa (arrowheads). One-way ANOVA was used to assess the difference between the groups. In contrast, there was a significant difference in coracoglenoid angle between the tendinosis-tear pathologies and the tendon normal groups. 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. Involvement of the subacromial bursa with calcific bursitis or synovial chondromatosis has also been described2,9,12. There were When your hip functions normally, the femoral head glides in the hip socket. A statistically insignificant increase in coracohumeral angle was noted. Giaroli EL, Major NM, Lemley DE et-al. Intact rotator cuff, mild subacromial bursitis, inadvertent injection of subcoracoid bursa during anterior injection of joint. (17b) The distended subcoracoid bursa (arrowheads) is confirmed on the T2-weighted sagittal view. 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. In subcoracoid impingement, etiology, idiopathic, iatrogenic, anatomic, and traumatic factors are involved [ 10, 18 - 21 ]. Giaroli et al. Also note the fluid collection in the subcoracoid bursa, an obvious sign of bursitis. 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]. Primary coracoid impingement syndrome. A coronal fat suppressed T1-weighted image (2a), and a coronal fat suppressed T2-weighted image (2b). DMC Sinai-Grace Hospital is a 400-bed teaching hospital and offers a complete range . In cases where there is no communication between the subcoracoid bursa and the subacromial bursa, fluid within the subcoracoid bursa cannot be explained simply by the presence of a supraspinatus tendon tear. The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Coracohumeral distance, coracoglenoid angle, and coracohumeral angle values were compared with post hoc Tukey test among the types of coracoids. 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. [23] found a significant relationship between narrowed coracohumeral distance and subscapularis tendon pathologies. The femoral head, or the ball portion of the joint. government site. 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. 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]). (18a) A sagittal T2-weighted image demonstrates a thickened coracohumeral ligament (arrow), infiltration of the subcoracoid fat triangle (short arrow), and a distended subcoracoid bursa (arrowheads). A new approach uses coracohumeral angle to evaluate subcoracoid impingement. 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. Relation between narrowed coracohumeral distance and subscapularis tears. 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.). 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. Hekimoglu 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]. P value=0.02 according to chi square analysis. In the subscapularis tendon tears, the coracohumeral distance narrowed and the mean value was 6 mm. Several authors have used roentgen, computed tomography (CT), or MRI to evaluate coracoid morphology, coracohumeral distance, and coracoglenoid angle [1,3,7,10,16]. Coracoid morphology and subscapularis tendon were evaluated. In this study, a new approach used the coracohumeral angle to evaluate subcoracoid impingement. This bursa does not normally communicate with the glenohumeral joint but may communicate with the subacromial bursa [ 1 ]. Relationship between Radiological Measurement of Subcoracoid Impingement and Subscapularis Tendon Lesions. The normal coracohumeral distance measures > 10 mm in asymptomatic patients. 14a 14b Figure 14:(14a) A gradient-echo axial image reveals a retracted subscapularis tendon (arrow) due to a full thickness tear. 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. 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. 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. The results measurement of coracohumeral distance, coracoglenoid angle and coracohumeral angle in the subscapularis tendon pathologies. (A) Flat coracoid. Mild amount of fluid surrounding the tendon of long head of biceps muscle (tendinitis). For the hooked coracoid, the axis of the coracoid deviated posteriorly a few centimeters lateral to the base of the coracoid [9] (Figure 1C). FOIA 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). Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. Arthroscopy. Clinico-radiological correlation of subcoracoid impingement with reduced coracohumeral interval and its relation to subscapularis tears in Indian patients. The deposition of hydroxyapatite calcium crystals should not be considered as a static process but rather a dynamic pathological process with different/possible . The PMC legacy view will also be available for a limited time. Careers. Because of its relative rarity in isolation and nonspecific presentation, diagnosis and management are often challenging for orthopaedic surgeons and their patients. 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). 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. Authors Leonardo Osti 1 , Francesco Soldati , Angelo Del Buono , Leo Massari Affiliation 1 Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy. Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. All patients who were selected in this study were having shoulder MRI. There are studies in the literature that evaluated the effect of dynamic imaging on the subcoracoid impingement [5,6,8,10,22]. Subcoracoid impingement syndrome is the cause of anterior shoulder pain, first reported by Gerber et al. Images from an MR arthrogram are presented. 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). In subscapularis normal tendon subjects, orthopedic examination results were selected from those with no evidence of subcoracoid impingement. Bennett WF. Synovial chondromatosis of the subcoracoid bursa. Relationship between narrowed coracohumeral distance and subscapularis tears. 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. MeSH terms Adult Aged Coracoid Process / diagnostic imaging Female Humans Epub 2022 Jul 21. [10]. (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). To learn more about Sinai-Grace's School of Radiologic Technology: call (313) 966-6866, or email Liz Oras, Program Director, at MOras@dmc.org. Brunkhorst JP, Giphart JE, LaPrade RF, Millett PJ. There was no significant difference between tendinosis and tear groups for coracohumeral distance and coracoglenoid angle values (P>0.05). Coracohumeral distance, coracoglenoid angle and coracohumeral angle were measured in all subjects. The results of correlation analysis of coracohumeral distance, coracoglenoid angle, and coracohumeral angle are shown in Table 4. There was a positive correlation between coracohumeral distance and coracoglenoid angle (R=0.749 P=0.000). 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. For binary comparisons, Tukey post hoc analysis was done. 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. 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. Small changes in the subcoracoid space may result in compression of subscapularis bursa and tendon [10]. Dugarte AJ, Davis RJ, Lynch TS, et al. Would you like email updates of new search results? Friedman et al. Epub 2018 Aug 29. 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 . 1998;21(5):54548. To date, there are a few papers in literature that have addressed specifically the subcoracoid impingement. CONCLUSIONS In subscapularis tendon pathologies, decrease in coracohumeral distance and coracoglenoid angle was observed. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. The groups showed normal distribution and the variances were homogeneous. 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. Coracohumeral distance values were 213.5 mm. Indeed this bursa is actually a recess of the joint, alternatively referred to as the subscapularis recess. 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. Anat Rec. There was a statistically significant decrease in coracoglenoid angle values and coracohumeral distance in patients with subscapularis tendon pathologies (P=0.000). If your doctor recommends a radiology test, Ascension sites of care provide convenient imaging services, close to home. Figure 18 demonstrates findings commonly associated with adhesive capsulitis, together with a distended subcoracoid bursa. Magnetic resonance imaging based coracoid morphology and its associations with subscapularis tears: A new index. 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. 2018;70(7):116468. Orthopedics. American Journal of Roentgenology 2010;195: 567-576, Kim HJ, Han TI, Lee KW, et al. Let our care team know if you or your child have special needs or concerns, so we can make . (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. We are experimenting with display styles that make it easier to read articles in PMC. 2017 Apr;33(4):734-742. doi: 10.1016/j.arthro.2016.09.003. There was no significant difference between the coracoid types and coracoglenoid angle values in our study. Accessibility Identification of a fluid-filled subcoracoid bursa should thus prompt a diligent search for associated pathology of the shoulder. However, there was only a difference of less than 1 between the tendinosis and the tear groups in the angle values and no statistically significant difference was detected. It extends caudal to the tendon of the coracobrachialis and the short head of the biceps. MRI subcoracoid impingement diagnoses were falsely positive. The subscapularis tendon is thickened and displays abnormal intrasubstance bright signal in T2WI most likely partial tear. A normal coracohumeral distance measures 8-11mm, with an average value of 5.5mm in symptomatic individuals 8,9. 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. 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American Journal of Roentgenology 2010 ; 195 subcoracoid impingement radiology 567-576, Kim HJ, Han TI Lee... Dynamic Ultrasonography: correlation with subscapularis tear confirms the same loose body arrow! Shoulder is put in extreme abduction and external rotation position of the subscapularis tears. Gakkai Zasshi 1979 ; 53:225-231, Yi-Hsuan Lee, Ginger H.F. Shu, Ching-Juei Yang, Tzeng. 12C ) a gradient-echo axial image reveals a retracted subscapularis tendon pathologies coracoid, the axis of the anterior of! Uses coracohumeral angle to evaluate subcoracoid impingement bright signal in T2WI most likely partial...., orthopedic examination results were selected in this Case are consistent withsubcoracoid impingement Lath M, L! Zhang J, Jr, Doukas WC, Basamania CJ inter-value angle variability was decreased TK, Rauh PB McFarland!