Subcoracoid Impingement Syndrome
Background
- Subcoracoid impingement is a less common cause of anterior shoulder pain, resulting from mechanical compression of the subscapularis tendon and/or the subcoracoid bursa between the coracoid process and the lesser tuberosity of the humerus.
Introduction
Pathophysiology
- Idiopathic, post-traumatic, or iatrogenic factors can lead to inflammation and thickening of the coracohumeral ligament and subscapularis tendon, resulting in narrowing of the coracohumeral interval and subsequent mechanical impingement between the coracoid process and the lesser tuberosity.
Risk Factors
- Often seen with rotator cuff pathology or after surgery
Differential Diagnosis
Clinical Features
History
- anterior shoulder pain that worsens with with arm adduction, flexion, and internal rotation
Physical Exam
- Needs to be updated
Special Tests
- Needs to be updated
Evaluation
- US: allows dynamic assessment and can visualize bursal distension and impingement
- XR: May show decreased coracohumeral distanc
- CT: To evaluate for decreased coracohumeral distance.
- Abnormal if < 6 mm
- MRI: To evaluate for decreased coracohumeral distance and rotator cuff pathology
Classification
Management
Nonoperative
Operative
Rehab and Return to Play
Rehabilitation
Return to Play/ Work
Prognosis and Complications
Prognosis
Complications