Coracoid

Synovial chondromatosis of the shoulder is a rare disorder characterized by metaplastic synovial proliferation, causing multiple loose bodies usually localized intra-articularly. Surgical treatment with open techniques through a deltopectoral approach has been commonly used. The evolution of arthroscopy has allowed a complete joint assessment and the extraction of intra-articular loose bodies with less morbidity than open techniques. Nevertheless, this pathology occurs less frequently in the subcoracoid bursa...

There are several treatment options for recurrent shoulder instability. The Latarjet addresses bone loss via coracoid transfer, and creates a "sling effect" on the humeral head with the conjoint tendon. It does however carry a high potential risk of complications including graft resorption, hardware failure, and neurologic injury. It is hypothesized that the long head of the biceps can function similarly, without the donor site morbidity of a coracoid transfer. We present a case of recurrent instability and musculocutaneous nerve palsy following primary arthroscopic stabilization three years prior, and treatment via long head of the biceps stabilization...

Introduction: Acromioclavicular (AC) joint injury associated with coracoid process (CP) fracture is a rare injury and only case reports had been published in the literature. Although AC joint injury is not uncommon, there is controversy as regard the best stabilization method whether to use wires, hook plate, arthroscopic reconstruction or the recently described techniques of anatomic restoration of both the coracoclavicular (CC) and acromioclavicular (AC) ligaments to add stability in both the vertical as well as the horizontal plane for the AC joint...

Several techniques have been introduced to treat acromioclavicular separation with coracoclavicular ligament reconstruction using graft augmentation. A modified arthroscopic technique for coracoclavicular ligament reconstruction was used based on a previous technique where the supportive device and tendon graft share the clavicular and coracoid drill holes. A notable problem with the previous technique was large protruding suture knots on the washer and clavicle, which could predispose to wound infection. In this modified technique, titanium implants were introduced...

Anteroinferior glenoid bone loss plays a significant role in recurrent glenohumeral instability. Current surgical strategies to reconstruct the glenoid include coracoid transfer (Bristow-Latarjet procedure), iliac crest autograft, and allograft (osteochondral and iliac crest). These may carry drawbacks of technical difficulty, increased surgical time, neurovascular injury, and nonanatomic reconstruction. We report a technique to manage glenoid bone loss using a pre-shaped, predrilled allograft (Glenojet; Arthrosurface) that matches the native contour of the glenoid...

The arthroscopic Latarjet procedure is challenging because it can be difficult to place 2 screws parallel to the glenoid surface and a medial portal (dangerous for the brachial plexus) is mandatory. In addition, precise positioning of the coracoid bone block flush with the joint line and in a subequatorial position as recommended is troublesome without the use of a guiding system because of the arthroscopic lens distortion. To improve the reproducibility of the arthroscopic Latarjet procedure and to minimize the risk of nerve complications, we developed a guiding system to optimize the positioning of the coracoid bone block and 2 cortical buttons to facilitate its fixation...

BACKGROUND: Although previous literature has described the relevant anatomy for an open anterior Bankart approach of the shoulder, there is little known regarding the anatomic relationship changes in the neurovascular structures after an open Latarjet procedure. PURPOSE: To define the neurovascular anatomy of the native shoulder in relation to the coracoid and to define the anatomy after the Latarjet procedure in relation to the glenoid to determine distances to these neurovascular structures with and without neurolysis of the musculocutaneous nerve (MCN) from the conjoint tendon...

The coracoid process is the origin of the trapezoid ligament, the deltoid ligament, and the coracoacromial ligament (CAL). Detailed knowledge about their anatomy is crucial for surgical procedures such as the reconstruction of the coracoclavicular ligaments or coracoid transfer. Although the coracoclavicular ligaments are considered important stabilizers of the acromioclavicular joint and are therefore highly protected, the CAL seems less important, which is why it is generally cut during coracoid transfer procedures...

Coracoid fractures are a frequent presentation in wild birds, commonly caused by collisions with motor vehicles, windows, or other obstacles such as pylons. Despite this, there are few reports of outcomes, and those published consist of small numbers of birds with conflicting results when comparing conservative management with surgical intervention. To determine outcome success of conservative management in a larger population of wild birds, records of 232 adult wild birds in the United Kingdom (UK) with closed unilateral coracoid fractures confirmed on radiography and surviving more than 48 hours after admission were retrospectively analyzed...

BACKGROUND: Coracoid transfer has become increasingly popular for recurrent anterior shoulder instability. Despite the success, glenohumeral arthropathy develops in some patients. Arthroplasty in this population is complicated by altered anatomy, scarring, and retained hardware. This study evaluated shoulder arthroplasty in patients with a previous Latarjet or Bristow procedure. METHODS: Between 1980 and 2014, 33 patients underwent shoulder arthroplasty after coracoid transfer...

Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft sources...

Background: Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology. Purpose: To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results...

We have analyzed anatomic variations in the pectoralis major and pectoralis minor muscles of common chimpanzees (Pan troglodytes) and bonobos (Pan paniscus) and compared them to anatomic variations in these muscles in humans (Homo sapiens) . We have macroscopically dissected these muscles in six adult Pan troglodytes , five Pan paniscus of ages ranging from fetus to adult, and five adult Homo sapiens . Although Pan troglodytes are thought to lack a separate pectoralis abdominis muscle, we have identified this muscle in three of the Pan troglodytes ; none of the Pan paniscus , however, had this muscle...

OBJECTIVES: The aim of this study was to determine the inter-rater reliability of glenohumeral internal rotation (GIR) range of motion (ROM) and pressure measurements among four measurement methods: (1) Manual stabilization of the humeral head and coracoid process (MSHC) without applying consistent pressure (ACP) to both the stationary and the moving arms (BSaMA); (2) MSHC with ACP to the moving arm; (3) MSHC with ACP to the stationary arm; and (4) MSHC with ACP to BSaMA. DESIGN: Test-retest analyses...

INTRODUCTION: Simultaneous fracture of the acromion and coracoid process represents a double disruption of the superior shoulder suspensory complex (SSSC). To date, the two largest reported series have comprised five and eight cases. The aim of this study was to investigate the functional outcome in patients who sustained this rare injury and to provide a review of the relevant literature. MATERIAL AND METHODS: In this retrospective study, patients who were surgically treated between 2009 and 2014 were identified from medical records and the patients were asked to attend a follow-up examination...

Background: The effectiveness of the Latarjet largely depends on accurate graft placement, as well as on proper position and direction of the screws. We present our technique for an arthroscopically-assisted Latarjet comparing radiological results with the open technique. Methods: We retrospectively reviewed the postoperative computed tomography scans of 38 patients who underwent a Latarjet procedure. For 16 patients, the procedure was performed with the open technique and, for 22 patients, it was performed using an arthroscopically-assisted technique...

OBJECTIVES: To analyze the functional and radiographic outcomes of anatomic coracoclavicular ligament reconstruction (ACCR) using allograft tendon without interference screw fixation. DESIGN: Retrospective nonrandomized study. SETTING: Level I trauma center (University Hospital). PATIENTS: Seventeen patients (mean age of 44 years) with Rockwood III through V acromioclavicular joint disruptions. Twelve of 17 patients had a primary reconstruction, including 4 patients sustaining their injuries as part of a polytrauma incident...

BACKGROUND: Supraspinatus muscle atrophy is typically assessed by the occupation ratio of the cross-sectional area of the muscle belly to the supraspinatus fossa at the medial border of the coracoid process in a slice along the oblique-sagittal plane on MRI. Previous studies have shown that the occupation ratio of the supraspinatus changed soon after rotator cuff repair compared with before surgery. However, no studies have examined the perioperative change in the muscle volume assessed with 3-dimensional measurement...

Anteroinferior glenohumeral instability can be treated by variants of the Bankart repair, remplissage , and the Latarjet procedure, although all options remain associated with complications, including recurrence, stiffness, persistent pain, apprehension, and dislocation arthropathy. The authors therefore thought of a concept of dynamic anterior stabilization to treat anteroinferior glenohumeral instability by transferring the long head of the biceps within a subscapularis split to the anterior glenoid margin, thereby creating a "sling effect" by using a conservative technique...

In the treatment of anterior shoulder instability, there are various conditions in which a sling effect is needed to enhance anterior stability. The traditional Bristow-Latarjet procedure provides a sling effect but destroys or does not purposely protect the coracoacromial (CA) arch, which may result in superior instability. To preserve the CA arch and create a sling to enhance the anterior-inferior side of the shoulder, we introduce an arthroscopic technique to transfer the conjoined tendon-coracoid tip complex (CTCTC) with the intention to keep the CA ligament intact to the utmost...