Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Coracoid Impingement Syndrome

Coracoid impingement syndrome is an unusual syndrome that causes anterior shoulder pain. The space between the coracoid process and the anterior part of the humerus can be reduced by changes in the
structures around the process. This can be seen as a result of fractures of the arm, calcification within the subscapularis tendon, abnormal orientation of the shoulder joint, or simple prominence of the coracoid process itself. It is also seen as a complication of previous surgery for impingement, biceps tendon lesions, or instability.

Symptoms and diagnosis

– The patient has anterior shoulder pain localized to the coracoid process.
– The patient has tenderness over the anteromedial shoulder at the location of the coracoid process.
– The pain is made worse by forward flexion and medial rotation combined with adduction (the arm is moved forward against the chest). This maneuver can produce a painful click. This is called the coracoid impingement sign.
– An injection of local anesthetic solution between the humeral head and coracoid process can give relief.
– A CT scan can assist with the diagnosis, showing a lengthening of the coracoid process and/or a decrease in the distance between the coracoid process and the humeral head.

Treatment

The treatment in chronic cases is the surgical removal or shortening of the outermost anterior part of the tip of the coracoid process. Active exercises are started 2–3 weeks after surgery, but heavy loading is avoided for 6 weeks to allow the tendons to heal back to the coracoid process. Return to sports is possible after 3–6 months.

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