This paper describes subcoracoid impingement, a form of chronic shoulder impingement occurring between the humeral head and coracoid process rather than the acromion. Using CT measurements of normal shoulders and a clinical series, the authors define the syndrome and classify it into idiopathic, iatrogenic, and traumatic types.
When a patient has anterior shoulder pain that reproduces on forward flexion with medial rotation, think beyond classic subacromial impingement and check the coracoid.
The most sensitive provocative position is abduction to 90 degrees with medial rotation, and the coracoid tip is exquisitely tender. Because this is not a functional position, you will miss it if you only test the movements the patient reports.
This matters most after instability surgery. A Trillat, Bristow, Latarjet, or Eden-Hybbinette that places the coracoid or bone block too laterally can drive the humeral head into the coracoid, causing pain, limited medial rotation, and even rapid arthritis.
The practical rule: keep the transplant medial to the glenoid plane, and if postoperative anterior pain with limited rotation appears, suspect iatrogenic subcoracoid impingement rather than hardware intolerance. Treatment is inferolateral coracoplasty to restore clearance.
This paper describes subcoracoid impingement, a form of chronic shoulder impingement occurring between the humeral head and coracoid process rather than the acromion. Using CT measurements of normal shoulders and a clinical series, the authors define the syndrome and classify it into idiopathic, iatrogenic, and traumatic types.
When a patient has anterior shoulder pain that reproduces on forward flexion with medial rotation, think beyond classic subacromial impingement and check the coracoid.
The most sensitive provocative position is abduction to 90 degrees with medial rotation, and the coracoid tip is exquisitely tender. Because this is not a functional position, you will miss it if you only test the movements the patient reports.
This matters most after instability surgery. A Trillat, Bristow, Latarjet, or Eden-Hybbinette that places the coracoid or bone block too laterally can drive the humeral head into the coracoid, causing pain, limited medial rotation, and even rapid arthritis.
The practical rule: keep the transplant medial to the glenoid plane, and if postoperative anterior pain with limited rotation appears, suspect iatrogenic subcoracoid impingement rather than hardware intolerance. Treatment is inferolateral coracoplasty to restore clearance.