Dugarte Anthony J, Davis Rocklend J, Lynch T Sean, Schickendantz Mark S, Farrow Lutul D
Regions Hospital, University of Minnesota, St Paul, Minnesota, USA.
Kent State University, Kent, Ohio, USA.
Orthop J Sports Med. 2017 Oct 16;5(10):2325967117731996. doi: 10.1177/2325967117731996. eCollection 2017 Oct.
Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space.
Descriptive laboratory study.
In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes.
The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively.
The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders.
Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.
喙突下撞击被认为是肩前部疼痛和肩胛下肌腱撕裂的一个原因。
目的/假设：本研究的目的是评估喙突的骨解剖结构和喙突下间隙。我们假设，可能导致喙突下撞击的与年龄相关的变化发生在喙突下间隙。
描述性实验室研究。
本研究共纳入418个肩部骨骼标本。我们使用了来自年轻队列（25 - 35岁）的214个肩部和来自老年队列（>55岁）的204个肩部进行比较。我们评估了喙突和喙突下间隙的几个形态学特征：喙突宽度、喙突形状、喙突厚度和喙突下距离。观察每个喙突是否有骨刺或其他形态学变化。
在我们的年轻女性和男性队列中，喙突尖的平均前后（AP）厚度分别为7.9毫米和9.4毫米，而在我们的老年女性和男性队列中，平均AP厚度分别为8.1毫米和9.7毫米。在108个年轻女性肩部中有31个喙突尖呈钩状，而在102个老年女性肩部中有55个呈钩状；在106个年轻男性肩部中有25个喙突尖呈钩状，而在102个老年男性肩部中有45个呈钩状。年轻和老年女性肩部在中立旋转时的平均喙突下距离分别为14.8毫米和12.5毫米，而在这些相同队列中内旋时的平均喙突下距离分别为8.7毫米和7.0毫米。年轻和老年男性肩部在中立旋转时的平均喙突下距离分别为14.8毫米和13.3毫米，而在年轻和老年男性肩部内旋时的平均喙突下距离分别为8.6毫米和8.1毫米。
我们研究的主要发现表明，与喙突下撞击相关的解剖学变化可能是发育性的，并随年龄增长而恶化。在我们的老年肩部队列中，喙突下间隙更窄。此外，与年轻肩部相比，这些老年肩部的AP宽度更大，喙突更呈钩状。
喙突下间隙变窄已被证明是肩前部疼痛和肩胛下肌腱撕裂的一个原因。这是第一项表明与喙突下撞击相关的形态学变化随年龄增长而更普遍的研究。这可能有助于解释老年患者肩胛下肌腱撕裂患病率的增加。此外，喙突下减压可能被视为老年肩前部疼痛和肩胛下肌腱撕裂患者的一种选择。
