- Avulsion Fracture of the Coracoid Process at the Coracoclavicular Ligament Insertion: A Report of Three Cases. [Journal Article]
- CRCase Rep Orthop 2016; 2016:1836070
- Avulsion fracture at the site of attachment of the coracoid process of the coracoclavicular ligament (CCL) is extremely rare. We presented three adult cases of this unusual avulsion fracture associat…
Avulsion fracture at the site of attachment of the coracoid process of the coracoclavicular ligament (CCL) is extremely rare. We presented three adult cases of this unusual avulsion fracture associated with other injuries. Case 1 was a 25-year-old right-handed male with a left distal clavicular fracture with an avulsion fracture of the coracoid attachment of the CCL; this case was treated surgically and achieved an excellent outcome. Case 2 was a 39-year-old right-handed male with dislocation of the left acromioclavicular joint with two avulsion fractures: one at the posteromedial surface of the coracoid process at the attachment of the conoid ligament and one at the inferior surface of the clavicle at the attachment site of the trapezoid ligament; this case was treated conservatively, and unfavorable symptoms such as dull pain at rest and sharp pain during some daily activities remained. Case 3 was a 41-year-old right-handed female with a right distal clavicular fracture with an avulsion fracture of the coracoid attachment of the conoid ligament; this case was treated conservatively, and the distal clavicular fracture became typical nonunion. These three cases corresponded to type I fractures according to Ogawa's classification as the firm scapuloclavicular connection was destroyed and also to double disruption of the superior shoulder suspensory complex. We recommend surgical intervention when treating patients with this type of acute or subacute injury, especially in those engaging in heavy lifting or overhead work.
- Coracoid fractures: therapeutic strategy and surgical outcomes. [Journal Article]
- JTJ Trauma Acute Care Surg 2012; 72(2):E20-6
- CONCLUSIONS: Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union.
- Computer simulation of pectoralis major muscle strain to guide exercise protocols for patients after breast cancer surgery. [Journal Article]
- JOJ Orthop Sports Phys Ther 2011; 41(6):417-26
- CONCLUSIONS: PM muscle lengthening estimates were not linearly proportioned to shoulder joint motions, and varied for 3 portions of the PM. This information may help clinicians and researchers to estimate lengthening of PM portions throughout measurable shoulder motions.
- Defining impairment and treatment of subacute and chronic fractures of the coracoid process. [Journal Article]
- JTJ Trauma 2009; 67(5):1040-5
- CONCLUSIONS: In the overlooked and untreated type I fracture with persistent pain and functional impairment, reduction and fixation of the coracoid fracture aimed at reconstruction of the firm scapuloclavicular connection and structural restoration of the coracoacromial arch results in gratifying outcomes. In the cases of type II fracture, conservative treatment is indicated. When presenting with atypical manifestations of subcoracoid impingement, releasing of the coracoacromial ligament proves effective.
- Fractures of the coracoid process. [Journal Article]
- JBJ Bone Joint Surg Br 1997; 79(1):17-9
- We reviewed 67 consecutive patients with fractures of the coracoid process, classifying them by the relationship between the fracture site and the coracoclavicular ligament. The 53 type-I fractures w…
We reviewed 67 consecutive patients with fractures of the coracoid process, classifying them by the relationship between the fracture site and the coracoclavicular ligament. The 53 type-I fractures were behind the attachment of this ligament, and the 11 type-II fractures were anterior to it. The relationship of three fractures was uncertain. Type-I fractures were associated with a wide variety of shoulder injuries and consequent dissociation between the scapula and the clavicle. Treatment was usually by open reduction and fixation for type-I fractures and conservative methods for type-II. At follow-up of the 45 available patients, 87% had excellent results, with no significant differences between the operative and non-operative groups or between the type-I and type-II fractures. We consider that operative treatment should be reserved for patients with multiple shoulder injuries with severe disruption of the scapuloclavicular connection.
- Clavicular fractures and ipsilateral acromioclavicular arthrosis. [Journal Article]
- JSJ Shoulder Elbow Surg 1996 May-Jun; 5(3):181-5
- Nine healed fractures of the clavicle were detected in an examination of 300 scapuloclavicular bone segments. In no instance did the adjacent acromioclavicular joint display significant arthritic cha…
Nine healed fractures of the clavicle were detected in an examination of 300 scapuloclavicular bone segments. In no instance did the adjacent acromioclavicular joint display significant arthritic changes. It may be speculated that the clavicular shortening that occurred in all instances provided a "physiological arthroplasty," sparing the adjacent acromioclavicular joint from arthritic change.
- The prevention and treatment of injuries to the shoulder in swimming. [Review]
- SMSports Med 1989; 7(3):182-204
- The biomechanics of swimming cause considerable stress on the shoulder joint which may be accentuated by improper stretching or training techniques. The rotator cuff, and particularly the supraspinat…
The biomechanics of swimming cause considerable stress on the shoulder joint which may be accentuated by improper stretching or training techniques. The rotator cuff, and particularly the supraspinatus tendon, is at risk in repetitive overhead stroke activity. Arthritis in the shoulder is primarily centered at the acromioclavicular joint; degeneration may occur as a result of overuse or leverage of the scapuloclavicular mechanism, or from motion related to upward pressure at the undersurface of the acromion due to subluxation or instability of the glenohumeral joint. Instability of the glenohumeral joint is a major problem which may occur in itself or in combination with rotator cuff tendinitis. The glenohumeral joint is stabilised superiorly by a posterior superior sling consisting of the long biceps tendon, the superior joint capsule, and the coracoacromial and coracohumeral ligaments. An anterior inferior sling mechanism consisting of the inferior glenohumeral ligament and subscapularis musculotendinous unit provides significant stability if uninjured. Fragments of labral tissue may mechanically wedge into the joint also leading to symptoms of subluxation. If the humeral head is wedged or allowed to slip out of joint due to capsular incompetency, secondary rotator cuff 'impingement' may occur; this is particularly difficult to manage. Prevention of injury is best accomplished through a programme of flexibility and strengthening avoiding overuse.
- Reconstruction for chronic scapuloclavicular instability. [Journal Article]
- AJAm J Sports Med 1983 Jan-Feb; 11(1):17-25
- Seventeen young patients with chronic scapuloclavicular instability were treated with tendon graft reconstruction. Sixteen patients had sustained a Type III and one sustained a Type II injury accordi…
Seventeen young patients with chronic scapuloclavicular instability were treated with tendon graft reconstruction. Sixteen patients had sustained a Type III and one sustained a Type II injury according to Allman's classification (Allman, FL: Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg 49A: 774-784, 1967). Both the coracoclavicular ligaments and the ligaments of the acromioclavicular joint were reconstructed. The operation was performed an average of 7.6 months after injury. The followup was from 8 months to 18 years, averaging 5.1 years. After surgery, 12 patients returned to heavy or moderately heavy work and eight engaged in athletics. All patients regained normal motion and muscle strength, except for one patient with posttraumatic hemiplegia. None required further surgery. Followup x-ray films showed no instability or degenerative changes.