Subcoracoidimpingement

Dr. E. GalindoDr. E. Galindo

Definición:Subscapularis tendon impingement between:

Coracoid process. Minor tuberosity.

Definition

Aetiology:

• Idiopathic.• 3 anatomic variants*• Coraco-glenoid space*

*Gumina S, Postacchini F, Orsina L, Cinotti G. “204” The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome. Int. Orthop. 1999; 23(4):198-201.

Anterior pain of the shoulder.

Differential diagnosis: Subscapularis tendinitis. SLAP. Biceps tendinitis. Supraspinatus tendinitis.

Clinical manifestations:

Lift-off test*.

Diagnosis:

*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.

Napoleon test*

Negative 0º

*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.

Diagnosis:

Napoleon test*

Intermediate 30º-60º Positive 90º

*Burkhart SS, Tehrany AM. Arthroscopic subscapularis tendon repair: Technique and preliminar results. Arthroscopy. 2002 May-Jun;18(5):454-63.

Diagnosis:

M.R.I.(axial)

Diagnosis:

Fisiopathology:

Narrowspace

Roller-Wringer

Inflamation

TendinitisTUFF

Subscapularis Rupture

The Roller-Wringer effect

*Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150.

Fisiopathology:

*Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150.

Fisiopathology:The Roller-Wringer effect

TUFF lesion (Tensile undersurface fiber failure)

*Burkhart SS, Ian K, Lo. The etiology and assessment of subscapularis tendon tears: the Roller-Wringer effect, and TUFF lesions of subscapularis. Arthroscopy. 2003 Dec;19(10):1142-1150.

Fisiopathology:

Conservative:

Rest. NEAIs. Rehabilitation:

Short waves.Microwaves.Electrotherapy.

• Infiltrations

Treatment:

Surgically:

• Open surgery.• Subacromial arthroscopy *.• Articular arthroscopy **.

*Karnaugh RD. Arthroscopic treatment of coracoid impingement. Arthroscopy.2001 Sep.**Lo IK, Burkhart SS. Arthroscopic coracoplasty through the rotator interval. Arthroscopy. 2003 Jul-Aug.

Treatment:

Gleno-humeral approach:

• Easier technique.• Less invasive.• Correct orientation performing the coracoplasty.• Correct measurement of thenew space (8mm).

Arthroscopic surgery:

Surgical technique:

• Regional anesthesia• Lateral position• Pump (<80mm Hg)

• Lateral position• Pump (<80mm Hg)

Surgical technique:

Artroscopic portals

• Posterior.• Anterosuperior.

Surgical technique:

Posterior portal:

Intra-articular inspection of the Rotator interval.

Surgical technique:

Antero-superior portal:

Osseus Prominence.

Surgical technique:

Surgical technique:

Antero-superior portal:

Osseus Prominence.

VAP ®

Surgical technique:

Surgical technique:

VAP ®

Conjoined tendon

Surgical technique:

Coracoplasty

Surgical technique:

Surgical technique:

Coracoplasty

Measurement of the new space.

Surgical technique:

Conclusion:

This technique, through the rotator interval, allowed us:

• An easily technique.• Secure and reproductible.• Coracoplasty in the subscapularis line.• Measurement of the new space.• Faster rehabilitation.• Minimal complications.

Many thank’s !!!