Clinical and radiological outcomes of arthroscopic subcoracoid decompression for idiopathic coracoid impingement, a stepped approach


  • Mohei M. Fadel Department of Orthopedic Surgery and Traumatology, Alexandria University, Egypt
  • Hesham M. Gawish Department of Orthoaedic Surgery and Traumatology, Kafr El Sheikh University, Egypt
  • Mohamed A. Elsheikh Department of Orthopedic Surgery and Traumatology, Alexandria University, Egypt



Coracoid, Subcoracoid decompresion, Arthroscopy, Subscapularis tear, Subscapularis repair


Background: Idiopathic subcoracoid impingement is considered now as a well-established cause of anterior shoulder pain. There are multiple techniques reported for management of subcoracoid impingement. Open decompression and reattachment of conjoint tendon as well as arthroscopic resection of coracoid tip. The aim of this study was to evaluate the results of arthroscopic stepwise approach for management of idiopathic coracoid impingment.

Methods: This prospective therapeutic case series study included 26 consecutive patients suffering from anterior shoulder pain and were diagnosed as subcoracoid impingement. All cases were evaluated preoperatively and followed up for 12 months after surgery both clinically and radiologically. Arthroscopic subcoracoid decompression, coracoplasty and arthroscopic repair of partial subscapularis tear if present were done for all cases.

Results: The mean age at the time of surgery was 45.3±5.4years. At the final follow up, the mean VAS score improved significantly to 0.8±0.8points postoperatively (p<0.01). The mean Constant score improved significantly to 87.8±7.8 at the final follow-up (p<0.001). The mean UCLA score improved significantly to 32.1±2.4 at the end of follow-up (P<0.001)

Conclusions: Coracoid impingement should be in mind when evaluating any patient with anterior shoulder pain. The arthroscopic management in form of bone, bursal and tendon procedures (triple attack) is a good treatment to relieve clinical symptoms with excellent patient reported outcomes.


Author Biography

Mohei M. Fadel, Department of Orthopedic Surgery and Traumatology, Alexandria University, Egypt

Assistant professor Alexandria University


Friedman RJ, Bonutti PM, Genez B. Cine magnetic resonance imaging of the subcoracoid region. Orthopedics. 1998;21(5):545-8.

Goldthwait JE. An anatomic and mechanical study of the shoulder-joint, explaining many of the cases of painful shoulder, many of the recurrent dislocations, and many of the cases of brachial neuralgias or neuritis. J Bone Joint Surg Am. 1909;2(4):579-606.

Gerber C, Terrier F, Ganz R. The role of the coracoid process in the chronic impingement syndrome. J Bone Joint Surg Br. 1985;67(5):703-8.

Gerber C, Terrier F, Zehnder R, Ganz R. The subcoracoid space. An anatomic study. Clinic Orthop 1987; 215:132-8.

Freehill MQ. Coracoid impingement: diagnosis and treatment. J Am Acad Orthop Surg. 2011;19(4):191-7.

Lo IK, Parten PM, Burkhart SS. Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: an arthroscopic approach. Arthroscopy. 2003;19(10):1068-78.

Okoro T, Reddy V, Pimpelnarkar A. Coracoid impingement syndrome: a literature review. Curr Rev Musculoskel Medic. 2009;2(1):51-5.

Kleist KD, Freehill MQ, Hamilton L, Buss DD, Fritts H. Computed tomography analysis of the coracoid process and anatomic structures of the shoulder after arthroscopic coracoid decompression: a cadaveric study. J Shoulder Elbow Surg 2007;16(2):245-50.

Gumina S, Postacchini F, Orsina L, Cinotti G. The morphometry of the coracoid process–its aetiologic role in subcoracoid impingement syndrome. Int Orthop1999;23(4):198-201.

Ferreira Neto AA, Almeida AMd, Maiorino R, Zoppi Filho A, Benegas E. An anatomical study of the subcoracoid space. Clinics. 2006;61(5):467-72.

Bhatia DN, De Beer JF, Du Toit DF. Coracoid process anatomy: implications in radiographic imaging and surgery. Clinic Anat. 2007;20(7):774-84.

Dugarte AJ, Davis RJ, Lynch TS, Schickendantz MS, Farrow LD. Anatomic study of subcoracoid morphology in 418 shoulders: potential implications for subcoracoid impingement. Orthop J Sports Med. 2017;5(10):2325967117731996.

Martetschläger F, Rios D, Boykin RE, Giphart JE, de Waha A, Millett PJ. Coracoid impingement: current concepts. Knee Surgery, Sports Traumatology, Arthroscopy. 2012;20(11):2148-55.

Lo IK, Burkhart SS, Parten PM. Surgery about the coracoid: neurovascular structures at risk. Arthroscopy. 2004;20(6):591-5.

Dumontier C, Sautet A, Gagey O, Apoil A. Rotator interval lesions and their relation to coracoid impingement syndrome. J Shoul Elbow Surg. 1999;8(2):130-5.

Karnaugh RD, Sperling JW, Warren RF. Arthroscopic treatment of coracoid impingement. Arthroscopy. 2001;17(7):784-7.

Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 2006;22(10):1076-84.

Constant C, Murley A. A clinical method of functional assessment of the shoulder. Clinic Orthop. 1987(214):160-4.

Romeo AA, Bach JR BR, O'Halloran KL. Scoring systems for shoulder conditions. Am J Sports Med. 1996;24(4):472-6.

Lafosse L, Van Raebroeckx A, Brzoska R. A new technique to improve tissue grip:“the lasso-loop stitch”. Arthroscopy 2006;22(11):1246e1-3.

Mohammed H, Skalski MR, Patel DB, Tomasian A, Schein AJ, White EA, et al. Coracoid process: the lighthouse of the shoulder. Radiographics. 2016;36(7):2084-101.

Dines DM, Warren RF, Inglis AE, Pavlov H. The coracoid impingement syndrome. J Bone Joint Surg Br. 1990;72(2):314-6.

Cunningham G, Lädermann A. Redefining anterior shoulder impingement: a literature review. Int Orthop. 2018;42(2):359-66.

Park J-Y, Lhee S-H, Oh K-S, Kim NR, Hwang J-T. Is arthroscopic coracoplasty necessary in subcoracoid impingement syndrome? Arthroscopy 2012;28(12):1766-75.

Osti L, Soldati F, Del Buono A, Massari L. Subcoracoid impingement and subscapularis tendon: is there any truth? Muscl Ligam Tend J. 2013;3(2):101.

Garofalo R, Conti M, Massazza G, Cesari E, Vinci E, Castagna A. Subcoracoid impingement syndrome: a painful shoulder condition related to different pathologic factors. Musculoskel Surg. 2011;95(1):25-9.

Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 2003;19(10):1142-50.

Giaroli EL, Major NM, Lemley DE, Lee J. Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI. AJR Am J Roentgenol. 2006;186(1):242-6.

Zhang H, Zhang Q, Li Z-L. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. Int Orthopaed. 2019;43(8):1909-16.

Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U. Subscapularis tendon slip number and coracoid overlap are more related parameters for subcoracoid impingement in subscapularis tears: a magnetic resonance imaging comparison study. Arthroscopy. 2017;33(4):734-42.

Çetinkaya M, Ataoğlu MB, Özer M, Ayanoğlu T, Kaptan AY, Kanatlı U. Korakoid taşma ile subskapularis yırtıklarının ilişkisi. Cukurova Medic J. 2018;43(4):1008-14.

Leite MJ, Sá MC, Lopes MJ, Matos RM, Sousa AN, Torres JM. Coracohumeral distance and coracoid overlap as predictors of subscapularis and long head of the biceps injuries. J Should Elb Surg. 2019;28(9):1723-7.






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