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Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
The patient is set up supine with a sandbag between the shoulder blades to bring the glenoid neck into view. A deltopectoral approach is utilised, as already described. The coracoid is identified and the pectoralis minor attaching medially is released, as is the coraco-acromio ligament laterally. An osteotomy is then performed to release the coracoid, using an oscillating saw and osteotomes. The conjoint tendon is gently freed from the underlying structures, taking care to protect the musculocutaneous nerve. The coracoid is then turned so that the inferior portion will eventually point to the glenoid. The coracoid is prepared with pre-drilled holes to use later and tucked into the wound.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The acromioclavicular joint is also considered part of the shoulder girdle, since the acromion process is part of the scapula. Several ligaments connect the clavicle to the scapula. At this joint, the acromioclavicular ligament is a thickening of the joint capsule, equivalent to the glenohumeral ligament at the glenohumeral joint. In addition, coracoclavicular ligaments, between the coracoid process and the clavicle assist in keeping the clavicle in place. These ligaments attach to the clavicle medial to the acromioclavicular joint and connect to the coracoid process inferiorly. There are two distinct coracoclavicular ligaments, the trapezoid and conoid, named according to their shape (trapezoidal and cone-shaped). The conoid is the more medial of the two. The important role of these ligaments becomes apparent after an acromioclavicular joint separation. This injury is a dislocation of the acromioclavicular joint which typically occurs as a result of a fall directly onto the shoulder. The severity of the injury is determined by the degree of separation of the clavicle from the acromion process. If only the acromioclavicular joint is torn, there is no apparent separation of the joint because the coracoclavicular ligaments keep the clavicle in place. In a more severe injury, the coracoclavicular ligaments are also torn, and the clavicle is now free to move superiorly and become separated from the acromion. In this case, the lateral end of the clavicle can be identified clearly under the skin as a bump on the superior aspect of the shoulder.
Anatomy and biomechanics of the shoulder
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Lucca Lacheta, Bastian Scheiderer
The coracoid process originates from the anterior superior neck of the scapula. Its horizontal part curves lateral and can be palpated in the deltopectoral groove. The coracoid apex gives insertion to the conjoined tendons (short head of the biceps brachii, coracobrachialis) (Figure 1.2). Lateral at the horizontal portion the coracoacromial ligament is attached, medially the pectoralis minor muscle inserts. Located close to the coracoid base, the coracoclavicular ligaments originate at an average distance of 28.5 mm from the anterior tip.9 The vertical part of the coracoid process is supplied by the supra-scapular artery and the horizontal part by branches of the axillary artery. It was thought that preservation of the axillary artery branches could be a possible solution to prevent non-union and lysis of the bone transfer in the Latarjet procedure.10
Position of Coracoid Button Predicts Loss of Reduction in Acromioclavicular Joint Dislocation Patients Treated With the Suture-Button
Published in Journal of Investigative Surgery, 2021
Xian-Bin Yu, Tong Li, Wei Hu, Hua Chen, Yao-Sen Wu, Liao-Jun Sun
We also found that the incidence of loss of reduction was the highest in the lateral area, the second highest in the medial area and the lowest in the central area. There were some reasons for it. In order to avoid damage to important structures such as blood vessels and nerves in the medial region of the coracoid, we often tended to insert the guide pin toward the outside of the coracoid base during surgery. Moreover, it was also influenced by the anatomical features of the coracoid. The medial bone tissue of the base of the coracoid was slightly thicker than that of the lateral one. As a result, the strength of the bone in the medial region of the coracoid might be greater than that in the lateral region. Third, the orientations of the clavicle and coracoid tunnels drilled by separate drilling method during surgery might be parallel but not in the same axis. The weak lateral bone tissue was hard to resist the increased cutting of the rope against the tunnel wall and reduction loss or failure was inevitable. Although there was no statistically significant difference in the rate of loss of reduction between the lateral and medial malpositions, a greater chance of failure in the lateral area should be noted.
The Benefits of Preserving the Coracoid Process and Its Attachments
Published in Journal of Investigative Surgery, 2020
The current study provides an innovative surgical option for the resection of malignant bone tumors of the proximal humerus. The results are enlightening, as this study reawakens our awareness of the function of the coracoid process and its surrounding attachments. Previous studies often focused on achieving extensive resection to prevent tumor recurrence in most cases. This is understandable, as the medical techniques and equipment were insufficient and the structure of the shoulder joint was not thoroughly studied at that time. Functional rehabilitation was also considered less important than patient survival. Yet now, with improvements in examination techniques, patients have higher demands for postoperative recovery and quality of life. Less tissue damage within a reasonable resection range often means faster and better recovery. We surgeons should change our mindset and adopt new techniques to meet the requirements.
A novel method of acromioclavicular joint separation fixation using a knotless dog bone technique
Published in Baylor University Medical Center Proceedings, 2019
Brian J. Page, Daniel L. Stahl
An anterior approach to the AC joint was obtained with a scalpel through the skin and then blunt dissection was carried down to the fascia. The distal clavicle was isolated and retracted posteriorly to gain access to the coracoid. The coracoid process was exposed, isolating the center of its base, and a 3.0-mm cannulated drill bit was used to make a drill hole through the base of the coracoid. A McGlamry elevator was placed underneath the coracoid to protect nearby structures and then the drill was removed from the cannulated drill bit, allowing the drill bit to rest on the McGlamry elevator. A Hewson suture passer was then placed through the drill bit and was guided out with the McGlamry elevator. Two ABS TightRopes were selected and the interlocking loops of the ABS TightRope were placed in the suture slots of the Arthrex Dog Bone Button® with the concave side facing cranially on the inferior aspect of the coracoid. Next, a #2 Fiberwire passing suture was looped through two TightRopes and then the tails of the #2 Fiberwire passing suture were looped through the suture passer and pulled through the coracoid (Figure 1a). The TightRope suture tails were then tagged with hemostats.