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Examination of Pediatric Shoulder
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
With the patient standing, the examiner forward flexes the arm to 90° and then internally rotates the shoulder. This compresses the supraspinatus tendon against the coracoacromial ligament and coracoid process. Pain indicates a positive test for supraspinatus tendinosis.
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
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.
Feasibility Analysis and Clinical Applicability of a Modified Type V Resection Method for Malignant Bone Tumors of the Proximal Humerus
Published in Journal of Investigative Surgery, 2020
Qing Liu, Zhibing Dai, Junshen Wu, Suzhi Ji, Jingping Bai, Renbing Jiang
The humerus was truncated at least 5 cm away from the lesion according to the tumor-free principle; then we cut off the humeral shaft using a swing saw or wire saw. With the shoulder joint capsule exposed, we measured a distance of about 4 mm from the medial margin of the articular capsule to the basal outside lateral margin of the coracoid process. In all cases, the medial margin of the articular capsule was visually observed to be unaffected by the tumor. We performed the modified type V resection, resecting the shoulder joint outside the coracoid process, preserving the coracoid process and the coracoacromial ligament. The scapula glenoid fossa was cut at a distance 4 mm from the outside lateral margin of the coracoid process, 15° counterclockwise from the top to the bottom, and then clockwise from the bottom up, creating a nearly concave resection. We completely removed the shoulder joint (including the long-head tendon of the biceps brachii) and the humeral tumor segment.
Comparison of the Radiological and Functional Results of Tight Rope and Clavicular Hook Plate Technique in the Treatment of Acute Acromioclavicular Joint Dislocation
Published in Journal of Investigative Surgery, 2022
Emre Gültaç, Fatih İlker Can, Cem Yalın Kılınç, Hüseyin Aydoğmuş, Fatih Emre Topsakal, Ahmet Emrah Açan, Nevres Hurriyet Aydogan
Recently, the TR technique has become widespread and popular in the surgical treatment for acute AC joint dislocations [11]. In this method, the coracoid process is fixated to the clavicle with nonabsorbable suture materials. Unlike CHP fixation, the TR technique works by providing reduction with smaller incisions without injury to the surface of the AC joint and is hence advantageous; however, it does not require implant removal [12]. It has been observed that better functional results can be obtained with this technique, as it is less invasive and does not cause damage to the acromion. However, reduction loss may occur because it cannot provide as rigid a fixation as the CHP technique [12].