Anatomy and biomechanics of the shoulder
Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss in Atlas of Advanced Shoulder Arthroscopy, 2017
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
Scapular fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Fractures of the surgical neck of the scapulaare the most frequent of the three types of surgical neck fractures. Part of the glenoid fragment is the coracoid. The pull of muscles attached to this process (the short head of biceps, the coracobrachialis and the pectoralis minor) may displace the glenoid fragment inferomedially. The decisive factor in this respect is the integrity of the coracoacromial and coracoclavicular ligaments. If they are intact, the fracture is stable in relation to the acromion and the clavicle. A rupture of the coracoacromial ligament affects the relationship between the glenoid fragment and the acromion, but not the clavicle; the fracture is unstable rotationally. In cases of a rupture of the coracoclavicular ligament, the fracture is fully unstable, which is shown by a larger separation between the coracoid and the clavicle.
A to Z Entries
Clare E. Milner in 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.
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.
Comprehensive review of the physical exam for glenohumeral instability
Published in The Physician and Sportsmedicine, 2020
Brandon T. Goldenberg, Lucca Lacheta, Samuel I. Rosenberg, W. Jeffrey Grantham, Mitchell I. Kennedy, Peter J. Millett
The anterior drawer test can detect insufficiency of the anterior capsular mechanism and is best performed with the patient lying supine and the ipsilateral scapula supported by the bed. Gerber et al first described this technique with the affected shoulder held in 80° to 120° of abduction, 0° to 20° of forward flexion, and 0° to 30° degrees of external rotation. The examiner places the middle and index finger on the scapular spine and thumb on the coracoid process to control scapular motion. The other hand then grasps the patients relaxed arm at the humeral head and applies an anteromedial force toward the glenoid fossa [16]. McFarland et al recently proposed a modified technique to improve control of the scapula and ability to feel the humeral head subluxate over the glenoid rim. With the patient’s shoulder abducted 60° to 70°, the examiner’s hands grasp the humerus and the patient’s wrist – instead of the scapula and humerus – and applies an anteromedial force throughout the arm (Figure 1) [17].
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.
Related Knowledge Centers
- Homology
- Sternum
- Coracoid Process
- Scapula
- Humerus
- Biceps
- Scapulocoracoid