Impingement Syndrome Associated with old Type Fracture of the Coracoid Process combined with Recurrent Anterior Dislocation of the Shoulder

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  • 陳旧性烏口突起骨折によるインピンジメント症候群：<BR>反復性肩関節前方脱臼に合併した１例

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Description

We presented a case of a patient with impingement syndrome associated with an old type fracture of the coracoid process, distal part from the insertion of the coracoclavicular ligament. A 47-year-old man had no history of direct injury, but epilepsy. He had had subluxation of the shoulder 4 times in the past one year. The coracoid tip could not be touched and he felt pain at the anterior side of the shoulder when a supination of the forearm was restricted. His range of motion was limited by pain, active elevation was 110°(135°), external rotation was 30° (70°), internal rotation was Th9 (Th7) and horizontal adduction was 110°(150°). Radiographic and enhanced computed tomographic examinations showed a bony Bankart lesion and an old type fracture of the coracoid process. The fragment of the coracoid process displaced inferolaterally. At operation, the displaced fragment of the coracoid process, the conjoint tendon, coracoacromial ligament and the tendon of pectoralis minor covered an anterior part of the humeral head. When the coracoacromial ligament was released from the fragment, the fragment had shifted to the medial side. The bursa was worn away and impingement tear of the rotator cuff was at the anterior part of the supraspinatus and superior part of the subscapularis, under the coracoacromial ligament and the fragment of the coracoid. 2 screws were used to reattach the bony Bankart's lesion. But the coracoid fragment was not fixed because the friction had disappeared. In this case, the shifted fragment of fractured coracoid process with the coracoacromial ligament and the conjoint tendon changed the shape of the coracoacromial arch and there occurred an impingement. In a case like this, the resection of the coracoacromial ligament is simple and effective.

Journal

  • Katakansetsu

    Katakansetsu 32 (3), 719-722, 2008

    Japan Shoulder Society

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