Top

Published in:

01-08-2020 | Painful Arc | Original Article

Anatomical variations of the acromial and coracoid process: clinical relevance

Authors: Uriel Alfaro-Gomez, Luis Donaldo Fuentes-Ramirez, Karla Ivonne Chavez-Blanco, Jose Felix Vilchez-Cavazos, Matthew J. Zdilla, Rodrigo E. Elizondo-Omana, Jesus Dante Guerra-Leal, Guillermo Elizondo-Riojas, Ricardo Pinales-Razo, Santos Guzman-Lopez, Alejandro Quiroga-Garza

Published in: Surgical and Radiologic Anatomy | Issue 8/2020

Abstract

Purpose

The acromial and coracoid process morphology is of clinical relevance due to associations with functional limitations and shoulder pathology. Our objective was to describe the anatomical characteristics of the acromial and coracoid process using computed tomography (CT).

Methods

Descriptive, observational, transversal and retrospective study. A total of 155 CT of patients without shoulder pathology, of both genders, and indistinct age were evaluated and grouped by age: Group 1 < 25 years; group 2 25–40 years; group 3 > 40 years. The following parameters were evaluated: Acromial type (AcT), vertical coracoid distance (VCD), acromial tilt (AT), acromial projection (AP), critical shoulder angle (CSA), type of the subcoracoid outlet (TSO), and the area of the subcoracoid outlet (ASO).

Results

Statistically significant differences were found between men and women for VCD (14.44 ± 4.79 vs. 11.76 ± 4.00 mm; p < 0.001) and AP (3.66 ± 4.71 vs. 1.62 ± 4.99 mm; p < 0.05) as well as between age groups 1 and 3 for AT (35.08 ± 11.53 vs. 28.41 ± 6.60; p < 0.05) and ASO (398.99 ± 153.91 vs. 255.56 ± 124.58 mm²; p < 0.001). An unexpected high ASO variation was identified with 11% of S-shaped acromion and 1.3% clock-shaped TSO.

Conclusion

The age group between 25–40 years had the most uniform distribution of data. There is a high morphological variability present in an asymptomatic population, which should be considered in the clinical assessment such as shoulder impingement syndrome.

Alraddadi A, Alashkham A, Lamb C, Soames R (2017) Variability in attachment of the coracoacromial ligament in relation with its morphology. Surg Radiol Anat 39(12):1323–1330. https://doi.org/10.1007/s00276-017-1900-5 CrossRefPubMed

Alraddadi A, Alashkham A, Lamb C, Soames R (2019) Examining changes in acromial morphology in relation to spurs at the anterior edge of acromion. Surg Radiol Anat 41(4):409–414. https://doi.org/10.1007/s00276-018-2141-y CrossRefPubMed

Andrade R, Correia AL, Nunes J, Xará-Leite F, Calvo E, Espregueira-Mendes J, Sevivas N (2019) Is bony morphology and morphometry associated with degenerative full-thickness rotator cuff tears? A systematic review and meta-analysis. Arthroscopy 35(12):3304–3315. https://doi.org/10.1016/j.arthro.2019.07.005 CrossRefPubMed

Aoki M, Ishii S, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10:228

Balke M, Banerjee M, Vogler T, Akoto R, Bouillon B, Liem D (2014) Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surg Sport Traumatol Arthrosc 22(2):415–421. https://doi.org/10.1007/s00167-012-2327-5 CrossRef

Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M (2014) Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-014-3499-y CrossRef

Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D (2013) Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 84(2):178–183. https://doi.org/10.3109/17453674.2013.773413 CrossRefPubMedPubMedCentral

Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:216

Casier SJ, Van den Broecke R, Van Houcke J, Audenaert E, De Wilde LF, Van Tongel A (2018) Morphologic variations of the scapula in 3-dimensions: a statistical shape model approach. J Bone Jt Surg 27(12):2224–2231. https://doi.org/10.1016/j.jse.2018.06.001 CrossRef

10.

Chopp-Hurley JN, O’Neill JM, Dickerson CR (2016) Distribution of bone and tissue morphological properties related to subacromial space geometry in a young, healthy male population. Surg Radiol Anat 38(1):135–146. https://doi.org/10.1007/s00276-015-1529-1 CrossRefPubMed

11.

Clavert P, Jouanlanne M, Koch G (2019) Validation of the inter-individual variability of the lateral offset of the acromion. Surg Radiol Anat 41(6):693–697. https://doi.org/10.1007/s00276-019-02241-8 CrossRefPubMed

12.

Coskun N, Karaali K, Cevikol C, Demirel BM, Sindel M (2006) Anatomical basics and variations of the scapula in Turkish adults. Saudi Med J 27(9):1320–1325. https://doi.org/10.1007/s00167-012-2327-5 CrossRefPubMed

13.

Epstein R, Schweitzer M, Frieman B, Fenlin JJ, Mitchell D (1993) Hooked acromion: prevalence on MR images of painful shoulders. Radiology 187:479–481. https://doi.org/10.1148/radiology.187.2.8475294 CrossRefPubMed

14.

Flatow EL, Soslowsky LJ, Ticker JB, Pawluk RJ, Hepler M, Ark J, Mow VC, Bigliani LU (1994) Excursion of the rotator cuff under the acromion. Patterns of subacromial contact. Am J Sports Med 22(6):779–788. https://doi.org/10.1177/036354659402200609 CrossRefPubMed

15.

French ED, Alfaro-Gomez U, Guzman-Lopez S, Elizondo-Omaña R, Quiroga-Garza A, Zdilla MJ (2019) The contour of the glenoid fossa: variance in concavity. FASEB J 33(1_supplement):616–628

16.

Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF (2014) Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: a biomechanical analysis. J Orthop Res 32(7):952–957. https://doi.org/10.1002/jor.22621 CrossRefPubMed

17.

Hijioka A, Suzuki K, Nakamura T, Hojo T (1993) Degenerative change and rotator cuff tears: an anatomical study in 160 shoulders of 80 cadavers. Arch Orthop Trauma Surg 112:61–64. https://doi.org/10.1007/BF00420255 CrossRefPubMed

18.

Hyvönen P (2003) On the pathogenesis of shoulder impingement syndrome. Oulun yliopisto, pp 17–71

19.

Jih-Yang K, Chun HS, Wei JC, Kaohsiung T, Ryuji Y (1994) Coracoid impingement caused by a ganglion from the subscapularis tendon. J Bone Jt Surg 76-A(11):1709–1711

20.

Karns MR, Jacxsens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT (2018) The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elb Surg 27(1):151–159. https://doi.org/10.1016/j.jse.2017.08.025 CrossRef

21.

Kitay GS, Iannotti JP, Williams GR, Haygood T, Kneeland BJ, Berlin J (1995) Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome. J Shoulder Elb Surg 4(6):441–448. https://doi.org/10.1016/S1058-2746(05)80036-9 CrossRef

22.

Mayerhoefer ME, Breitenseher MJ, Roposch A, Treitl C, Wurnig C (2005) Comparison of MRI and conventional radiography for assessment of acromial shape. Am J Roentgenol 184:671–675. https://doi.org/10.2214/ajr.184.2.01840671 CrossRef

23.

Meneses AG, Molina ÓAM, González FSV (2010) Patologías de hombro. Editor Alfil 1(1):511

24.

Morelli KM, Martin BR, Charakla FH, Durmisevic A, Warren GL (2019) Acromion morphology and prevalence of rotator cuff tear: a systematic review and meta-analysis. Clin Anat 32(1):122–130. https://doi.org/10.1002/ca.23309 CrossRefPubMed

25.

Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Jt J 95 B(7):935–941. https://doi.org/10.1302/0301-620X.95B7.31028 CrossRef

26.

Naidoo N, Lazarus L, Osman SA, Satyapal KS (2015) Acromial morphology and subacromial architecture in a South African population. Int J Morphol 33(3):817–825. https://doi.org/10.4067/S0717-95022015000300002 CrossRef

27.

Neer C (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Jt Surg Am 52-A(1):41–50CrossRef

28.

Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Jt Surg Am 88(4):800–805. https://doi.org/10.2106/JBJS.D.03042 CrossRef

29.

Oh J, Kim J, Lee H, Choi J-A (2010) Classification and clinical significance of acromial spur in rotator cuff tear. Clin Orthop Relat Res 468:1542–1550. https://doi.org/10.1007/s11999-009-1058-5 CrossRefPubMed

30.

Okoro T, Reddy VRM, Pimpelnarkar A (2009) Coracoid impingement syndrome: a literature review. Curr Rev Musculoskelet Med 2(1):51–55. https://doi.org/10.1007/s12178-009-9044-9 CrossRefPubMedPubMedCentral

31.

Pandey V, Vijayan D, Tapashetti S, Agarwal L, Kamath A, Acharya K, Maddukuri OS, Willems WJ (2016) Does scapular morphology affect the integrity of the rotator cuff? J Shoulder Elb Surg 25(3):413–421. https://doi.org/10.1016/j.jse.2015.09.016 CrossRef

32.

Porter NA, Singh J, Tins BJ, Lalam RK, Tyrrell PNM, Cassar-Pullicino VN (2015) A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography. Skelet Radiol 44:1309–1316. https://doi.org/10.1007/s00256-015-2166-9 CrossRef

33.

Prato N, Peloso D, Franconeri A, Tegaldo G, Ravera GB, Silvestri E, Derchi LE (1998) The anterior tilt of the acromion: radiographic evaluation and correlation with shoulder diseases. Eur Radiol 8(9):1639–1646. https://doi.org/10.1007/s003300050602 CrossRefPubMed

34.

Sasiponganan C, Dessouky R, Ashikyan O, Pezeshk P, McCrum C, Xi Y, Chhabra A (2019) Subacromial impingement anatomy and its association with rotator cuff pathology in women: radiograph and MRI correlation, a retrospective evaluation. Skelet Radiol 48(5):781–790. https://doi.org/10.1007/s00256-018-3096-0 CrossRef

35.

Schetino LPL, Sousa Junior RR, Amâncio GPO, Schetino MAA, Almeida-Leite CM, Silva JH (2013) Anatomical variations of acromions in Brazilian adult’s scapulas. J Morphol Sci 30(2):98–102

36.

Stehle J, Moore SM, Alaseirlis DA, Debski RE, McMahon PJ (2015) A reliable method for classifying acromial shape. Int Biomech 2(1):36–42. https://doi.org/10.1080/23335432.2015.1014847 CrossRef

37.

Totlis T, Gowd AK, Bernardoni ED, Cole BJ, Verma NN, Natsis K (2018) A simple method to directly evaluate the lateral extension of the acromion: an anatomic study of 128 cadaveric scapulae. J Shoulder Elb Surg 27(9):1694–1699. https://doi.org/10.1016/j.jse.2018.02.072 CrossRef

38.

Wang JC, Shapiro MS (1997) Changes in acromial morphology with age. J Shoulder Elb Surg 6(1):55–59. https://doi.org/10.1016/S1058-2746(97)90071-9 CrossRef

39.

Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J (2003) Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc 12(1):23–26PubMed

40.

Zuckerman JD, Kummer FJ, Cuomo F, Simon J, Rosenblum S, Katz N (1992) The influence of coracoacromial arch anatomy on rotator cuff tears. J Shoulder Elbow Surg 1(1):4–14. https://doi.org/10.1016/S1058-2746(09)80010-4 CrossRefPubMed

Title: Anatomical variations of the acromial and coracoid process: clinical relevance
Authors: Uriel Alfaro-Gomez
Luis Donaldo Fuentes-Ramirez
Karla Ivonne Chavez-Blanco
Jose Felix Vilchez-Cavazos
Matthew J. Zdilla
Rodrigo E. Elizondo-Omana
Jesus Dante Guerra-Leal
Guillermo Elizondo-Riojas
Ricardo Pinales-Razo
Santos Guzman-Lopez
Alejandro Quiroga-Garza
Publication date: 01-08-2020
Publisher: Springer Paris
Keyword: Painful Arc
Published in: Surgical and Radiologic Anatomy / Issue 8/2020
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-020-02497-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anatomical variations of the acromial and coracoid process: clinical relevance

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2020

Three-dimensional topography of scapular nutrient foramina

The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve

Absence of flexor digitorum profundus muscle and variation of flexor digitorum superficialis muscle in a little finger: two case reports

Correction to: Three‑dimensional topography of scapular nutrient foramina

In vivo changes in length of elbow collateral ligaments during pronation and supination on an outstretched arm

The anatomical features of denticulate ligament in human fetuses