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Coracohumeral interval associated with anterior shoulder pathologies, study finds
There is still no causal evidence between coracohumeral interval and shoulder pathologies.
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SAN DIEGO — Subcoracoid space narrowing is closely related to pathologies of the rotator interval and rotator cuff, though no causal relationship has been found between the two, according to a recently presented study.
The findings were presented by Peter J. Millett, MD, MSc, at the 28th Annual Meeting of the Arthroscopy Association of North America, here.
“Coracoid impingement is an interesting phenomenon that may be more relevant than we have thought over time,” Millett said. “The purpose of this study was to determine whether the coracohumeral interval (CHI) width was actually related to any anterior shoulder pathologies.”
“A very strong relationship”
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In the study, researchers collected surgical data prospectively for 94 consecutive patients who underwent arthroscopic shoulder surgery. MRI was used to measure CHI on routine axial and oblique sagittal preoperative X-rays.
They found the average coracohumeral distance to be 11.3 mm and that CHI decreased with age, although it had no association with gender or previous surgery. Pathologies of the rotator interval (RI) — defined as long head of the biceps tendon (LHB), subscapularis or biceps pulley — were found to have a definitive association to the narrowing of the CHI. The investigators reported that patients without RI pathologies had a CHI of 12.3 mm vs. 10.2 mm found in patients with RI pathologies. Those with a biceps pulley tear also had a narrower CHI than those without.
Narrowing of the CHI was also found to be related to rotator cuff tears, including the subscapularis and supraspinatus tendons. A complete rotator cuff tear, they found, had a smaller CHI compared to partial or no tears. Patients with pathologies of the LHB were also found to have a smaller CHI vs. patients without.
“We found that the surgical and exam findings closely associated with narrowing of the coracohumeral interval,” Millett said. “It was a very strong relationship.”
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Images: Millett PJ |
Still no proof of cause or effect
He added, “This study certainly shows that coracohumeral interval narrowing is closely associated with pathologies of the rotator interval and the anterosuperior rotator cuff, and this seems to vary across different shoulder pathologies. It does not prove whether it is cause or effect. It certainly proves that it is related. We still do not know if this is causal or not.”
Moderator James P. Tasto, MD, a member of the Orthopedics Today editorial board, stressed that there were still some areas that warrant further investigation.
“The variations in measurements are very, very small — 1.5 to 2 mm in most of these — but that does reach statistical significance,” he said. “To be able to correlate that to a variety of clinical syndromes is still a large leap. This paper will add to our understanding of anterior shoulder pain and pathology, and it may provide another diagnostic tool.”
“The authors admit, and I think this is a critical part of the manuscript, that the findings of this study show correlations with various shoulder pathologies and narrowing of the CHI, but there is no evidence that the narrowing of the CHI is the result of – or trigger for – these pathologies,” he added.
For more information:
- Peter J. Millett, MD, MSc, is a sports medicine specialist at the Steadman-Hawkins Clinic in Vail, Colo. He can be reached at Steadman Hawkins Clinic, Suite 400, 181 West Meadow Drive, Vail, CO 81657; 970-476-1100; e-mail: drmillett@steadman-hawkins.com.
- James P. Tasto, MD, is a clinical professor at the University of California at San Diego. He can be reached at 6719 Alvarado Road., #200, San Diego, CA 92120-5256; 619-229-3932; e-mail: doctas007@aol.com.
Reference:
- Millett PJ. Coracoid impingement: a prospective cohort study on he association between coracohumeral interval narrowing and anterior shoulder pathologies. Paper #SS-09. Presented at the 28th Annual Meeting of the Arthroscopy Association of North America. April 30-May 3, 2009. San Diego.