Coracohumeral Distances and Correlation to Arm Rotation

Subcoracoid impingement, while relatively uncommon in clinical incidence when compared to subacromial impingement, has been increasingly diagnosed in patients with anterior shoulder pain and tenderness. However, studies have suggested that subcoracoid impingement may not be as rare as once thought. In fact, one study reported that 19% of patients with combined subscapularis, supraspinatus, and infraspinatus tears had subcoracoid impingement, and another reported subcoracoid impingement as a postoperative complication in 5.1% of patients following rotator cuff repair and anterior acromioplasty.

Subcoracoid impingement has been defined as the encroachment of the posterolateral coracoid process upon the lesser tuberosity of the humerus. This mechanism is common in patients who repetitively engage in activities involving forward flexion, adduction, and internal rotation because this position reduces coracohumeral distance and potentially impinges the intervening soft tissue structures. This compression of the soft tissues between the lesser tuberosity and coracoid tip has been termed the roller-wringer effect and reportedly can lead to progressive degeneration and injury to the rotator cuff, specifically subscapularis tendon tears, long head biceps tendon injuries, and anterior shoulder pain.

Anatomic variations of the humerus and scapula, specifically lesser tuberosity prominences and coracoid length/ orientation, respectively, can decrease coracohumeral distance. Modern imaging techniques have a role in the evaluation of coracohumeral distance, lending to the diagnosis and treatment of patients with subcoracoid impingement. The coracoid index, or lateral extension of the coracoid process, is subject to individual variation, and the coracohumeral interval is affected by dynamic arm positions. No specific imaging positions have been described to help interpret coracohumeral distance. Therefore, the purpose of this study was to determine the variability in coracohumeral distance and coracoid index as a function of arm rotation in healthy male subjects. Our null hypothesis was that there would be no differences in coracohumeral distance with respect to shoulder rotation.

Full Article: Coracohumeral Distances and Correlation to Arm Rotation

Peter Millett, MD

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39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Coracohumeral Distances and Correlation to Arm Rotation

About the Author: Peter Millett, MD