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Fracture of the coracoid process with acute subscapularis tear without shoulder dislocation.

Yoo JH, Min BC, Sung KH, Kim JY - Indian J Orthop (2014)

Bottom Line: An associated acute subscapularis tear is still rare.He was operated upon with reattachment of subscapularis to lesser tuberosity and conjoint tendons to pectoralis major.At 6 mo followup he had good range of motion and his MRI revealed complete healing.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Myongji Hospital, Goyang, Korea.

ABSTRACT
Coracoid process fracture is an uncommon injury and can be easily missed. An associated acute subscapularis tear is still rare. Herein, we describe a 61 year old male who fell from a 2 meter height (stair case) and presented with isolated coracoid process fracture with acute subscapularis tear without dislocation of (R) shoulder joint. The plain x-rays, CT scan and MR arthrography comprised the diagnosis. He was operated upon with reattachment of subscapularis to lesser tuberosity and conjoint tendons to pectoralis major. At 6 mo followup he had good range of motion and his MRI revealed complete healing.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional computed tomography reconstruction image showing of displaced coracoid process fracture
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Figure 2: Three-dimensional computed tomography reconstruction image showing of displaced coracoid process fracture

Mentions: A 61 year old male driver presented with right shoulder pain due to trauma which occurred 2 days ago. The patient fell from 2 meter height (stair case) with the shoulder in abduction and then hit the ground directly impacting the anterior shoulder. He had no history of shoulder trauma previously or any other shoulder disease. At initial radiologic evaluation, a displaced coracoid process fracture was identified on the axillary lateral view [Figure 1]. Three dimensional computed tomography confirmed the coracoid process fracture. It was displaced about 2.5 cm inferiorly without any other shoulder girdle fracture or dislocation [Figure 2]. It was a midprocess level fracture, a type II injury as per the classification of Eyres et al. and Ogawa et al.34 From the coracoid fracture classification point of view, conservative treatment could be sufficient. However, at physical examination, the patient revealed a positive belly press test and internal rotation lag sign, although there was mild pain that limited complete examination. For further evaluation, magnetic resonance arthrography (MRA) of the shoulder was performed and complete and retracted tear of the subscapular tendon was identified [Figure 3]. Sagittal MRA revealed Goutallier grade 1 fatty infiltration indicating acute tear. No evidence of shoulder dislocation such as an anteroinferior labral tear or a Hill-Sachs lesion was seen.


Fracture of the coracoid process with acute subscapularis tear without shoulder dislocation.

Yoo JH, Min BC, Sung KH, Kim JY - Indian J Orthop (2014)

Three-dimensional computed tomography reconstruction image showing of displaced coracoid process fracture
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232835&req=5

Figure 2: Three-dimensional computed tomography reconstruction image showing of displaced coracoid process fracture
Mentions: A 61 year old male driver presented with right shoulder pain due to trauma which occurred 2 days ago. The patient fell from 2 meter height (stair case) with the shoulder in abduction and then hit the ground directly impacting the anterior shoulder. He had no history of shoulder trauma previously or any other shoulder disease. At initial radiologic evaluation, a displaced coracoid process fracture was identified on the axillary lateral view [Figure 1]. Three dimensional computed tomography confirmed the coracoid process fracture. It was displaced about 2.5 cm inferiorly without any other shoulder girdle fracture or dislocation [Figure 2]. It was a midprocess level fracture, a type II injury as per the classification of Eyres et al. and Ogawa et al.34 From the coracoid fracture classification point of view, conservative treatment could be sufficient. However, at physical examination, the patient revealed a positive belly press test and internal rotation lag sign, although there was mild pain that limited complete examination. For further evaluation, magnetic resonance arthrography (MRA) of the shoulder was performed and complete and retracted tear of the subscapular tendon was identified [Figure 3]. Sagittal MRA revealed Goutallier grade 1 fatty infiltration indicating acute tear. No evidence of shoulder dislocation such as an anteroinferior labral tear or a Hill-Sachs lesion was seen.

Bottom Line: An associated acute subscapularis tear is still rare.He was operated upon with reattachment of subscapularis to lesser tuberosity and conjoint tendons to pectoralis major.At 6 mo followup he had good range of motion and his MRI revealed complete healing.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Myongji Hospital, Goyang, Korea.

ABSTRACT
Coracoid process fracture is an uncommon injury and can be easily missed. An associated acute subscapularis tear is still rare. Herein, we describe a 61 year old male who fell from a 2 meter height (stair case) and presented with isolated coracoid process fracture with acute subscapularis tear without dislocation of (R) shoulder joint. The plain x-rays, CT scan and MR arthrography comprised the diagnosis. He was operated upon with reattachment of subscapularis to lesser tuberosity and conjoint tendons to pectoralis major. At 6 mo followup he had good range of motion and his MRI revealed complete healing.

No MeSH data available.


Related in: MedlinePlus