Coracohumeral Distances and Correlation to Arm Rotation

http://ojs.sagepub.com/content/1/2/2325967113496059.full.pdf+html

Coracohumeral Distances and Correlation to Arm Rotation

An In Vivo 3-Dimensional Biplane Fluoroscopy Study

1. John P. Brunkhorst, MD*
2. J. Erik Giphart, PhD*
3. Robert F. LaPrade, MD, PhD*,†‡
4. Peter J. Millett, MD, MSc*,†

1. Investigation performed at the Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA
2. ^*Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, USA.
3. ^†The Steadman Clinic, Vail, Colorado, USA.

1. ↵‡Robert F. LaPrade, MD, PhD, Steadman Philippon Research Institute, Complex Knee and Sports Medicine Orthopaedic Surgery, The Steadman Clinic, 181 West Meadow Drive, Vail, CO 81657 USA (e-mail: drlaprade@sprivail.org).

Abstract

Background: Reduced coracohumeral distances have been reported to be associated with anterior shoulder disorders such as subscapularis tears, biceps tendon injuries, and leading edge supraspinatus tears.

Purpose: To determine the variability in coracohumeral distance as a function of arm rotation in healthy male subjects. The null hypothesis was that no differences in coracohumeral distance would exist with respect to arm rotation.

Study Design: Descriptive laboratory study.

Methods: A total of 9 male participants who had full range of motion, strength, and no prior surgery or symptoms in their tested shoulders were enrolled in this institutional review board–approved study. Computed tomography scans of the shoulder were obtained for each subject. A dynamic biplane fluoroscopy system recorded internal and external shoulder rotation with the arm held in the neutral position. Three-dimensional reconstructions of each motion were generated, and the coracohumeral distance and coracoid index (lateral extension of the coracoid) were measured.

Results: The mean coracohumeral distance in neutral rotation was 12.7 ± 2.1 mm. A significantly shorter minimum coracohumeral distance of 10.6 ± 1.8 mm was achieved (P = .001) at a mean glenohumeral joint internal rotation angle of 36.6° ± 19.2°. This corresponded to a reduction in coracohumeral distance of 16.4% (range, 6.6%-29.8%). The mean coracoid index was 14.2 ± 6.8 mm. A moderate correlation (R = −0.75) existed between the coracohumeral distance and coracoid index.

Conclusion: Coracohumeral distance was reduced during internal rotation. Decreased coracohumeral distance was correlated with larger coracoid indices.

Clinical Relevance: This study provides a reference value for coracohumeral distance in the healthy male population. Knowledge of how coracohumeral distance varies over the range of arm internal-external rotation may improve the clinical diagnosis and treatment plan for patients with anterior shoulder pathology, specifically subcoracoid impingement. Imaging of the coracohumeral distance during internal rotation with the hand at approximately midline should be considered to assess patients with anterior shoulder pain.