[Coracoplasty with mini-incision for treatment of subcoracoid impingement syndrome].

OBJECTIVE: To investigate the method and effectiveness of coracoplasty with mini-incision for subcoracoid impingement syndrome.

METHODS: Between May 2006 and September 2011, 4 patients with subcoracoid impingement syndrome were treated, including 3 cases of congenital dysplasia of the coracoid process and 1 case of anterior glenohumeral instability. There were 3 males and 1 female with an average age of 36 years (range, 20-56 years). The disease duration was 6-22 months (mean, 11.2 months). The patients had a history of chronic pain and click of the anterior should, which was aggravated in adduction, internal rotation, and flexion. The results of the coracoid impingement test were positive by Neer and Hawkins-Kennedy impingement sign. The axial CT in adduction position showed that the coracohumeral interval decreased and coracoid index increased. The 2 cm lateral coracoid incision was made and the 0.5-1.5 cm coracoid neck was revealed and cut by osteotomy. The coracoplasty was performed by amputating the conjoined tendon insertion of the short head of the biceps and the coracobrachialis muscle and suturing to proximal coracoid osteotomy surface. Shoulder was fixed with the external braces for 6 weeks.

RESULTS: Healing of incision by first intention was observed in all cases without any complication. All the 4 patients were followed up from 8 months to 5 years. At last follow-up, pain and click disappeared. The mean visual analogue scale (VAS), University of California at Los Angeles (UCLA), Constant, and simple shoulder test (SST) scores were significantly improved from 7.75, 10.25, 65.50, and 9.75 at preoperation to 0.25, 34.25, 91.25, and 0.25 at last follow-up respectively. The axial CT in adduction position and MRI showed that long coracoid process was removed; the coracohumeral interval was increased to 13.38 mm from 4.16 mm at preoperation; and the coracoid index was decreased to 0.28 mm from 13.08 mm at preoperation.

CONCLUSION: Coracoplasty with mini-incision is an effective method to relieve clinical symptoms of subcoracoid impingement, which has less complications and faster recovery.