M. SIMONI & O.
LECH
ARTIGO ORIGINAL / ORIGINAL ARTICLE
O tratamento cirrgico da sndrome de
impacto idioptica no processo coracide*
Surgical treatment of coracoid process
idiopathic impingement syndrome*
MICHAEL SIMONI1, OSVANDR LECH2
RESUMO
A dor na regio anterior do ombro pode ter inmeras
causas. Os autores relatam os casos de 10 pacientes (11
ombros) com dor nessa regio causada por sndrome de
impacto do processo coracide de origem idioptica. Dor
localizada sobre o processo coracide, causada por ativi-
dades com o brao em flexo e rotao interna, era a prin-
cipal queixa. A histria e o exame clnico especfico condu-
ziram ao diagnstico. Aps um perodo de tratamento
fisioterpico sem melhoras, foi realizado tratamento ci-
rrgico (aberto em sete e artroscpico em trs pacientes)
para coracoplastia pstero-lateral, que evoluiu com reso-
luo dos sintomas em todos.
Unitermos Ombro; sndrome do impacto; processo coracide
INTRODUO
A dor na regio anterior do ombro pode, em diversas oca-
sies, ser de difcil diagnstico. Muitas doenas cursam com
esse sintoma, entre elas: leses do manguito rotador, sndro-
me do impacto, alterao da cabea longa do msculo bceps
do brao, artrose glenoumeral, leses labiais e a sndrome do
impacto do processo coracide(1).
Goldthwait(2) descreve em 1909 a compresso da bursa sub-
coracide entre a cabea do mero e o processo coracide.
* Trabalho realizado no Hospital Samaritano Rio de Janeiro, RJ.
1. Mdico Ortopedista do Hospital Samaritano Rio de Janeiro, RJ; Membro
da American Shoulder and Elbow Surgeons.
2. Chefe do Servio de Residncia Mdica do Instituto de Ortopedia e Trauma-
tologia de Passo Fundo Passo Fundo, RS; Presidente da Comisso de Edu-
cao Continuada-SBOT.
Endereo para correspondncia (Correspondence to): Rua Alberto de Campos, 168/101 22411-030 Rio de Janeiro, RJ, Brasil.
Recebido em (Received in) 7/5/03. Aprovado para publicao em (Approved in) 14/10/03.
Copyright RBO2004
14
ABSTRACT
Pain at the anterior shoulder region may have several caus-
es. The authors report 10 patients (11 shoulders) with pain
at that region caused by an idiopathic nature impingement
syndrome of the coracoid process. Localized pain on the co-
racoid process caused by activities with the arm in flexion
and internal rotation was the chief complaint. The history
and specific clinical examination led to the diagnosis. After
a period of unsuccessful physical therapy treatment, patients
were submitted to surgical treatment (open surgery in sev-
en patients and arthroscopically in three) for posterolater-
al coracoplasty, leading to symptom resolution in all pa-
tients.
Key words Shoulder; impingement syndrome; coracoid process
INTRODUCTION
Pain at the anterior shoulder region can often be difficult to
diagnose. Many conditions cause such symptoms, including
rotator cuff injuries, impingement syndrome, changes at the
biceps muscle long head of the arm, glenohumeral arthrosis,
labrum lesions, and coracoid process impingement syn-
drome(1).
Goldthwaith(2), in 1909, described the compression of sub-
coracoid bursa between the humeral head and the coracoid
* From Hospital Samaritano Rio de Janeiro, RJ, Brazil.
1. Orthopedic Surgeon, Hospital Samaritano Rio de Janeiro, RJ; American
Shoulder and Elbow Surgeons Member.
2. Head, Medical Residence, Instituto de Ortopedia e Traumatologia de Passo
Fundo, RS, Brazil; President of CEM, SBOT.
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
O TRATAMENTO CIRRGICO DA SNDROME DE IMPACTO IDIOPTICA NO PROCESSO CORACIDE
Segundo Shankwiler et al, Codman no aceitava a existncia
desse tipo de impacto(1).
O impacto do processo coracide pode ser idioptico, ia-
trognico, traumtico ou secundrio a outras patologias. Mi-
croinstabilidade anterior, cirurgias de Bristow-Latarjet, seqe-
las de fraturas da cabea do mero ou do processo coracide
podem estar associadas com impacto no processo coraci-
de(3).
O objetivo deste trabalho estudar o comportamento clnico
e propor uma coracoplastia pstero-lateral (aberta ou artros-
cpica) para os pacientes com impacto idioptico no proces-
so coracide que no melhoram com tratamento conservador.
MATERIAL E MTODOS
Entre janeiro de 1993 e outubro de 2002, um total de 18
pacientes tratados no Hospital Samaritano do Rio de Janeiro
(HS-RJ) tiveram o diagnstico isolado de sndrome do impac-
to do processo coracide e no melhoraram com tratamento
conservador. Pacientes com instabilidade anterior do ombro,
tendinite calcria do subescapular, peitoral menor aberrante e
fraturas foram excludos pela possvel associao. Dez pa-
cientes (11 ombros) foram considerados idiopticos e resis-
tentes a mtodos conservadores, conseqentemente, inclu-
dos neste estudo.
Seis pacientes eram do sexo masculino (sete ombros, um
bilateral) e quatro do feminino. A faixa etria variou entre 30
e 49 anos (mdia de 36), sendo todos os pacientes destros.
Em nove pacientes o lado direito foi acometido, em um, o
ombro esquerdo e um foi tratado bilateralmente.
A queixa principal era dor na regio anterior do ombro por
mais de quatro meses, ligada principalmente a atividades com
o brao em flexo e aduo (ex.: dirigindo um veculo) e de
carter progressivo em intensidade e freqncia. No exame
clnico todos os pacientes apresentavam dor palpao ex-
clusiva do processo coracide. As manobras de irritao suba-
cromial foram negativas, sendo mobilidade e fora normais
em todos os casos. O sinal do impacto do processo coracide
(flexo de 90o e rotao interna) foi positivo em 100% dos
casos (fig. 1). Trs ombros apresentavam dor abduo hori-
zontal de 900 com rotao interna e seis ombros, dor aduo
horizontal.
O estudo radiogrfico foi feito em todos os pacientes, sem
alteraes correlatas. A ressonncia nuclear magntica foi rea-
lizada em sete pacientes, sendo que em cinco havia aumento
de sinal na ponta do processo coracide e em dois, um peque-
no esporo em T2 (com supresso de gordura) nos planos
axial e coronal oblquo (figs. 2A e 2B).
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
Fig. 1 Sinal do impacto do processo coracide (flexo de 90o e
rotao interna)
Fig. 1 Impingement sign of the coracoid process (flexion of 90o
and internal rotation)
process. According to Shankwiler et al(1), Codman did not
accept the existence of such impingement.
The impingement of the coracoid process can be idiopath-
ic, iatrogenic, traumatic, or secondary to other conditions.
Anterior microinstability, previous Bristow/Latarjet proce-
dures, humeral head or coracoid process fractures all may be
associated to coracoid process impingement(3).
The aim of this study is to assess clinical behavior and pro-
pose a posterolateral coracoplasty (either open or arthroscop-
ically) for patients with idiopathic impingement of the cora-
coid process who do not improve with conservative treatment.
MATERIAL AND METHODS
Between January 1993 and October 2002, a total of 18
patients treated at Hospital Samaritano do Rio de Janeiro
(HS-RJ) were diagnosed with isolated coracoid process im-
pingement syndrome and did not improve with conservative
treatment. Those patients with shoulder anterior instability,
subscapularis tendon calcified tendonitis, aberrant pectora-
lis minor muscle, and fractures, all have been excluded due to
the possible association. A total of 10 patients (11 shoulders)
were considered idiopathic and irresponsive to conservative
methods and, consequently, were included in the study.
Six patients were male (seven shoulders, one bilateral case)
and four were female. Age ranged from 30 to 49 years (mean,
36 years), and all of them were right-handed. In nine patients,
the right side was affected, one patient had the left shoulder
15
M. SIMONI & O. LECH

Fig. 2A A ressonncia nuclear magntica pode auxiliar o diag-
nstico identificando alteraes no processo coracide. Imagem
em T2 coronal oblquo.
Fig. 2A Magnetic resonance imaging can help diagnosis by iden-
tifying changes in the coracoid process. A T2-weighted oblique
coronal image.
Fig. 2B Imagem de ressonncia magntica em T2 axial com su-
presso de gordura mostrando aumento de sinal na ponta do pro-
cesso coracide
Fig. 2B Magnetic resonance image in axial T2-weighted with fat
suppression showing signal increase on the tip of the coracoid
process

A B

Fig. 3A e 3B O objetivo da cirurgia resseco de 5 a 10mm da extremidade pstero-lateral do processo coracide,

eliminando o impacto sobre o tubrculo menor do mero e o subescapular
Fig. 3A and 3B The aim of the surgery is a 5 to 10 mm resection of the posterolateral tip of coracoid process, eliminating
the impingement of the humerus and subscapularis on the lesser tubercle

O procedimento cirrgico foi realizado aps trs meses de
tratamento fisioterpico, orientado por profissional com ex-
perincia em reabilitao de patologias do ombro, associado
a medicaes analgsicas e antiinflamatrios no esterides e
sem resoluo dos sintomas. No grupo inicial de oito ombros
(sete pacientes), utilizamos a via aberta e no grupo de trs
ombros tratados mais recentemente, a via artroscpica. O ob-
jetivo do procedimento era de executar uma coracoplastia
pstero-lateral aumentando, conseqentemente, a distncia
coracoumeral (figs. 3A e 3B).
16
affected, and one patient was treated for symptoms of both
sides.
The chief complaint was pain at the anterior region of the
shoulder for more than four months, particularly during ac-
tivities with flexed and adducted arm (e.g., driving a car) and
with progressive intensity and frequency. Upon clinical ex-
amination, all patients presented with pain on palpation only
on the coracoid process. The subacromial irritation maneu-
vers were negative, with normal mobility and strength in all
cases. The coracoid process impingement sign (flexion of 90
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
O TRATAMENTO CIRRGICO DA SNDROME DE IMPACTO IDIOPTICA NO PROCESSO CORACIDE
Tcnica cirrgica aberta (oito ombros) Com o paciente
em posio de cadeira de praia feita uma via de acesso ante-
rior de 3cm seguindo as linhas de Langer. O deltide divul-
sionado sem qualquer desinsero. O processo coracide
exposto e o ligamento coracoacromial desinserido de sua base.
O tendo conjunto dissecado do processo coracide em ape-
nas 1cm. Uma coracoplastia pstero-lateral executada e sua
rea regularizada posteriormente criando um espao e um pro-
cesso coracide lateral liso sem proeminncias sseas. O del-
tide suturado e, posteriormente, a pele com sutura subcuti-
cular. O paciente utiliza uma tipia para proteo, inicia
exerccios pendulares no 2o dia ps-operatrio e movimentos
ativos aps o 10o dia.
Tcnica cirrgica artroscpica (trs ombros) Com o
paciente colocado em posio de cadeira de praia feito por-
tal posterior convencional. Aps inspeo glenoumeral com-
pleta, um novo portal ntero-lateral, junto ao acrmio, usa-
do para palpar e para executar a coracoplastia. Com auxlio
de radiofreqncia o processo coracide individualizado atra-
vs do intervalo dos rotadores. Usando uma broca (Eggburr
ou Barrelburr) por meio do shaver, a coracoplastia realiza-
da com a resseco de aproximadamente 5 a 10mm e regula-
rizao ssea da regio pstero-lateral do processo coracide.
No ps-operatrio os movimentos ativos so liberados ime-
diatamente e exerccios pendulares e de rotao lateral incen-
tivados (fig. 4A, 4B, 4C e 4D).
RESULTADOS
O tempo de seguimento mnimo foi de seis meses e o m-
ximo de 10 anos no momento desta reviso. Todos os pacien-
tes estavam sem dor e com mobilidade e fora normais, soman-
do 35 pontos pelo escore da UCLA. No houve complicaes
imediatas ou tardias. Os pacientes tornaram-se assintomti-
cos entre dois e quatro meses de ps-operatrio no grupo aberto
e, em mdia, de um ms no grupo artroscpico. O sinal do
impacto do processo, antes 100% positivo, estava negativo
em torno do 2o ms aps a cirurgia. Todos os pacientes esta-
vam satisfeitos com o procedimento. No houve complica-
es em nenhum dos grupos, mas as queixas dolorosas foram
significativamente menores no grupo artroscpico, sendo ne-
cessrios doses e tempos menores de analgsicos.
DISCUSSO
Poucos artigos falam sobre o possvel contato do processo
coracide com estruturas moles adjacentes cabea do me-
ro como causa de dor. Gerber et al(3), em 1985, descreveram
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
and internal rotation) was positive in 100% of cases (figure
1). Three shoulders presented pain at 90 horizontal abduc-
tion and internal rotation, and six shoulders presented pain
at horizontal adduction.
The radiographic evaluation was performed in all patients
without correlated changes. Magnetic resonance imaging was
performed in seven patients, with five patients showing en-
largement of the tip of the coracoid process, and two patients
showed a small spur in T2 (with fat suppression) on axial and
coronal oblique planes (figures 2A and 2B).
Surgery was performed after three months of physical ther-
apy treatment led by a professional experienced in rehabilita-
tion of shoulder conditions, in conjunction with analgesic and
non-steroidal antiinflammatory drugs, without resolution of
symptoms. In the initial group of eight shoulders (seven pa-
tients), we used the open approach, and for the group of three
more recently treated shoulders we employed the arthroscop-
ic approach. The purpose of the procedure was to perform a
posterolateral coracoplasty, thus increasing the coracohumer-
al distance (figures 3A and 3B).
Open surgical procedure (eight shoulders) With the pa-
tient in beach chair position, a 3 cm anteriorly located ap-
proach is established following Langer lines. The deltoid is
bluntly divulged. The coracoid process is exposed and the
coracoacromial ligament is disinserted at its base. The con-
joint tendon is dissected from the coracoid process by only 1
cm. A posterolateral coracoplasty is performed and then
smoothened, creating a space and a smooth lateral coracoid
process without bony prominences. Firstly, the deltoid is su-
tured and then the skin by subcuticular stitches. The patient
uses a sling for protection, starts pendulation exercises on
second day after surgery, and active movements after 10th day.
Arthroscopic surgery (three shoulders) With the patient
in beach chair position, a conventional posterior portal is
established. After complete glenohumeral inspection, a new
anterolateral portal, nearby the acromion is used to palpate
and to perform the coracoplasty. Using radiofrequency, the
coracoid process is identified through the rotator interval.
Using a burr (Eggburr or Barrelburr) with the shaver, the co-
racoplasty is performed by coracoid process resection. Post-
operatively, active movements are started immediately and
pendulation and lateral rotation exercises are encouraged (fig-
ures 4A, 4B, 4C and 4D).
RESULTS
There was a minimum follow-up of six months and maxi-
mum of 10 years at the time of this review. All patients had no
17
M. SIMONI & O. LECH
coracide
radiofreqncia
Fig. 4A A ponta do processo coracide individualizada com
uso de radiofreqncia
Fig. 4A The tip of the coracoid process is identified with the use
of radiofrequency
coracide
tend.
conjunto
Fig. 4C Aspecto aps resseco de 5 a 10mm do processo cora-
cide, sendo possvel identificar o tendo conjunto e o ligamento
coracoacromial
Fig. 4C After a 5 to 10 mm resection of the coracoid process, the
conjoint tendon and the coracoacromial ligament can be seen
50 casos de sndrome de impacto do processo coracide, sen-
do que, dentre esses, 23 considerados idiopticos. Um pro-
cesso coracide aumentado sugerido como possvel fator.
Nesse trabalho fica evidente que o diagnstico dessa doena
eminentemente clnico e baseado nas caractersticas e loca-
lizao da dor, assim como no exame clnico especfico. A
abduo horizontal com rotao interna aparentemente gera-
18
coracide
broca
Fig. 4B Coracoplastia com uso de broca
Fig. 4B Coracoplasty with a burr
coracide
subescapular
Fig. 4D Aumento da distncia entre o processo coracide e a
cabea do mero
Fig. 4D Distance increase between the coracoid process and the
humeral head
pain and normal mobility and strength, achieving 35 points
according to the UCLA score. There were no immediate or late
complications. Patients from the open surgery group became
asymptomatic between two and four months post-operatively,
and averaged one month in the arthroscopy group. The im-
pingement sign of the process, formerly 100% positive, was
negative around the second month after surgery. All patients
were satisfied with the procedure. There were no complica-
tions in any group, but there were significantly less pain com-
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
O TRATAMENTO CIRRGICO DA SNDROME DE IMPACTO IDIOPTICA NO PROCESSO CORACIDE
va o menor espao entre o processo coracide e a cabea do
mero, mas no foi na sua srie, assim como nesta, a manobra
mais sensvel. O sinal do impacto do processo coracide des-
crito por Gerber et al(3) foi 100% positivo para esse grupo de
pacientes, sendo considerada a mais sensvel em ambos os
trabalhos.
Em relao aos exames de imagem, Masala et al(4) conclu-
ram, em 1995, que a radiologia convencional e a ultra-sono-
grafia seriam teis em excluir outras fontes de dor, tendo pou-
ca utilidade no diagnstico de impacto no processo coracide.
Concluem tambm que a tomografia computadorizada e a
ressonncia nuclear magntica podem ser de algum auxlio.
Bonutti et al(5), em 1993, produziram a cinerressonncia mag-
ntica como o melhor mtodo para estudar a distncia entre a
cabea do mero e o processo coracide do ponto de vista
dinmico. Fica claro, no entanto, que o exame clnico se mos-
trou mais sensvel e especfico quando comparado com os
mtodos de imagem disponveis.
Gerber et al(3,6) demonstraram que a distncia coracoume-
ral normal em torno de 8,6mm, estando diminudo em m-
dia para 6,7mm nos casos sintomticos. Existe, portanto, pouco
espao para o deslizamento do tendo do subescapular entre
o processo coracide e a cabea do mero. O tratamento ini-
cial foi fisioterpico em todos os pacientes, tendo como crit-
rio a coordenao desse mtodo por fisioterapeuta experiente
em patologias e alteraes da cintura escapular. Medicaes
analgsicas e antiinflamatrios no esterides foram igual-
mente utilizados, sem resoluo dos sintomas.
A tcnica cirrgica realizada foi descrita por Gerber et al(3)
e consiste numa coracoplastia lateral, formando um espao
maior entre a cabea do mero e o processo coracide, po-
dendo ser criada uma analogia com a acromioplastia para tra-
tamento das sndromes de impacto subacromiais. Os excelen-
tes resultados com 100% de satisfao foram obtidos tanto na
srie original como no nosso estudo. Dines et al(7) descreve-
ram certa tcnica, em 1990, na qual feita resseco de 1,5cm
do processo coracide com desinsero e reinsero do ten-
do conjunto. Nos oito pacientes estudados por esses autores
houve melhora em seis. Essa tcnica mostrou-se mais trau-
mtica, implicando desinseres musculares desnecessrias.
A partir de 2002, com a progresso da curva de aprendiza-
do e aperfeioamento tcnico, passamos a utilizar a via artros-
cpica como mtodo de eleio. Seguimos a tcnica descrita
por Lo e Burkhart(8) utilizando radiofreqncia para visuali-
zao adequada do processo coracide, na poro que fica
em ntimo contato com a insero do subescapular junto
tuberosidade menor do mero. possvel, utilizando a artros-
Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004
plaints in the arthroscopy group, requiring lower doses and
reduced time on analgesics.
DISCUSSION
Few studies mention the possible contact of the coracoid
process with the soft structures surrounding the humeral head
as the cause of pain. In 1985, Gerber et al(3) described 50
cases of impingement syndrome of the coracoid process, of
those 23 were considered idiopathic. An enlarged coracoid
process is suggested as a possible causative factor. In this
study, it is evident that the diagnosis of this condition is main-
ly clinical and based on pain features and location, as well as
on specific clinical examination. The horizontal abduction with
internal rotation seemed to generate the smallest space be-
tween the coracoid process and the humeral head, but that
did not represent the most sensitive maneuver, either in their
series or in this one. The impingement sign of the coracoid
process described by Gerber et al(3) was 100% positive for
this group of patients, and considered the most sensitive in
both studies.
Concerning imaging evaluation, Masala et al(4) concluded,
in 1995, that conventional radiology and ultrasound would
be useful to exclude other pain sources, but not useful to diag-
nose impingement of the coracoid process. Additionally, they
concluded that CT scan and magnetic resonance imaging could
be of some help. Bonutti et al(5), in 1993, produced the kine-
magnetic resonance imaging as the best method to study the
distance between the humeral head and the coracoid process
from the dynamic standpoint. However, it is clear that clinical
examination showed to be more sensitive and specific when
compared to the available imaging methods.
Gerber et al(3,6) have shown that the normal coracohumer-
al distance is approximately 8.6 mm, and reduced, on aver-
age, to 6.7 mm in symptomatic cases. Therefore, there is little
space for subscapularis tendon gliding between the coracoid
process and the humeral head. Initial treatment was physical
therapy for all patients, with the pre-requisite that such meth-
od should be coordinated by a physical therapist experienced
in shoulder girdle pathology and changes. Analgesic, non-
steroidal antiinflammatory drugs were also used without symp-
tom resolution.
The surgical technique used was described by Gerber et
al(3), consisting of lateral coracoplasty for a larger room be-
tween the humeral head and the coracoid process; an analo-
gy can be made with acromioplasty for the treatment of sub-
acromial impingement syndromes. Excellent results, with
100% satisfaction, were achieved both in the original series
19
M. SIMONI & O. LECH
copia, avaliar se h presena de dano da insero do subesca-
pular, assim como uma noo da distncia e suas modifica-
es conforme o movimento. A resseco pstero-lateral do
processo coracide bastante precisa, evidenciando aumento
significativo da distncia coracoumeral.
CONCLUSO
O processo coracide pode ser fonte de impacto, podendo
gerar dor na regio anterior do ombro. A anomalia pode ser
idioptica ou ligada a diversas situaes patolgicas. O diag-
nstico eminentemente clnico, mas a excluso de outras
fontes de dor fundamental para o tratamento adequado. A
dor localizada sobre o processo coracide e o sinal de impac-
to do processo coracide (flexo de 90o e rotao interna) des-
crita por Gerber et al so os sinais com maior sensibilidade e
especificidade para o diagnstico. O tratamento cirrgico atra-
vs de coracoplastia pstero-lateral aberta ou artroscpica
procedimento reproduzvel, descrito na literatura e que levou
cura a totalidade dos nossos pacientes. O objetivo deste tra-
balho no de comparar as tcnicas e, sim, evidenciar que
ambas as tcnicas produzem resultados satisfatrios e podem
ser utilizados, dependendo da experincia do cirurgio.
REFERNCIAS / REFERENCES
1. Shankwiler J.A., Ciepiela M.D., Burkhead Jr. W.Z.: The coracoacromial
arch impingement syndromes. In Burkhead Jr. W.Z., et al: Rotator cuff dis-
orders. Baltimore, Williams & Wilkins, p. 111-132, 1996.
2. Goldthwait J.E.: An anatomic and mechanical study of the shoulder joint
explaining many cases of painful shoulder, many of the recurrent dislocation,
and many of the cases of brachial neuralgias and neuritis. Am J Orthop Surg
6: 579-606, 1909.
3. Gerber C., Terrier F., Ganz R.: The role of the coracoid process in chronic
impingement syndrome. J Bone Joint Surg [Br] 67: 703-708, 1985.
20
of the author and in our study. Dines et al(7) described a tech-
nique in 1990, in which a 1.5 cm resection is made on the
coracoid process with disinsertion and reinsertion of the con-
joint tendon. Six out of the eight patients studied by those
authors showed improvement. This technique proved to be
more traumatic, requiring unnecessary muscle disinsertions.
Starting in 2002, with the progression of the learning curve
and technical improvement, we have begun to use the arthro-
scopic approach as the method of choice. We follow the tech-
nique described by Lo and Burkhart(8) using radiofrequency
for the proper visualization of the coracoid process at the site
where it is in close contact with the subscapularis insertion
by the lesser tuberosity of the humerus. Arthroscopy enables
damage assessment from subscapularis insertion, as well as
the distance and motion changes. The posterolateral resec-
tion of the coracoid process is rather accurate, showing a
significant increase in the coracohumeral distance.
CONCLUSION
The coracoid process can be the source of impingement,
causing pain in the anterior region of the shoulder. The anom-
aly can be idiopathic or linked to several pathologic condi-
tions. Diagnosis is mainly clinical, but the exclusion of other
pain sources is crucial for proper treatment. Localized pain
on the coracoid process and the impingement sign of the co-
racoid process (flexion of 90 and internal rotation) described
by Gerber are the greatest sensitivity and specificity signs for
diagnosis. Surgical treatment by posterolateral open or ar-
throscopic coracoplasty is a reproducible procedure described
in literature, producing cure for all our patients. The purpose
of this study is not to compare techniques, but to show that
both techniques result in satisfactory outcomes and can be
used depending on the surgeons experience.
4. Masala S., Fanucci E., Maiotti M., Nardocci M.: Subcoracoid impingement syn-
drome. Clinical and radiologic findings. Radiol Med (Torino) 89: 18-21, 1995.
5. Bonutti P., Norfray J., Friedman R.J., Genez B.: Kinematic MRI of the shoul-
der. J Comput Assist Tomogr 17: 666-669, 1993.
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Rev Bras Ortop _ Vol. 39, Nos 1/2 Jan/Fev, 2004