The Volleyball Player Who Could Not High-five! - Page #4

Working Diagnosis:
Initial diagnosis: Coracoid Impingement
Patient was sent to work with PT on scapular stabilization and strengthening. She was started on Naproxen. PT also worked on her posture and stretching out her pec minor muscle.
She improved greatly over the next five weeks with PT and was able to finish out the volleyball season.
She had a return of pain in the off season and was sent for an MR Arthrogram of her shoulder.
MR Arthrogram shows small articular sided tear supraspinatus, otherwise normal

She consulted with orthopedics.
She had a shoulder arthroscopy done. The supraspinatus was not repaired. The anterior labrum had a small tear and that was shaved. She had a subacromial decompression and the coracoid process was shaved down.

She slowly progressed in activity after surgery over the course of several weeks.
She has continued with PT and has laid off on the heavy lifting.
She has been participating in practices without pain and has full, pain-free range of motion.
She can “high five” without difficulty.

Author's Comments:
Coracoid Impingement
Occurs when the subscapularis tendon impinges between the lesser tuberosity of the humerus and the coracoid.
Exacerbated by activities that involve forward flexion and medial rotation.
Ultrasound may be utilized as a tool to objectively measure the coracohumeral interval, the distance between the lesser tuberosity of the humerus and the coracoid process while the arm is adducted across the chest (narrower with impingement,

Dines DM, Warren RF, Inglis AE and Pavlov H. The Coracoid Impingement Syndrome. J Bone Joint Surg 1990; 72-B:314-6.
Tracy MR, Trella TA, Nazarian LN, Tuohy CJ and Williams GR. Sonography of the Coracohumeral Interval: A Potential Technique for Diagnosing Coracoid Impingement. J Ultrasound Med 2010; 29:337-341.
Okoro T, Reddy VRM and Pimpelnarkar A. Coracoid Impingement Syndrome: A literature review. Curr Rev Musculoskelet Med. 2009 March; 2(1): 51-55.

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