The coracoacromial arch is an important anatomic concept in understanding shoulder pathology. The arch is formed by the coracoid posteriorly, by the acromion anteriorly, and by the coracoacromial ligament, which forms the anterior roof of the arch (Fig... .. . 27.5:3). The humeral head provides the floor of the arch. This arch defines the space within which the muscles of the rotator cuff, the tendon of the long head of the biceps, and the subacromial bursa must fit and function. The coracoacromial ligament is considered vestigial; however, by virtue of its position it can contribute to compression or impingement of the rotator cuff.
FIG. 275-3. Lateral view of shoulder illustrating coracoacromial arch with rotator cuff and subacromial bursa.
Repetitive use of the arm overhead or above the horizontal compresses the rotator cuff and related structures between the humeral head and coracoacromial arch (Fig. 275:4). The impingement syndrome refers to the pathologic changes that occur in the structures of the rotator cuff due to this repetitive compression. Also referred to as painful arc syndrome, cuffitis, supraspinatus syndrome, and bursitis, impingement syndrome is the leading cause of shoulder pain and dysfunction. A basic understanding of this concept is essential for the proper evaluation and treatment of the patient with shoulder pain.
FIG. 275-4. Impingement of subacromial bursa and rotator cuff.
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