Curr Rev Musculoskelet Med (2009) 2:51–55 DOI 10.1007/s12178-009-9044-9 Coracoid impingement syndrome: a literature review T. Okoro Æ V. R. M. Reddy Æ Ashvin Pimpelnarkar Published online: 27 January 2009 The Author(s) 2009. This article is published with open access at Springerlink.com Abstract Coracoid impingement syndrome is a less common cause of shoulder pain. Symptoms are presumed to occur when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. Coracoid impingement should be included in the differential diag- nosis when evaluating a patient with activity-related anterior shoulder pain. It is not thought to be as common as subacromial impingement, and the possibility of the coexistence of the two conditions must be taken into con- sideration before treatment of either as an isolated process. If nonoperative treatment fails to relieve symptoms, sur- gical decompression can be offered as an option. Keywords Coracoid impingement Anterior shoulder pain Introduction The mechanical impingement on the rotator cuff by the overlying acromial arch was postulated early in 1909 [1]. The same article also considered the possibility of rotator cuff impingement by its anteromedial portion, that is, the T. Okoro (&) University Hospitals Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK e-mail: tosanwumi@hotmail.com V. R. M. Reddy University Hospitals Leicester NHS Trust, Glenﬁeld Hospital, Leicester LE3 9QP, UK A. Pimpelnarkar Heart of England NHS Foundation Trust, Good Hope Hospital, Sutton Coldﬁeld, Birmingham B75 7RR, UK coracoid process. Coracoid impingement was also descri- bed in 1937 [2] and in 1941 [3]. The coracoacromial interval includes the acromion, the coracoacromial ligament, and the tip of the coracoid pro- cess (Fig. 1) [4]. It is the variation in the height and length of the coracoid process in most cases that is responsible for altering the size and shape of the space between the cora- coacromial arch and the rotator cuff [5]. A recent cadaveric study also suggests that the problem is functional with anterior instability leading to a narrowing of the coraco- humeral distance [6]. There are no reports in the published literature of the incidence or prevalence of this condition. Coracoid impingement syndrome is a less common cause of shoulder pain. Symptoms are presumed to occur when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus [7]. This causes tend- inosis and pain in the soft tissues. The causes are classiﬁed as idiopathic, traumatic, or iatrogenic, (Table 1) [8–10]. Diagnosis The syndrome is most common after a history of chronic overuse with multiple episodes of microtrauma, especially when the shoulder is persistently in a forward-elevated, adducted and internally rotated position [8]. Patients with this syndrome typically present with a history of dull pain in the anterior aspect of the shoulder that is exacerbated by activities performed when the shoulder is in a forward ﬂexed, adducted and internally rotated position [11]. The diagnosis of coracoid impingement has not been extensively studied, and it remains a diagnosis of exclusion based on the ﬁndings of the physical examination, the results of injections, and radiographic features [10]. It is