What can a physiotherapist do for coracoid impingement?

Q: My orthopedic surgeon thinks I have something called coracoid impingement.  She wants me to see a physical therapist before considering surgery.  What can a therapist do for this problem?

A: The coracoid process is a small hook-like structure at the top front part of the scapula (shoulder blade). The coracoid process works together with the acromion to stabilize the shoulder joint

The acromion is a curved piece of bone that comes from the back of the shoulder blade around and over the top of the shoulder joint. Muscles and tendons of the rotator cuff slip underneath the coracoid and the acromion to attach to the humerus (upper arm bone). Some ligaments stretch between the coracoid process and the acromion.

Pinching of the soft tissue structures by the coracoid process is referred to as coracoid impingement. The patient's first inkling that something is wrong is a dull, aching pain along the front of the shoulder. As the arm moves forward and up, across the chest, or internally rotates, the coracoid pinches against the subscapularis tendon, subcoracoid bursa, and/or the biceps tendon.

Coracoid impingement is an uncommon problem and rarely occurs alone without some other change in the nearby anatomic structures contributing to the problem. For example, rotator cuff tears or degeneration or an unusual shape or length of the coracoid bone can lead to coracoid impingement. Calcium build up in the subscapularis bone or the formation of a ganglion cyst can also cause impingement in this area.

Conservative (nonoperative) care is possible for this problem. In fact, this is the first-line of treatment before doing surgery. A physical therapist will work with you to restore normal posture and shoulder stability. This may involve a strengthening program for the rotator cuff, and taping of the scapula and shoulder (called kinesiotaping).

Kinesiotaping is used to place the shoulder in the right position and re-teach the muscles to hold and move properly. The result is to take pressure off the subcoracoid soft tissues and prevent impingement.

Any areas of scar tissue or tightness may be treated with manual therapy and stretching exercises. The physiotherapist will evaluate how you move and any compensatory patterns of movement you may have developed as a result of anatomic changes or soft tissue injuries or degeneration. Activity modification may be required at home during daily activities, at work, and during recreational or sports activities.

A conservative program that is successful can save you the time, expense, and need for long-term rehab required with shoulder surgery. Although the patient is required to participate and do a home program, rehab of this type is well worth your time and can potentially prevent surgery.

If it turns out you still need surgery, you will go into the procedure stronger and in better alignment. That will help ensure a better response to surgery and possibly faster recovery as well. Give it a try and let us know how you do!

Reference: Michael Q. Freehill, MD. Coracoid Impingement: Diagnosis and Treatment. In Journal of the American Academy of Orthopaedic Surgeons. April 2011. Vol. 19. No. 4. Pp. 191-197.