Coracoid Process

FIGURE 49.22 (a) A plot of the tips of the acromion and coracoid process on roentgenograms taken at successive... 

Tilt Depends on joint Depends on joint Term used to describe certain movements of the scapula and pelvis. In the scapula, an anterior tilt occurs when the coracoid process moves in an anterior and downward direction while the inferior angle moves in a posterior and upward direction. A posterior tilt of the scapula is the opposite of an anterior tilt. In the pelvis, an anterior tilt is rotation of the anterior superior spines (ASISs) of the pelvis in an anterior and downward direction a posterior tilt is movement of the ASISs in a posterior and upward direction. A lateral tilt of the pelvis occurs when the pelvis is not in level from side to side, but one ASIS is higher than the other one. 

The ossification centres for the acromion and coracoid processes may be mistaken for fractures. The acromion process may develop in two parts. 

Fig. 7.9. Large, unfused ossification centre for the coracoid process in an adolescent (arrow)...

With an anterior dislocation the humeral head lies under the coracoid process on the AP radiograph (Fig. 17.5). The Y view shows the head to be displaced... 

Carter C, Sweetman R (1960) Recurrent dislocation ofthe patella and of the shoulder their association with familial joint laxity. J Bone Joint Surg (Br) 42 721-727 Comhalia A, Arandes JM, Alemany X, Ramon R (1995) Acromioclavicular dislocation with epiphyseal separation of the coracoid process report of a case and review of the literature. J Trauma 38 812-815 Curtis RJ (1990) Operative management of children s fractures of the shoulder region. Orthop Clin North Am 21 315-324... 

The cephalic vein, a conunon venous access site for pacemaker implantation, drains directly into the axillary vein just superior to the pectoralis minor. The axillary vein is an excellent site for venous access, but is usually not considered because it is a rather deep structure. The surface landmarks of note are the infraclavicular space, deltopectoral groove, and the coracoid process. 

Fig. 4.19 Deep (A) and superficial (B) anatomic relationships of the Magney approach to subclavian vena puncture. Point M indicates the medial end of the clavicle. X defines a point on the clavicle directly above the lateral edges of the clavicular/subclavius muscle (tendon complex). Rl. Point D overlies the center of the subclavian vein as it crosses the first rib. St, the center of the sternal angle Cp, coracoid process Ax, axillary vein star, costoclavicular ligament open circle with closed circle, costoclavicular ligament open circle with closed circle inside, costoclavicular ligament sm, subclavius muscle. The arrow points to Magney s ideal point for venous entry. (Magney JE, Staplin DH, Flynn DM, et al. A new approach to percutaneous subclavian venipuncture to avoid lead fracture or central venous catheter occlusion. Pacing Clin Electrophysiol 1993 16(11) 2133-2142, with permission.)...

The humerus is the long bone of the upper arm and at its proximal end is a neck with a smooth, round head that is covered with cartilage and forms one articulating surface of the true shoulder joint. The scapula is a flat, triangular bone overlying the ribs posteriorly. Easily palpable are its borders, spine posteriorly, coracoid process anteriorly, and the acromion process supero-laterally. 

The two functional joints in the shoulder girdle are the suprahumeral joint and the scapulothoracic joint. As mentioned, both figure prominently in shoulder biomechanics and pathology. The suprahumeral joint is formed by the articulation of the head of the humerus with the coracoacromial arch, composed of the acromion, the coracoid process, and the ligament between them. Articulation occurs during abduction. 

Short head of biceps inferolateral to the coracoid process... 

After the biceps has been examined, the patient is asked to rotate the arm externally in order to evaluate the subscapularis tendon on the anterior aspect of the shoulder. This maneuver stretches the subscapularis and helps to move its tendon from underneath the coracoid process into a more superficial position for an adequate examination (Fig. 6.25). Dynamic scanning during passive internal and... 

Fig. 6.28a,b. Short head of the biceps tendon, coracobrachialis and pectoralis minor. a,b Transverse 12-5 MHz US images obtained a at the level of the coracoid process of the scapula and b approximately 2 cm caudal to it. In a, the relationship of the coracoid (Co) with the humeral head (HH), the subscapularis tendon (SubS) and the deltoid muscle are illustrated. The coracoid is easily identified with US owing to its medial position relative to the humeral head and the curvilinear hyperechoic appearance of its bony surface. In b, three individual structures are seen arising from the coracoid. From lateral to medial, they are the hyperechoic tendon of the short head of the biceps (curved arrow), the hypoechoic myotendinous junction of the coracobrachialis (straight arrow) and that of the pectoralis minor (arrowheads)... 

Fig. 6.67a,b. Anterior shoulder instability, a Chronic anterior instability in an elderly patient. Note the anterior dislocation of the humeral head (HH) relative to the acromion (Acr) and the coracoid (asterisk).b Anterior glenohumeral dislocation, subcoracoid type. Anteroposterior radiograph demonstrates anterior displacement of the humeral head, which appears located inferior to the coracoid process. A Hill-Sachs deformity is present (arrow)... 

Ogawa K,Yoshida A,Takahashi M (1997) Fractures of the coracoid process. J Bone Joint Surg Br 79 17-19 Pancione L, Gatti G, Mecozzi B (1997) Diagnosis of Hill-Sachs lesion of the shoulder comparison between ultrasonography and arthro-CT. Acta Radiol 38 523-526... 

The anterior compartment of the arm houses three muscles the coracobrachialis, the biceps brachii and the brachialis (Fig. 7.2). The coracobrachialis takes its origin from the tip of the coracoid process, medial to the insertion of the short head of the biceps, and continues down and laterally to insert onto the medial aspect of the middle third of the humeral shaft. The biceps brachii is formed by a combination of two muscle bellies the long head and the short head. As already described in Chapter 6, the long head originates from a long tendon which... 

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