Differential Diagnosis

  • AC joint sprain
  • Clavicle fracture
  • Glenohumeral dislocation
  • Displaced coracoid fracture
  • Os acromiale

Diagnosis

The shoulder series reveals a displaced coracoid fracture (red arrow), as well as widening of the acromioclavicular (AC) joint interval (yellow arrow) with slight elevation of the distal clavicle.

Background

  • This injury is uncommon, but is relatively often associated with acromial, clavicular, or other scapular fracture, glenohumeral dislocation, or acromioclavicular joint injury
  • Coracoid fractures are classified into five types:1
    • Type I – Tip or epiphyseal fracture
    • Type II – Mid-process fracture
    • Type III – Basal fracture
    • Type IV – Fracture extending to the superior body of the scapula
    • Type V – Extending to the glenoid fossa

Pearls for Urgent Care Management

  • Initial treatment involves immobilization with a sling for comfort and treatment for pain as well as referral to an orthopedist for further evaluation
  • The coracoid process is an important shoulder stabilizer, and surgical management may be necessary for displaced fractures to avoid painful nonunion, especially in younger patients
  • Scapular fractures imply a high-energy mechanism of injury and are often associated with other significant injuries/fractures. Exposing the entire neck, chest, and abdomen is important when a scapular fracture is identified to evaluate for additional injuries

References

  1. Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg. 2012;72:E20–E26.

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).

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