A 35-Year-Old Male with Shoulder Pain After a Fall

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).

View More Shoulder Pain Cases

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