European Journal of Cardiovascular Medicine

In the last 20 yrs, Coracoacromial arch impingement syndrome has become an increasingly common diagnosis for patients who have a painful shoulder. However, subacromial impingement syndrome is a specific diagnosis and is not the only cause of pain in the anterosuperior aspect of the shoulder. Impingement may be difficult to diagnose because the clinical presentation may be confusing. It is important to differentiate subacromial impingement syndrome from other conditions that may cause symptoms in the shoulder, such as glenohumeral instability, cervical radiculitis, calcific tendinitis, adhesive capsulitis, degenerative joint disease, isolated acromion-clavicular osteoarthrosis and nerve compression.

The Shoulder joint is the multiaxial ball and socket type of synovial joint. The Joint in between head of the humerus and glenoid cavity of the scapula. The acromion process, coracoacromial ligament (C-A) and coracoid process constitute coraco-acromial arch. Over the past many years, shoulder impingement syndrome has become frequently most common problem (Uhthoff & Sarkar 1990)¹.

 Charles Neer states the concept of shoulder impingement syndrome in his paper published in 1972². The term shoulder impingement is nothing but that describes pain in the shoulder region as a result of mechanical ‘impingement’ of the rotator cuff as it passes under the coraco-acromial ligament. If it is left untreated rotator cuff impingement may progress to partial or complete rotator cuff tendon rupture. Common causes of impingement are Anatomical, Traumatic, Degenerative and vascular.in that Anatomical causes due to acromion and coracoid process. Supraspinatus outlet is a space formed by the acromion, acrominoclavicular joint, and coracoacromial arch.the supraspinatus tendon runs through this outlet³.

Radiographs are often the first imaging examination performed on an individual with a suspected shoulder abnormality, and the complex anatomy of the shoulder has lead to the development of numerous radiographic views and techniques, each designed to optimize the evaluation of specific parts of the shoulder girdle. Knowledge of the standard views that are available, as well as the advantages and disadvantages of each projection, will aid in optimizing the radiographic evaluation based on the clinical presentation and suspected abnormality. the most common views of the shoulder are A-P view and Supraspinatus outlet view. Radiographs are not much expensive and give the clear idea of diagnosis of impingement within a short time.

Radiological evaluation is suggested after prolonged symptoms (over six weeks) to rule out rotator cuff tears (Sharma, Morrison et al.⁴2013; Diercks, Bron et al.⁵ 2014). Plain radiographs remain the start of any imaging evaluation for virtually all shoulder pathologies (Willick and Sanders⁶ 2004; Sharma, Morrison et al.⁴. 2013). Radiographs are taken to evaluate osseous abnormalities of the coracoacromial arch or osteoarthritis (Harrison and Flatow⁷ 2011). Routine radiographs include anteroposterior (in external and internal rotation), glenohumeral, axillary, and the scapular Y view (Willick and Sanders⁶ 2004; Harrison and Flatow⁷ 2011 Sharma, Morrison et al.⁴. 2013).

• Type of study- Prospective study.
• Sample size-

1. 100 A-P and& 100 supraspinatus outlet view radiograph of shoulder joint with shoulder pain patient.
2. 30 AP and & 30 Supraspinatus outlet view radiograph of shoulder joint of normal Individuals.

• Inclusive criteria-

Patients above age 18yr who attended orthopaedic OPD for shoulder pain.

• Exclusive criteria-

1. Patient with surgery on shoulder.
2. Patient with inflammatory diseases of shoulder joint.
3. Patient with congenital abnormality of shoulder joint.

• Study procedure –

1. Written Consent in English and in Marathi.
2. Detail history
3. Acromion- distance- (ad)-

• Y1 and Y2 angles-
• All the data obtained were subjected to statistical analysis.
• Method-

For, the present study, we studied 200 radiographs of shoulder joint (100 AP view and 100 supraspinatus outlet view) of patients with shoulder pain who are above age 18yr and attended orthopedic OPD for shoulder pain and 60 radiographs (30 AP view and 30 supraspinatus outlet view) of normal individuals.

1. Acromion- distance- (ad)-

The coraco-acromial ligament (C-A ligament) The distance have taken between tip of acromial process and the tip of the supra-glenoid tubercle.

• Y1 and Y2 angles-

 These angles will measured after construction of “Scapular Y” (Rubin S.A. et al. 1974)⁸. A reference line will draw by joining the mid points of glenoid cavity and the supra- glenoid tubercle. This reference line will take as body of the “Y”, the arms being the root of the coracoid process and base of the acromial spine.

1. Y1 angle- It is the angle between the reference line and the midline of root of the coracoid process representing the slope.
2. Y2 angle- It is the angle between the reference line and the midline of base of the spinous process.

All the data obtained were subjected to the statistical analysis.

Figure 1: Shows Y1, Y2 angle and ad distance       Figure 2: Shows Y1, Y2 angle and ad distance

Table no.1: Study of Y1 and Y2 angle on radiographs of Male and female normal Individuals

Graph No. 1: Angle of radiDographs according to Male and female Normal patients

Table no.2: Study of Y1 and Y2 angle on radiographs of Male and female shoulder pain Patients

Graph No. 2: Angle of radiographs according to Male and female in shoulder pain patients

Earliest illustration of such a lesion that Mosely H, F⁹ (1969⁾ found was in “Thesis” of Monroe presented in paris 1788, entitled “All the bursae, mucosae of the humen body.”¹⁰

The late Dr. Codman A.E¹¹.(1934) described one of the major causes of painful shoulder, namely rupture of supraspinatus tendon. Dr. Codman must receive the credit for describing the clinical picture of these injuries in his scientific papers and his masterpiece” The Shoulder”. (1934)¹¹.

In present study angle of radiographs according to male and female shoulder pain patient’s mean Y1 angle in male patient’s is 124.50, mean Y1 angle in female patients is 120.06, mean Y2 angle in male is 138.33, mean Y2 angle in female patient’s is 138.30, p-value for Y1 angle is 0.0066 which is significant and p-value for Y2 angle is 0.0001 is also significant.

Also, an angle of radiographs according to male and female normal patients mean Y1 angle in male patient’s is 122.66, mean Y1 angle in female patient’s is 121.26, mean Y2 angle in a male is 134.66, mean Y2 angle in female patients is 138.87, the p-value is 0.031 which is not significant.

In the present study, Y1 and Y2 angle of male shoulder pain patient's radiographs are slightly greater than Y1 and Y2 angle of female shoulder pain patient’s radiographs and which is significant.

In present study Y1 angle of male normal patient's radiographs is slightly greater than the Y1 angle of normal female patient’s radiographs but the Y2 angle of male normal patients radiographs is less than the Y2 angle of female normal patients radiographs and which is not significant.

 We did not get any other workers work on the above parameters.

1. Y1 and Y2 angles are greater in shoulder pain patients radiographs than normal patient’s radiographs.
2. Y1 and Y2 angles are greater in male shoulder pain patients radiographs than female shoulder pain patient’s radiographs. But in normal patients radiographs Y1 angles are greater in male patients radiographs than female patient’s radiographs. but Y2 angles are greater in female patients radiographs than male patient’s radiographs.

We did not get any other workers work on the above parameters. So this study takes for Consideration

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