Subacromial-coracoid conflict ❉ Etiology This syndrome is observed in handball players who engage in violent exercises with weights(weight training) or strikes (shots). It results from a conflict between the subdeltoid bursa, thetendons of the rotator cuff and the acromion-coracoid vault made up of the acromion and theacromio-coracoid ligament. This ligament does not present any specific function in modernman. It appears as a remnant from the late Cretaceous period when the scapula andcoracoid were two separate bones connected by this structure. The conflict originates fromrepetitive arm abduction movements such as those practiced for throwing. Exceptional inchildren, acromion-coracoid syndrome is encountered in high-level adolescents undergoingintensive training or in "retired" athletes during a fall on the stump of the shoulder or a Wrongmove. ❉ Diagnosis . Physical examination The condition is manifested by pain in the shoulder located on itsantero-superior part, very intense during the abduction movement responsible for theligament damage, gradually stiffening the shoulder "cold". During acute attacks, passiveabduction can be painful from 0° to 0°. The pain is increased by the opposed descent of thearm (pigment). The clinical examination makes it quite easy to make the diagnosis. Thehumero-ligamentous conflict is revealed by an anterior elevation of the arm to 0° withpassive movement in forced internal rotation (in external rotation, the pain disappears). .Radiological examination It is almost never necessary to prescribe additional tests other thanstandard radiography (ultrasound, MRI, arthroscopy, etc.). Frontal radiography (neutralposition, internal and external rotations, and arm abduction) allows visualization of the rise ofthe humeral head. ❉ Treatment The proposed treatment will depend on the time elapsed between the start of the lesion and the examination of the subject. . If the subject is seen early the treatment willbe short-lived (2 to 3 weeks), and the excellent prognosis. He will understand: - Prescriptionof oral anti-inflammatories. - The use of local anti-inflammatories (physiotherapy). - The initiation of gentle rehabilitation of the shoulder, which will be followed during recoveryby a possible modification of the training and the sporting gesture (if the lesion ismicrotraumatic). During this period the patient will keep his shoulder at rest, the recoveryonly taking place gradually. . treatment will take much longer. Indeed, this conflict is often complicated by chronicphenomena such as adhesive capsulitis of the shoulder, neuro algodystrophy, and
degenerative damage to the supraspinatus. Initially, the proposed treatment could be of thesame type (we will only replace local NSAIDs with calcitonin ionizations).Secondly, the physiotherapist will work along two axes: If the patient is examined later (two,three, or even six months, etc.), the duration of the - Decoaptation of the humeral head -Fight against retractions The second phase of rehabilitation may require the injection of acorticosteroid (Altim R) into the joint cavity. No infiltration will be offered at the level of thesupraspinatus tendon or of the acromio-coracoid ligament. If this treatment fails, it willsometimes be necessary to free the shoulder by resection of the acromio-coracoid ligament.