[Duplication of the acromioclavicular joint: A case dating from the end of the 19th century]. / Duplication de l'articulation acromio-claviculaire : un cas datant de la fin du 19e siècle.

The duplication of the acromioclavicular joint is a very rare anomaly of shoulder girdle. Here, we present a new case of unilateral duplication of the acromioclavicular joint observed on an individual from the 19th century. In the literature, two hypotheses are proposed to explain the origin of this anomaly. The first is a congenital origin that could be explained by in utero displacement of one of the clavicle's primary ossification centers, or the existence of an additional ossification center. The second is a traumatic origin resulting from an acromioclavicular fracture that occurred during the growth period of the individual. Our macroscopic observations and CT-scan images show no sign of a healed fracture, of complications, or of a bone callus after healing. The hypothesis of a congenital origin for this acromioclavicular duplication is therefore preferred.

Unilateral duplication of the acromioclavicular joint: case report and literature review.

Clavicle duplication is a rare anatomical variation of the scapular belt: only seven cases have been reported in the literature to date, and only one took note of the existence of a duplication of the acromioclavicular joint. Two hypotheses have been proposed to interpret this variation: genetic factors, or trauma occurred in the growth period. Clavicle duplication should not be mistaken for a quite frequent coracoclavicular joint widely described. The authors report the case of a left acromioclavicular joint duplication in a 51-year-old male patient presenting with left shoulder pain. This case was the first of literature providing 3D CT-scan images.

Symptomatic coracoclavicular joint: incidence, clinical significance and available management options.

PURPOSE: Coracoclavicular joint (CCJ) is a rare anomalous joint occasionally found between the coracoid process of scapula and the conoid tubercle of clavicle. The articulation has been extensively studied by means of anatomical, osteological and radiological investigations. Most cases are discovered incidentally, with the symptomatic variety remaining an exceptional rarity. Our aim was to review all reported symptomatic CCJ to increase the level of evidence and formulate a treatment algorithm to aid clinicians in management planning. METHODS: A thorough literature search was performed, and data from 17 (n = 17) symptomatic cases of CCJ were analysed. RESULTS: CCJ is a rare finding and mostly an incidental discovery, which is rarely symptomatic. However, when symptomatic, the most common symptom is shoulder pain. The mean age at presentation is 42 years, with a male:female ratio of 1.4:1. Brachial plexus involvement was the most common pathophysiological explanation provided. First-line treatment was conservative, with a very low success rate of 5.9%. Surgical intervention in the form of excision of anomalous joint by osteotomy had success rate of 100%. CONCLUSIONS: Symptomatic CCJ is rare, and its rarity leads to lack of awareness in the general orthopaedic community. When symptomatic, CCJ may lead to delayed diagnosis or inappropriate management due to lack of evidence and poor description in most orthopaedic textbooks. Despite its low success rate, conservative treatment is advocated before embarking upon surgical intervention.

Coracoclavicular and costoclavicular joints at a common juncture: a rare phenomenon / Articulaciones coracoclavicular y costoclavicular en una unión común: un raro fenómeno

Movements at the human shoulder girdle are the result of complex interplay of glenohumeral, acromioclavicular, sternoclavicular and scapulothoracic articulations. Clavicle apart from articulating with the scapula and sternum is also connected with first rib by costoclavicular ligament and with coracoid process by coracoclavicular ligament. At times the area of attachment of these ligaments on clavicle, first rib and scapula show faceted apophysis suggesting the presence of additional diarthrodial articulations. Costoclavicular joint exists between clavicle and first rib and coracoclavicular joint between clavicle and coracoids process. Both these joints are described in the literature, but the concurrent occurrence of them in the same bone has not been reported yet. We found two clavicles, one of right and other of left side, both of them showed faceted apophysis for costoclavicular and coracoclavicular joint simultaneously, which is rare phenomenon.

Los movimientos de la cintura escapular humana son el resultado de la interacción compleja de las articulaciones glenohumeral, acromioclavicular, esternoclavicular y escapulotorácica. La clavícula, aparte de la articulación con la escápula y el esternón también está conectada con la primera costilla por el ligamento costoclavicular y con el proceso coracoides por el ligamento coracoclavicular. A veces la zona de unión de estos ligamentos de la clavícula, la primera costilla y la escápula muestran procesos facetarios que sugieren la presencia de nuevas articulaciones diartrodiales. La articulación costoclavicular existe entre la primera costilla y la clavícula y la articulación coracoclavicular entre la clavícula y proceso coracoides. Ambas articulaciones están descritas en la literatura, pero la aparición simultánea de ellas en el mismo hueso no se ha informado aún. Se encontraron dos clavículas, uno del lado derecho y otra del lado izquierdo, las dos presentaron procesos facetarios para las articulaciones costoclavicular y coracoclavicular simultáneamente, lo cual es un fenómeno raro.

Articulación coracoclavicular. Caso clínico y revisión / Coracoclavicular joint. Case report and review

Objetivo: Presentar un caso de articulación coracoclavicular. Se hace una revisión bibliográfica sobre el tema. Caso clínico: Varón de 56 años que presenta una luxación escapulohumeral izquierda que presentaba además una articulación coracoclavicular izquierda. Discusión: Es un anomalía presente en el 0,6–30% de los casos y se discute si es congénita o adquirida o si determinadas características morfométricas de la clavícula y de la escápula pueden predisponer a su desarrollo. Generalmente es asintomática y se descubre casualmente con la imagen. Los casos sintomáticos se tratan con infiltraciones y raramente será necesaria su extirpación. Conclusión: La articulación coroclavicular no es una anomalía infrecuente (AU)

Objetive: A literature review is made in reference to the presentation of a case of coracoclavicular joint. Clinical case: A 56-year-old male presented with left scapulohumeral luxation. The X-ray study moreover revealed the presence of a left coracoclavicular joint. Discussion: The described anomaly is present in 0.6-30% of all cases, depending on the literature source. Discussion focuses on whether the joint is congenital or acquired, and on whether certain morphometric characteristics of the clavicle and scapula predispose to its development. The condition is generally asymptomatic, and constitutes a casual radiological finding, though symptoms can also develop. Symptomatic cases are treated with infiltrations, and resection is rarely necessary. Conclusion: A coracoclavicular joint is not a rare anomaly (AU)

Limb-threatening ischemia secondary to a congenital acromioclavicular remnant.

Upper extremity vascular compromise from thoracic outlet syndrome is rare and is usually the result of a "cervical rib," anterior scalene muscle abnormality, or clavicular trauma. We report a case of acute axillary artery thrombosis secondary to a congenital acromioclavicular remnant in a 40-year-old woman.

Congenital pseudoarthrosis of the clavicle: is operative treatment necessary? A report of four cases and literature review.

Congenital pseudoarthrosis of the clavicle (CPC) is not a common condition. The exact number of cases reported in literature is fewer than two hundred. We present four well-documented cases of true congenital pseudoarthrosis of the clavicle, including two cases of familial occurrence. None of the patients in this study were treated surgically. Evaluation of upper extremity function was done with use of the Constant-Murley method. In spite of clavicle pseudoarthrosis the score results were similar to the unaffected shoulder. Although vertical elevation of the upper ribs or cervical ribs has been suggested as a cause of congenital clavicle lesions, radiological examination failed to reveal such pathology in any of the patients described here. Clavicle pseudoarthrosis is generally regarded as a benign condition. The majority of patients who underwent surgery because of cosmetic or functional heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of their CPC and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.

Bilateral congenital coracoclavicular joint. Case report and review of the literature.

The diagnosis of coracoclavicular articulation was made in an elderly woman, who complained of bilateral anterior shoulder pain with impingement. This congenital pseudo-articulation is rarely symptomatic and is usually an incidental radiological finding. Surgical excision of the prominent bony projection, arising from the inferior surface of the clavicle at the level of the coracoid process, relieved the impingement and gave satisfactory pain relief.

Luxaçäo acromioclavicular do tipo III de Rockwood: reduçäo incruenta e fixaçäo percutânea / Rockwood type III acromioclavicular dislocation: close reduction and percutaneous fixation

Vinte e cinco pacientes com luxaçäo acromioclavicular do tipo III de Rockwood foram submetidos a reduçäo incruenta e fixaçäo percutânea com fios de Kirschner. O seguimento variou de 1 a 6 anos, com tempo médio de 3 anos e 10 meses. As idades estavam compreendidas entre 19 e 69 anos, com média de 35 anos. Todos os pacientes foram imobilizados no pós-operatório por período médio de 6 semanas. Oito pacientes cursaram com complicaçöes durante o tratamento, sendo estas tratadas ambulatorialmenttte. Os resultados clínicos, avliados segundo os critérios de Imatani modificados por Kumar, evidenciaram 88 por cento de excelentes e 12 por cento de bons resultados, näo havendo regulares ou ruins. A avaliaçäo radiológica mostrou-se normal em 12 por cento, subluxaçäo em 76 por cento e luxaçäo em 12 por cento dos pacientes. Os autores ressaltam a importância dessa técnica por sua eficiência, segurança, simplicidade, baixo custo, baixa morbidade, baixa incidência de complicaçöes, pronta recuperaçäo da mobilidade do ombro e satisfaçäo pessoal do paciente.

Oto-onycho-peroneal syndrome: confirmation of a syndrome.

We report two sibs with a similar syndrome of abnormal external ears, peculiar facial features, nail hypoplasia, a bilateral fibrous fusion of the outer third of the clavicle and the scapular spine, and the absence of a normal acromioclavicular joint. The present patients represent the fourth and fifth cases of the oto-onycho-peroneal syndrome (MIM 259780).

Os acromiale: anatomy and surgical implications.

We examined 270 scapular bones and found an incidence of os acromiale of 8.2%. In most cases, the free fragment was approximately one-third of the overall length of the acromion, and included the acromioclavicular facet and the principal areas of attachment of the coracoacromial ligament. Two-thirds of the specimens showed a distinctive pattern of osteophytic lipping. Based on this study, we devised operative procedures for symptomatic patients, and operated upon seven, with good results in six.

Congenital and developmental anomalies of the shoulder girdle.

An understanding of congenital and developmental anomalies of the shoulder girdle is facilitated by a knowledge of embryology, physeal appearance and closure, and phylogenetic changes. Scapular, clavicular, and proximal humeral anomalies are classified and discussed with reference to diagnosis and management. Finally anomalies of the shoulder girdle musculature are delineated.