|Year : 2012 | Volume
| Issue : 2 | Page : 81-85
A study of coracoclavicular joint in South Indian population
Umapathy Sembian1, M Muhil2, SD Nalina Kumari3
1 Assistant Professor of Anatomy, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamil Nadu, India
2 Associate Professor of Physiology, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamil Nadu, India
3 Professor of Anatomy, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy, Tamil Nadu, India
|Date of Web Publication||23-Jan-2020|
Assistant Professor, G-1, Staff Quarters, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy - 621 105
Source of Support: None, Conflict of Interest: None
Background: Movements taking place in the shoulder girdle is a result of complex coordinated movements between the glenohumeral, acromio clavicular, sternoclavicular and scapulothoracic articulations. Clavicle is connected with the first rib by the costoclavicular ligament apart from the sternum and scapula through sternoclavicular and coracoclavicular ligaments. Sometimes the area of attachment of these ligaments on the clavicle, first rib and scapula show faceted apophysis suggesting the presence of additional diarthrodial articulation. The incidence of Coraco- Clavicular (CCJ) joint in various populations is estimated to be ranging from 0.8% - 9.8%. Aim: The aim of our present study is to ascertain the prevalence of Coraco- Clavicular joint (CCJ) in South Indian population. Materials and methods: The present study was carried out on fifty cadavers embalmed with 10% formalin. Meticulous care was taken to include only cadavers from South Indian population. Cadavers exhibiting obscuring pathologies were excluded from the study. The dissections were carried out in all the limbs to note the presence of a diarthrotic coracoclavicular joint which is represented by the presence of an articular facet on the conoid tubercle of the clavicle & the superior surface of the coracoid process of the scapula. Results: In our study we came across a single cadaver having the coracoclavicular joint on the left side unilaterally. Conclusion: The coracoclavicular joint though a rare entity should be borne in mind as a differential diagnosis for thoracic outlet syndrome or costoclavicular syndrome and in general for shoulder pain. The present study has revealed the presence of CCJ in our population and it constitutes to only 2%.
Keywords: Clavicle, Coracoclavicular joint, Conoid tubercle, South Indian population, Trapezoid ligament
|How to cite this article:|
Sembian U, Muhil M, Nalina Kumari S D. A study of coracoclavicular joint in South Indian population. Natl J Clin Anat 2012;1:81-5
|How to cite this URL:|
Sembian U, Muhil M, Nalina Kumari S D. A study of coracoclavicular joint in South Indian population. Natl J Clin Anat [serial online] 2012 [cited 2021 Mar 7];1:81-5. Available from: http://www.njca.info/text.asp?2012/1/2/81/298011
| Introduction|| |
The shoulder girdle complex in humans is a complex structure consisting of shoulder joint, acromioclavicular joint, sternoclavicular joint and costoclavicular joints. Glenoidal labrum, joint capsule and ligaments act as static stabilizers where as muscles like deltoid, scapular muscles and rotator cuff act as dynamic supports of the shoulder girdle complex.
The Sternoclavicular and Acromioclavicular joints are the main articulations of the shoulder girdle complex. The clavicle articulates with the sternum at its medial end and laterally to the scapula at the acromioclavicular joint and the articular surfaces are not congruent.
The accessory ligaments of the joints such as the costoclavicular ligament and coracoclavicular ligament play an important role in stabilizing the joints. The acromioclavicular joint is stabilized by the coraco clavicular ligament where as the costoclavicular ligament stabilizes the sternoclavicular joint.
Sometimes the area of attachment of coracoclavicular ligament on the clavicle shows evidence of diarthrodial articulations, resulting in the formation of an anomalous joint adding up further complexity to the already complex joint.
The corococlavicular ligament consists of a conoid part and a trapezoid part and they are very thick and get attached strongly to the superior surface of the coracoid and inferior surface of the lateral end of the clavicle at the conoid tubercle and the trapezoid line. It is also worth to mention that a synovial bursa intervenes between these two parts of the coracoclavicular ligaments.
The incidence of coracoclavicular joint (CCJ) in various populations are said to be ranging from 0.8%- 9.8%,,. Furthermore it is found to be more commonly seen in Asians than in Europeans and Africans. It is also linked that the presence of CCJ is a predisposing factor for the development of arthritis in clavicles and leads to degenerative changes in other neighbouring joints too. Some authors also consider that the CCJ is associated with fracture of head of humerus, cervicobrachial syndrome and decrease in movements.
So we took this study to establish the prevalence of CCJ in south Indian population.
| Materials and Methods:|| |
The present study was carried out on fifty cadavers embalmed with 10% formalin allotted for routine undergraduate teaching at the Departments of Anatomy, Chennai Medical College Hospital And Research Centre, Trichy and Aarupadai Veedu Medical College, Puducherry.
This study extended for a period of five years (20082012). Out of the fifty cadavers, ten were of females and the rest were of male sex.
From all the cadavers the upper limbs on both sides were disarticulated after dissection. Efforts were taken to confirm whether the cadavers were from south Indian population. Limbs which exhibited obscure pathologies, fractures both during life as well as after death (during transportation), deformities, congenital anomalies, previous surgery in this region, trauma and also amputations were excluded from the study.
The dissection was carried out in all the limbs on the right and left side as per the instructions given by Cunningham’s Manual of practical Anatomy. The presence of coracoclavicular joint was confirmed by identifying the thickening of capsuloligamentous tissue around the conoid tubercle. Further whenever the coracoclavicular joint was identified it was dissected to expose its articular surfaces. The length of the clavicle was also measured to find out if there is any correlation between the length of the clavicle and the presence of coracoclavicular joint.
| Observation|| |
One hundred disarticulated limbs(fifty limbs of left side and fifty of right side) were thus studied along with the scapula and clavicle from fifty cadavers.
One specimen exhibiting coracoclavicular joint on the left side (unilaterally) was found in a male cadaver. Apart from the above finding, in the same limb an accessory Palmaris longus muscle in the flexor compartment of forearm was found.
The articular surface present on the corocoid process was round and covered by fibrocartilagenous disc where as the articular surface on the clavicle was oval shaped and covered by hyaline cartilage. [Figure 1], [Figure 2], [Figure 3] & [Figure 4].
| Discussion|| |
It is known that the CCJ is an anomalous joint, commonly observed in primates. Frequency of its occurrence in humans ranges between 0.7-10% according to osteological studies or cadaveric dissections, and between 0.55% - 21% according to radiological studies,,,.
The CCJ is known to occur more frequently unilaterally than bilaterally according to studies by different authors: 0.49% unilaterally versus 0.06% bilaterally, 5.02% unilaterally versus 4.58% bilaterally. Cho et al found the bilateral occurrence as higher at 8.8% of 9.8% overall occurrence. The radiological studies show a higher value in the study of coracoclavicular joint than those of studies with dry bones.
It is important to mention that wet specimen dissection only will reveal more accurately the existence of cartilaginous facets, often considered to be an evidence of a joint.
Poirier observed the presence of a CCJ in three out of ten cadavers studied. Nutter found the joint to be present in 12 out of 1000 radiological pictures with a frequency of 1.2%. Wertheimer found two cases of the joint out of a total of 277 radiographs examined, an incidence of 0.72%.
According to Hall only 54 cases of CCJ have been reported in the world literature, most of which have been discovered incidentally either during routine radiological examination or dissection. Lewis found the incidence of the joint to be substantially greater in males than in the females (11:1), which almost corresponds to the present study as CCJ was found in a male cadaver (limb).
The incidence of the joint was found to be 9.9% in the Japanese, and 0.7% in Australian aborigins. The percentage incidence in the South African population being 9.6% is comparable with the 9.7% incidence reported by Kaur & Jit in the North West Indian population and in the Japanese population with 9.9% incidence.
These reports by other authors are contrary to the results of the present study in which the incidence of CCJ in South Indian population was found to be very less-2% when compared to other studies including the study conducted in North west population of India.
The CCJ in the present study resembled a true joint with a complete capsule and covered with articular cartilage.
The embryological significance of this CCJ is obscure. It is said that the predisposition to this anomalous joint is transmitted by a dominant gene, whereas some authors conclude that it is an acquired condition due to changes in position of the scapula and clavicle with increasing age and it may be also due to pathological changes.
According to Hall any degenerative deformation of the CCJ may cause cervicobrachial syndrome, because of its close relationship to the brachial plexus, on the other hand, Cockshott’s study revealed that CCJ is subject to osteophytic marginal lipping and it may not create symptoms and disability.
It has been suggested that the CCJ may be a result of trauma and the joint itself has a tendency to undergo arthritic changes. A study conducted by Kaur & Jit proposed that this CCJ is not a congenital anomaly because neither of the 35 fetusus nor the 50 neonates studied by them showed the presence of this joint and they also stated that CCJ is due to genetic predisposition rather than by environmental factors.
A study conducted by Nalla et al did not show any statistically significant sexual or racial differences. They also found that individuals possessing this joint showed significantly larger scapulae, lengthier clavicle and longer first rib, but in our study we did not find any longer clavicle associated with this joint, and our observation coincides with the study of Cho & Kang.
The presence of this joint may cause shoulder pain due to neurovascular compression. Most authors consider CCJ as a rare entity and it may be the cause of shoulder pain, limitation of movements and pain radiating to mammary region, arm and neck.
This CCJ may be the cause of thoracic outlet syndrome compressing the brachial plexus apart from other causes of shoulder pain being cervical rib and costoclavicular syndrome.
The authors would like to express that the study conducted was focusing only on a small population and the results should be further confirmed by doing this type of study with more sample size and in different populations of India to come to a final conclusion as far as the Indian population is concerned.
| Conclusion|| |
The coracoclavicular joint though a rare entity should be borne in mind as a differential diagnosis for thoracic outlet syndrome or costoclavicular syndrome and in general for shoulder pain. The present study has revealed the presence of CCJ in our population and it constitutes to only 2%.
| References|| |
Nalla S, Asvat R. Incidence of the coracoclavicular joint in South African population. J Anat. 1995; 186:645-9.
Kaur H, Jit I. Brief communication: coracoclavicular joint in North west Indians. Am J Phys Anthropol. 1991; 85 (4): 457-60.
Soames RW. Skeletal system. In: Williams PL, Bannister LH, Berry MM et al. eds, Gray’s anatomy. 38th ed. Churchill Livingston. Edinburgh, 1995: 620-2.
Cho BP, Kang HS. Articular facets of the coracoclavicular joint in Koreans. Acta Anat. 1998; 186; 85: 457-60.
Gumina S, Salvatore M, Santis R, Orsina L, Postacchini F. Coracoclavicular joint: osteologic study of 1,020 human clavicles. J Anat. 2002; 201(6): 513-9.
Nehm A, Tricoire JL, Giorddano G, Rouge D, Chiron P, Puget J. Coracoclavicular joints. Reflection upon incidence, pathophysiology and etiology of the different forms. Surg Radiol Anat. 2004; 26: 33-8.
del Valle D, Giordano A. Cervico- brachial pain syndrome caused by coracoclavicular articulation. Operation healing. Rev Argent Norteam - Med Cine Med. 1943; 1:687- 93.
Romanes GJ. Upper and lower limbs. In: Cunningham’s Manual of Practical Anatomy. 15th ed. Vol 1. Oxford University Press. New York, 1993 : 67-8,74-6.
Frasseto F. Tre casi di articulazione coraco- claviculare osservati radiograficamente sul vivente. Chir org mov. 1921; 5 :116-124.
Hall FSJ. Coracoclavicular joint- A rare condition treated successfully by operation. Br Med J .1950:766768.
Olotu Joy E, Oladipo GS, Eroje MA, Edipamode IE: Incidence of coracoclavicular joint in adult Nigerian population. Scientific Research and Essay. 2008 ; 3 : 165-167.
Fischer L, Vuillard P, Blanc JF, Bouchet A. L’articulation coracoclaviculaire. Lyon Med. 1971; 225:1257-1260.
Poirier P. La clavicule et ses articulations. Journal 1’ Anatomie, Paris. 1890 ;26 : 81-103.
Nutter PD. Coracoclavicular articulations. J Bone Joint Surg. 1941 ;23: 177-9.
Wertheimer LG Coracoclavicular joint. J Bone Joint Surg. 1948 ; 30A: 570-578.
Lewis OJ. The coracoclavicular joint. J Anat. 1959; 93 : 296-303.
Ray LJ, Bilateral coracoclavicular articulations in the Australian Aboriginal. J Bone Joint Surg. Br. 1959; 41: 180-84.
Pillay VK. The coracoclavicular joint. Singapore Med J. 1967;8: 207-13.
Cockshott WP. The coracoclavicular joint. Radiol. 1979; 131: 313-6.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]