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 Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 81-85

A study of coracoclavicular joint in South Indian population


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 Publication23-Jan-2020

Correspondence Address:
Umapathy Sembian
Assistant Professor, G-1, Staff Quarters, Chennai Medical College Hospital & Research Centre, Irungalur, Trichy - 621 105
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


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 Jan 22];1:81-5. Available from: http://www.njca.info/text.asp?2012/1/2/81/298011




  Introduction Top


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[1] and the articular surfaces are not congruent[2].

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%[3],[4],[5]. 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[6], cervicobrachial syndrome[7] and decrease in movements.

So we took this study to establish the prevalence of CCJ in south Indian population.


  Materials and Methods: Top


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[8]. 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 Top


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].
Figure 1: Overall view of shoulder girdle complex

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Figure 2: Forceps pointing ACJ & CCJ

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Figure 3: Forceps pointing CCJ

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Figure 4: Showing articular surfaces on the coracoid process

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  Discussion Top


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[2],[5] and between 0.55% - 21% according to radiological studies[9],[10],[11],[12].

The CCJ is known to occur more frequently unilaterally than bilaterally according to studies by different authors: 0.49% unilaterally versus 0.06% bilaterally[11], 5.02% unilaterally versus 4.58% bilaterally[1]. Cho et al[4] 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[11].

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[13] observed the presence of a CCJ in three out of ten cadavers studied. Nutter[14] found the joint to be present in 12 out of 1000 radiological pictures with a frequency of 1.2%. Wertheimer[15] found two cases of the joint out of a total of 277 radiographs examined, an incidence of 0.72%.

According to Hall[10] 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[16] 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[17]. The percentage incidence in the South African population being 9.6% is comparable with the 9.7% incidence reported by Kaur & Jit[2] 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[18], 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[10] 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[19] 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[2] 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[1] 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[4].

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 Top


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 Top

1.
Nalla S, Asvat R. Incidence of the coracoclavicular joint in South African population. J Anat. 1995; 186:645-9.  Back to cited text no. 1
    
2.
Kaur H, Jit I. Brief communication: coracoclavicular joint in North west Indians. Am J Phys Anthropol. 1991; 85 (4): 457-60.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
    
4.
Cho BP, Kang HS. Articular facets of the coracoclavicular joint in Koreans. Acta Anat. 1998; 186; 85: 457-60.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
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.  Back to cited text no. 6
    
7.
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.  Back to cited text no. 7
    
8.
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.  Back to cited text no. 8
    
9.
Frasseto F. Tre casi di articulazione coraco- claviculare osservati radiograficamente sul vivente. Chir org mov. 1921; 5 :116-124.  Back to cited text no. 9
    
10.
Hall FSJ. Coracoclavicular joint- A rare condition treated successfully by operation. Br Med J .1950:766768.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
    
12.
Fischer L, Vuillard P, Blanc JF, Bouchet A. L’articulation coracoclaviculaire. Lyon Med. 1971; 225:1257-1260.  Back to cited text no. 12
    
13.
Poirier P. La clavicule et ses articulations. Journal 1’ Anatomie, Paris. 1890 ;26 : 81-103.  Back to cited text no. 13
    
14.
Nutter PD. Coracoclavicular articulations. J Bone Joint Surg. 1941 ;23: 177-9.  Back to cited text no. 14
    
15.
Wertheimer LG Coracoclavicular joint. J Bone Joint Surg. 1948 ; 30A: 570-578.  Back to cited text no. 15
    
16.
Lewis OJ. The coracoclavicular joint. J Anat. 1959; 93 : 296-303.  Back to cited text no. 16
    
17.
Ray LJ, Bilateral coracoclavicular articulations in the Australian Aboriginal. J Bone Joint Surg. Br. 1959; 41: 180-84.  Back to cited text no. 17
    
18.
Pillay VK. The coracoclavicular joint. Singapore Med J. 1967;8: 207-13.  Back to cited text no. 18
    
19.
Cockshott WP. The coracoclavicular joint. Radiol. 1979; 131: 313-6.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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