Subcoracoid neurovascular entrapment

A review of 19 patients with upper limb symptoms is presented; 3 patients had bilateral symptoms. The patients were young (22-44 years) and only 4 were women. The symptoms were usually precipitated by injury. Aching pain the the neck and shoulder area, upper arm and forearm, with some intermittent numbness were the main complaints. These symptoms may be aggravated or relieved by altering posture. The most constant and diagnostic physical finding was tenderness and reproduction of symptoms with pressure over the neurovascular bundle underneath the coracoid process and pectoralis minor. There are no constant positive findings on regular radiographs. Electromyography and venography were of doubtful diagnostic significance. Conservative measures were rarely curative but often alleviated some of the symptoms. These measures included local heat, and postural exercises with elevation and rotation of the shoulder forward. The neurovascular bundle was decompressed by dividing the pectoralis minor surgically in 10 limbs. This relieved the radiating symptoms in each case although mild aching pain in the shoulder had remained in 4 instances. This syndrome can be recognized clinically and may be controlled in half of the cases by conservative means. If the diagnosis is well localized, surgical release offers good relief.