Surgical excision of a symptomatic congenital coracoclavicular joint

The coracoclavicular joint is a rare anatomic variant that consists of an articulation between the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula. The coracoclavicular joint is most often asymptomatic and is found incidentally. A symptomatic coracoclavicular joint is exceedingly rare, with only 17 cases reported from 1915 to 2009. Symptoms may include limited range of motion, paresthesia, and brachialgia with radiation to the ipsilateral extremity. In the case of symptomatic coracoclavicular joints for which treatment data are reported, the response to conservative management with rest, analgesics, and physical therapy has been poor. Operative management resulted in complete resolution of symptoms in most patients and symptomatic improvement in the rest. This article reports the case of a 63-year-old man who presented with chronic left anterior shoulder pain exacerbated by forward flexion and overhead activities. Radiographs and computed tomography scan of the affected shoulder showed a bony articulation between the clavicle and the coracoid process of the scapula. The patient did not achieve long-term relief through conservative measures and corticosteroid injections, so the joint was surgically excised by an open procedure. Intraoperative findings were significant for a fully formed synovial joint with a capsule articulating between the clavicle and the coracoid process. After resection, the patient had minimal residual pain, improved range of motion, and symptomatic improvement with activity. The current case provides further data that the coracoclavicular joint can be the cause of significant shoulder pain and can be treated successfully with total resection of the joint if symptoms do not improve with conservative non-operative measures.