Prevalence, risk factors, and outcomes of patients with coracoid-based pain after reverse total shoulder arthroplasty

Coracoid-based pain is an underrecognized complication after reverse total shoulder arthroplasty (RTSA). The purpose of this study was to determine the prevalence, risk factors, and outcomes of patients with coracoid pain after RTSA.

A case-control study was performed. Patients with coracoid or conjoint tendon tenderness at least 3 months after RTSA were included as cases. Controls without surgical complications and with a minimum 1-year follow-up were matched 3:1 to cases. Patient-reported outcomes were collected retrospectively. Multivariable logistic regression was used to identify risk factors for the development of coracoid pain.

67 patients developed coracoid-based pain at a mean time of 10.0 months (range, 3-72 months) after RTSA. The overall prevalence over a 10-year period was 1.0%. Symptoms completely resolved in 33 (49%) patients at a mean time of 4.9 months (range, 1-15 months) with non-operative treatment. On multivariate analysis, osteoporosis, a decreased subcoracoid distance, more anterior glenosphere overhang, and less calcar distalization were significant predictors of coracoid pain.

Coracoid pain is uncommon and tends to completely resolve in 49% of patients with non-operative measures. It is associated with surgeon factors that decrease the subcoracoid space and humeral arc to impingement.