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Coracoclavicular – Anatomy, Ligament & Injuries

Coracoclavicular refers to the anatomical connection between the coracoid process of the scapula and the clavicle. The coracoclavicular ligament is essential for shoulder joint stability.

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Things worth knowing about "Coracoclavicular"

Coracoclavicular refers to the anatomical connection between the coracoid process of the scapula and the clavicle. The coracoclavicular ligament is essential for shoulder joint stability.

What Does Coracoclavicular Mean?

Coracoclavicular is a medical term referring to the anatomical relationship between the coracoid process of the scapula (shoulder blade) and the clavicle (collarbone). The term is derived from the Greek word korakoeides (raven-beak-shaped) and the Latin clavicula (little key, i.e., collarbone).

Anatomy of the Coracoclavicular Ligament

The coracoclavicular ligament (Ligamentum coracoclaviculare) connects the coracoid process of the scapula to the underside of the clavicle. It consists of two components:

Conoid ligament: The medial, cone-shaped portion that primarily resists vertical forces.
Trapezoid ligament: The lateral, trapezoid-shaped portion that stabilizes horizontal forces.

Together, these ligaments stabilize the acromioclavicular (AC) joint and prevent excessive displacement of the clavicle relative to the scapula.

Clinical Relevance

Injuries to the Coracoclavicular Ligament

Injuries to the coracoclavicular ligament complex are commonly caused by direct falls onto the shoulder or onto an outstretched arm. They are typically classified using the Rockwood classification (also known as the Tossy classification in Europe):

Rockwood I–II (Tossy I): Sprain or partial tear of the acromioclavicular ligament; coracoclavicular ligament remains intact.
Rockwood III (Tossy II): Complete tear of the acromioclavicular ligament with partial damage to the coracoclavicular ligament.
Rockwood IV–VI (Tossy III): Complete rupture of both ligament complexes, resulting in significant instability and superior displacement of the clavicle.

Symptoms of Injury

Pain over the acromioclavicular joint
Visible or palpable step deformity at the shoulder (so-called piano key sign)
Restricted range of motion of the shoulder
Swelling and tenderness over the AC joint

Diagnosis

Diagnosis is made clinically through inspection and palpation, as well as through imaging. Standard X-rays of the shoulder in two planes are performed, often under stress (weighted views). An MRI scan can provide additional information about the condition of soft tissues and ligaments.

Treatment

Treatment depends on the severity of the injury:

Conservative treatment: For mild injuries (Rockwood I–II), management includes immobilization, physiotherapy, and pain relief measures.
Surgical treatment: For severe injuries (Rockwood III and above), surgical reconstruction of the coracoclavicular ligament complex may be necessary, using techniques such as ligament repair, ligament reconstruction, or specialized implants (e.g., TightRope procedure).

Coracoclavicular Ligament in Orthopedics and Trauma Surgery

In modern orthopedics and trauma surgery, the coracoclavicular ligament plays a central role in the assessment and treatment of shoulder injuries. Reconstruction of this ligament is a common surgical procedure in athletes and active patients to restore full shoulder function.

References

Rockwood CA, Williams GR, Young DC. Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA (eds.): The Shoulder. 2nd edition. Saunders, Philadelphia 1998.
Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. American Journal of Sports Medicine, 35(2):316–329, 2007. PubMed PMID: 17251175.
Simovitch R et al. Acromioclavicular joint injuries: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons, 17(4):207–219, 2009.

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