A small bursa occasionally develops between the coracoclavicular ligament complex (trapezoid and conoid ligaments) and the inferior clavicle, reducing friction between these structures during shoulder elevation. It may enlarge in the presence of AC joint arthrosis, rheumatoid arthritis, or after clavicle fractures affecting the coracoclavicular interval.
The coracoclavicular bursa, when present and inflamed, contributes to superior shoulder pain that can mimic AC joint arthrosis, impingement, or coracoid impingement. On ultrasound or MRI, fluid in this space is identified between the clavicle and the coracoclavicular ligaments. Injection into this space requires careful technique to avoid the coracoclavicular ligaments and the underlying brachial plexus and axillary vessels.
Malunion or hypertrophic callus formation after midshaft clavicle fracture can cause friction between the inferior clavicle and the coracoclavicular ligaments, producing an adventitial bursal reaction with superior shoulder pain reproduced by cross-arm horizontal adduction, managed with corticosteroid injection or, if symptomatic callus, surgical revision.
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