title: Symptomatic coracoclavicular joint: incidence, clinical significance and available management options.
abstract: OBJECTIVE
  Coracoclavicular joint (CCJ) is a rare anomalous joint occasionally found between the coracoid process of scapula and the conoid tubercle of clavicle. The articulation has been extensively studied by means of anatomical, osteological and radiological investigations. Most cases are discovered incidentally, with the symptomatic variety remaining an exceptional rarity. Our aim was to review all reported symptomatic CCJ to increase the level of evidence and formulate a treatment algorithm to aid clinicians in management planning.
  
  
  METHODS
  A thorough literature search was performed, and data from 17 (n = 17) symptomatic cases of CCJ were analysed.
  
  
  RESULTS
  CCJ is a rare finding and mostly an incidental discovery, which is rarely symptomatic. However, when symptomatic, the most common symptom is shoulder pain. The mean age at presentation is 42 years, with a male:female ratio of 1.4:1. Brachial plexus involvement was the most common pathophysiological explanation provided. First-line treatment was conservative, with a very low success rate of 5.9%. Surgical intervention in the form of excision of anomalous joint by osteotomy had success rate of 100%.
  
  
  CONCLUSIONS
  Symptomatic CCJ is rare, and its rarity leads to lack of awareness in the general orthopaedic community. When symptomatic, CCJ may lead to delayed diagnosis or inappropriate management due to lack of evidence and poor description in most orthopaedic textbooks. Despite its low success rate, conservative treatment is advocated before embarking upon surgical intervention.
authors.affiliation: Epsom and St. Helier Hospital, Carshalton, Surrey, UK. orthopaediks@googlemail.com
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Singh
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Singh
authors.forename: Ravi
authors.initials: R
authors.lastname: Trehan
authors.forename: Simon
authors.initials: S
authors.lastname: Thompson
authors.forename: Ravi
authors.initials: R
authors.lastname: Pandit
authors.forename: Vipul
authors.initials: V
authors.lastname: Patel
mesh_terms: D000173:Acromioclavicular Joint / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000465:Algorithms; D001917:Brachial Plexus / Q000473:pathology / Q000503:physiopathology; D002968:Clavicle / Q000002:abnormalities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012540:Scapula / Q000002:abnormalities; D020069:Shoulder Pain / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult