title: Ossification of coracoclavicular ligament in complete paraplegia: a case report.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  The objective of this study was to highlight the possible etiological factors and functional implications of coracoclavicular ligament ossification in a man with paraplegia.
  
  
  METHODS
  This study was conducted in King Fahad Medical City, Riyadh, Saudi Arabia.
  
  
  METHODS
  A 25-year-old man was admitted as a case of complete traumatic spinal cord injury (SCI) at the T3 level for comprehensive rehabilitation after 4 months of injury. He also had a right clavicular fracture, which was managed conservatively. During his rehabilitation course, he complained of chronic right shoulder pain, which limited his activities of daily living, transfers and wheelchair mobility.
  
  
  RESULTS
  His shoulder examination was unremarkable for impingement but range of motion was restricted, which rendered the need for imaging. A computed tomography scan showed ossification of coracoclavicular ligament, illustrating a rare synostosis between the clavicle and scapula. In addition to pain management, the patient was trained on shoulder conservation techniques for performing functional tasks and showed enhanced independence in various activities of daily living.
  
  
  CONCLUSIONS
  SCI has an association with neurogenic heterotropic ossification (HO), which usually develops below the level of injury. A low threshold for investigating HO may be considered at fracture sites even if they are above the level of SCI, for early prevention and treatment of this disabling complication. The abnormal cross-union between the clavicle and the scapula owing to HO can alter the mechanics of the shoulder girdle along with soft tissue injuries and early degenerative changes. Formation of shoulder HO can be particularly accelerated in SCI patients due to excessive use of upper limbs and to the neurogenic nature of the injury.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Wake Forest Baptist Medical Center, Winston Salem, NC, USA; Department of Physical Medicine and Rehabilitation King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: A Z
authors.initials: AZ
authors.lastname: Qureshi
authors.affiliation: Department of Physical Medicine and Rehabilitation King Fahad Medical City , Riyadh, Saudi Arabia.
authors.forename: A J
authors.initials: AJ
authors.lastname: AlSaleh
authors.affiliation: Department of Physical Medicine and Rehabilitation King Fahad Medical City , Riyadh, Saudi Arabia.
authors.forename: A A
authors.initials: AA
authors.lastname: AlHalemi