Ossification of the coracoacromial ligament: association with rotator cuff pathology of the shoulder

The objective of this study was to assess the association of ossification of the coracoacromial ligament (CAL) observed on conventional radiographs with the presence of rotator cuff pathology as demonstrated by magnetic resonance imaging (MRI), arthrography, and/or surgery. Conventional radiographs (internal and external rotation and outlet and axillary views) on eight patients showed ossification of the coracoacromial ligament. Rotator cuff integrity was assessed by physical examination in all 8 patients, by arthrography in 3 patients, and by MRI in 2 patients. Surgery was performed on four of the patients. Physical examination showed impingement findings and decreased rotator cuff strength suggestive of rotator cuff disease in all eight patients. The arthrograms and MRI examinations showed the presence of full-thickness rotator cuff tears. Four of these patients underwent surgery and the rotator cuff defects were confirmed and repaired. Identification of ossification of the CAL on conventional radiographs should be recognized as strongly suggestive of associated significant rotator cuff pathology.