Variations in the architecture of the coracoacromial arch can lead to a clinically symptomatic rotator cuff lesion. Differences in the development and morphology of the acromion, and the presence of anterior acromial spurs and inferior acromioclavicular osteophytes decrease the volume of the subacromial space, leading to impingement. Recent anatomic, radiographic, biomechanical, and SPG studies have confirmed these architectural variations and their effects on the contents of the subacromial space. Abnormal contact between the acromion and these soft tissues can lead to pathologic lesions. Surgical procedures should be directed at increasing the space beneath the coracoacromial arch to reduce wear on the rotator cuff.
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