A systematic approach to the surgical treatment of chronic shoulder pain

A systematic surgical approach for dealing with chronic shoulder pain includes a carefully designed arthrectomy of the acromioclavicular joint, removal of the coracoacromial ligament, cuff repair, biceps tendon transfer, and removal of calcific deposits as indicated. Of 38 patients who have been followed for at least 24 months, 29 were rated as excellent on the basis of achieving a full range of pain-free movement and normal strength. Degenerative arthritis of the acromioclavicular joint was found in all cases, whereas bicipital tendinitis was noted in less than half. Inspection or transfer of the biceps tendon is not thought to be necessary, because adequate decompression will relieve bicipital tendinitis. An additional reward produced by resection of the lateral 1 ½ cm of the clavicle and the acromial portions of the AC joint is an excellent exposure of the lesional portion of the shoulder for performing cuff repairs, biceps tendon transfers, or excision of calcific deposits. A properly designed removal of the acromioclavicular joint provides adequate anterior decompression and eliminates the most commonly diseased tissue in the chronically painful shoulder without compromising function.