Coracoacromial attrition syndrome. Anatomy, clinical aspects and surgical treatment

Eighteen cases of coracoacromial attribution syndrome submitted to operative treatment over a 5-year period are analysed. Three types of syndrome were identified. The attrition manoeuvre was positive in all cases and, in 16, infiltration of local anaesthetic in the subacromial bursa abolished or considerably decreased the pain. The most frequent operative findings were excessive thickness of the acromion, sometimes associated with osteophytosis of the anterior margin of the bone, and inspissation of the subacromial bursa; in 3 cases there were fissures or lacerations of the bursal surface of the supraspinatus. In all patients the coracoacromial ligament was sectioned, horizontal osteotomy of the acromion performed and the subacromial bursa removed. When necessary, cheilotomy of the acromioclavicular joint was performed, and any partial lacerations of the cuff repaired. The results were satisfactory in 15 cases and fair in 3, and were directly related to the positivity of the attrition test and to the severity of the anatomical, coracoacromial and rotator cuff lesions observed at operation.