[Arthroscopic revision of the sub-acromial space in impingement syndrome]

Degenerative lesions of the subacromial structures can cause chronic anterior pain and disability of the shoulder. They are most frequently found in patients whose arms are repeatedly exposed to force while raised above head level, e.g. during tennis, volleyball or swimming. This is often due to impingement of the supraspinatus tendon, the subacromial bursa or the biceps tendon against the anterior edge and lower surface of the anterior third of the acromion, the coracoacromial ligament and, in some cases, the acromioclavicular joint. Open anterior acromioplasty as described by Neer is therefore a well-documented treatment for cases refractory to conservative therapy, and its efficacy is unquestioned. Acromioplasty or simple decompression by débridement can now be performed by means of basic arthroscopic techniques. Subacromial decompression is carried out with standard arthroscopic approaches and motorized instruments. The indications are about the same as for the open technique, and the three progression stags of impingement lesions must also be considered in the same way. Arthroscopic decompression was performed in 13 patients with a chronic impingement syndrome that had failed to respond to conservative management over 6 months. All underwent a débridement of the subacromial bursa, 11 shaving of a partial tear of the rotator cuff, and 8 anterior acromioplasty; in 5 patients spurs arising from the acromion or the acromioclavicular joint were also removed. In 2 cases the coracoacromial ligament was released and in 3 patients calcareous deposits were needled. In most cases these procedures were combined. The patients were evaluated postoperatively with reference to the UCLA Shoulder Rating Scale with a follow-up of 12-18 months, particular attention being paid to pain and function.(ABSTRACT TRUNCATED AT 250 WORDS)