ABSTRACT
@#Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.
ABSTRACT
OBJECTIVE: To investigate the effectiveness of reversed arthroscopic subacromial decompression in the treatment of rotator cuff tears.
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As características macroscópicas da origem do músculo deltoide foram estudadas em 12 ombros de cadáveres. A origem acromial anterior e lateral do deltoide foi dissecada e analisada macroscopicamente com auxílio de computação gráfica. Determinamos as medidas dos diâmetros ântero-posterior do acrômio e do deltoide e suas respectivas áreas e, a seguir, realizamos simulações por computação de descompressões subacromiais de 4, 6 e 8 mm. As descompressões subacromiais simuladas de 8 mm, 6 mm e 4 mm desinserem 34,7%, 32 % e 29,1% da área de origem do deltoide, respectivamente. Concluímos que os diâmetros ântero-posteriores e as áreas do acrômio e deltoide possuem diferenças estatísticas significantes. Os diâmetros lateromediais do acrômio em relação ao deltoide não apresentam diferenças estatísticas, assim como a área do deltoide remanescente após uma descompressão subacromial de 4 mm, quando comparada com a área do acrômio.
Subject(s)
Humans , Male , Female , Adult , Arthroscopy/methods , Dissection , Muscles/injuries , CadaverABSTRACT
Introduction: Rotator Cuff (RC) Impingement syndrome is the most common cause of shoulder pain. Partial RC tear diagnosis is difficult and treatment is controversial. The aim of this study is to evaluate clinical and echographically patients who underwent subacromial decompression as treatment for partial RC tear. Material and Methods: Two groups were evaluated, with fifteen operated shoulders each, the former without RC tear and the latter with partial RC tear. There were no differences regarding movement, functionality or pain among the groups before surgery. Results: After two years of follow up, both groups presented a similar satisfactory clinical progression. Additionally, there were no echographic differences between both groups. Conclusion: Favorable results in both groups are due to subacromial decompression. Degenerative partial RC tear would not be necessary to repair. The echographic control show a more benign pattern of injury after decompression in partial tear rotator cuff.
Introducción: El pinzamiento del manguito rotador (MR) es la causa más frecuente de consulta por dolor de hombro. El diagnóstico de una rotura parcial de éste es difícil y el tratamiento controversial. El objetivo principal de este trabajo es la evaluación clínico/ecográfica de pacientes sometidos a una descompresión del espacio subacromial como tratamiento de una rotura parcial. Material y Método: Se evalúan dos grupos de pacientes con 15 hombros operados mediante una descompresión subacromial, el primero sin rotura parcial y el segundo, con rotura parcial de MR, entre los cuales no existen diferencias en cuanto a movilidad, funcionalidad y dolor en el preoperatorio. No se realizó reparación en ningún caso de rotura parcial. Resultados: Luego de 2 años de seguimiento, se observó que ambos grupos presentan una evolución clínica similar y satisfactoria. Además, no existen diferencias significativas en cuanto a la evaluación ecográfica entre ambos. Conclusión: Las roturas parciales en un contexto degenerativo, tienen un resultado favorable y comparable a los que no tienen rotura con una descompresión subacromial. Incluso se observa en el control ecográfico postoperatorio una tendencia a disminuir la gravedad de la lesión.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Decompression, Surgical , Rotator Cuff/surgery , Rotator Cuff/injuries , Shoulder Impingement Syndrome/surgery , Arthroscopy , Pain Measurement , Retrospective StudiesABSTRACT
We treated 26 frozen shoulders in 26 cases separated into two groups by arthroscopic capsular release. Group A comprised 14 patients (male 7, female 7) with an average age of 53.7 (34-78) who underwent arthroscopic subacromial decompression (ASD). Group B consisted of 12 cases (male 5, female 7) with an average age of 58.2 (41-78) who were treated without ASD. The mean follow-up period was 14 (12-16) months. We compared the range of motion in the effected shoulders and the Japan Orthopaedic Association (JOA) scores between the two groups. We also investigated any improvement of ROM one month after operation in regards to rehabilitation being performed 3 times or under 2 times per week in order to acquire a greater ROM of external rotation. Group A led group B significantly with superior clinical results including ROM and JOA scores. Furthermore, rehabilitation administered 3 times per week increased the ROM of the shoulder after one month of operation. Therefore, it was found that in arthroscopic capsular release of frozen shoulder, additional treatment with ASD and frequent rehabilitation with ROM exercises for external rotation yielded clinical improvement in frozen shoulder outcomes.
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PURPOSE: To compare the results in patients with a complete repair, partial repair, and subacromial decompression and debridement of a massive rotator cuff tear. MATERIALS AND METHODS: Twenty-eight cases, who underwent surgery for massive rotator cuff tears with a minimum follow-up of 2 years, were reviewed. Group A with a complete repair comprised of 16 cases, group B with partial repair comprised of 5, and group C with only debridement comprised of 7. The results were assessed using the UCLA shoulder rating scale. RESULTS: The pain scores improved from 2.4 preoperatively to 8.5 points postoperatively in group A, 2.2 to 8.2 in group B, and 2.4 to 8 in group C. The active forward flexion improved from 86degrees to 149degrees in group A, 82degrees to 140degrees in group B, and 91degrees to 121degrees in group C. Overall, 13 cases (81%) from group A, 4 cases (80%) from group B, and 4 cases (57%) from group C had satisfactory results. CONCLUSION: The patients, who failed to achieve a repair, and received debridement or subacromial decompression instead demonstrated pain relief with poor restoration of their function. However, there was a favorable outcome in the patients with a partial repair because the complete repair could not be done. In conclusion, where possible, it is better to repair massive rotator cuff tears surgically.
Subject(s)
Humans , Debridement , Decompression , Follow-Up Studies , Rotator Cuff , ShoulderABSTRACT
Aim of this study was to compare the surgical outcomes after arthroscopic subacromial decompression and debridement in bursal and articular side partial thickness rotator cuff tear (PTRCT) with depth of less than 50%. This study was based on thirty-seven PTRCT with average follow-up of 3.5 years (range: 2-6 years). There were 24 articular side tears and 13 bursal side tears. Pre-operative impingement test showed 80% pain relief in bursal side and 67% in articular side tears. All patients were assessed in terms of pain relief and functional recovery using the standard method of Research Committee of American Shoulder & Elbow Surgeons (ASES). At postoperative 6 months, average pain score decreased to 1.7 from 6.2 and average ASES score increased to 79 from 38 in articular side tears, and pain scores decreased to 0.9 from 7.1 and ASES scores increased to 87 from 37 in bursal side tears. Eighty-six percent of the patients showed satisfactory results at the final follow-up. After subacromial decompression and debridement in bursal and articular side PTRCT, pain relief and functional recovery was excellent in both groups. However, the result was better in bursal side PTRCT till 6 months after operation.
Subject(s)
Humans , Arthroscopy , Debridement , Decompression , Elbow , Follow-Up Studies , Rotator Cuff , ShoulderABSTRACT
PURPOSE: To analyze the improvement in the patient self-evaluation for shoulder function and range of motion after arthroscopic subacromial decompression for shoulder impingement syndrome. Materials and Method: We performed a study of 21 patients out of 45 patients who could be assessed preoperatively and at 6 weeks and 3, 6, 9 and 12 months, using the standardized method of Research Committee of American Shoulder & Elbow Surgeons. We used two-sample unequal variance student t-test and Mann-Whitney U test to compare the initial findings. RESULTS: Nineteen patients were satisfied subjectively at 12 months after operation. Pain improvement was significant at 6 weeks. The total score of patient self-evaluation, put on a coat and manage using the toilet improved at 3 months, while sleep on painful side, wash back, comb hair, reach a high shelf and lift 5 kg above the shoulder improved at 6 months. Throwing a ball overhead improved at 9 months. The gain in range of motion was not noticeable except for internal rotation, which improved from T11 to T8. CONCLUSION: We found an arthroscopic subacromial decompression to be an effective method for treating impingement syndrome of the shoulder. Functional recovery could improve during a prolonged period despite of early relief of pain.
Subject(s)
Animals , Humans , Comb and Wattles , Decompression , Diagnostic Self Evaluation , Elbow , Follow-Up Studies , Hair , Range of Motion, Articular , Shoulder Impingement Syndrome , ShoulderABSTRACT
To analyze the improvement of shouder function after arthroscpic subacrominal decompression and open repair for complete rotator cuff tear, we performed a prospective study in 14 patients using self evaluation form from the American Shouder and Elbow Society(ASES). All patients were treated with arthrscopic biplanar subacromial decompression and open repair by use of bony trough and followed for more than 1 year from November 1994 to June 1996 in Dankook university hospital. All patients were assessed preoperatively and at final follow-up using the standardised method of research committee of American shoulder & elbow surgeons. Tears of the rotator cuff were divided into medium(8 shoulders), large(3 shoulders) and massive(3 shoulders). Most of the patients were heavy laborers. Average age was 56.2 years (51-73 years). There were 9 male and 5 female patients. The dominant arm was affected in 8 shoulders. Postoperative abduction brace was used in all cases and passive range of mortion exercise was started from postoperative third day. At average follow-up of 17 months, average pain scores decreased to 0.8+/-1.1 from 6.9+/-2.3. Scores of ASES evaluation form increased to 87.3+/-12.2 from 35.8+/-16.3(p<0.05). As to the range of mortion, only internal rotation improved from T12 to T8(p<0.05). Thirteen patients achieved excellent or good result. Twelve patients returned to initial occupations. Arthroscopy is helpful to define the tear size which may affect the surgical approach and open repair by use of bony trough and tunnel is useful to recovery of shoulder function.
Subject(s)
Female , Humans , Male , Arm , Arthroscopy , Braces , Decompression , Diagnostic Self Evaluation , Elbow , Follow-Up Studies , Occupations , Prospective Studies , Rotator Cuff , ShoulderABSTRACT
A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good.