title: Arthroscopic subacromial decompression.
abstract: In this study, we analyzed the results of two series of patients treated for impingement syndrome by undergoing arthroscopic subacromial decompression (ASD). Patients had not responded to nonoperative treatment. Group 1 included 112 consecutive patients (average age, 41 years) with 96 (77%) patients available for 2-year follow-up. Group 2 (28 patients, 29 shoulders; average age, 43 years; range, 22 to 72) had ASD and the subacromial space digitally palpated to determine if adequate decompression was performed. Twenty-two (85%) of 26 shoulders were available for follow-up. At follow-up, pain, function, range of motion, strength, impingement signs, and patient satisfaction were assessed. In group 1, according to the Neer criteria, 48% of the patients were graded as satisfactory and 52% unsatisfactory. Workers' Compensation patients had a satisfactory rate of 32%, whereas non-Workers' Compensation patients had a satisfactory rate of 59%. Twenty patients had open acromioplasty after ASD. Inadequate decompression was noted in 14 of 20 failed patients. In group 2, 86% of the patients were graded as satisfactory according to the Neer criteria, with 14% unsatisfactory, which included the 2 failures. The 2 (9%) of 22 shoulders that failed the ASD went on to further surgical treatment. Average follow-up was 56 months (range, 13 to 78 months). The average American Shoulder and Elbow Society score at follow-up was 90.4. No difference between Workers' Compensation cases and the other cases was seen (P <.7). Finger palpation can help to improve outcomes by allowing the surgeon to assess the adequacy of decompression.
authors.affiliation: Steadman Hawkins Clinic and Steadman Hawkins Sports Medicine Foundation, Vail, Colo 81657, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hawkins
authors.forename: K D
authors.initials: KD
authors.lastname: Plancher
authors.forename: S R
authors.initials: SR
authors.lastname: Saddemi
authors.forename: L S
authors.initials: LS
authors.lastname: Brezenoff
authors.forename: J T
authors.initials: JT
authors.lastname: Moor
mesh_terms: D000174:Acromion; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D019534:Shoulder Impingement Syndrome / Q000473:pathology / Q000601:surgery*; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014942:Workers' Compensation