[Arthroscopic subacromial decompression.].
Arthroscopic subacromial decompression is a generally recognized method of the treatment of the primary impingement sydrome and is one of the basic arthroscopic methods. The data in literature present 73-94 % of good and very good results. From May 1993 till June 1996 we treated at our clinic 40 patients with arthroscopic subacromial decompression of which 38 patients were followed up. The average period of follow-up is 3 years (2-5 years). All patients had clinical symptoms of impingement syndrome prior to operation. The patients who were indicated to resection of the lateral part of the clavicula and suture of the rotator cuff were not incorporated in the group. For the evaluation we used UCLA score after Ellman, the subjective satisfaction of patients was evaluated in detail. In 79 % the results after UCLA were good and very good (satisfactory). The most marked improvement was achieved in the evaluation of pain. 84 % of patients evaluated subjectively the result of the operation as good and very good. Worse evaluation on average was provided by patients who suffered the injury of the shoulder joint, patients already disabled before the surgery and women. The causes of unsatisfactory results in our group were the following: insuficient resection of acromion in 2 patients, persisting pain of acromioclavicular joint in 2 patients, non-diagnosed complete rupture of the rotator cuff in 1 patient, secondary impingement syndrome in 1 patient, CB syndrome in 1 patient and unclear cause of persisting complaints in 1 patient. Unsatisfactory results are caused by technical errors during the surgery and incorrect indications. The results can be improved by a careful clinical examination (acromioclavicular joint, stability, elimination of a secondary impingement), preliminary planning of the extent of resection of acromion according to radiographs (Y-projection, projections after Rockwood) and a correct evaluation of arthroscopic findings (lesion of labrum, SLAP, lesion of the rotator cuff). Key words: impingement syndrome, subacromial decompression, arthroscopy.
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Ortopedická klinika IPVZ, FN Na Bulovce, Praha.
Stasa
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M
Dvorák
V
V
Vaculík
J
J