title: A preoperative scoring system to select patients for arthroscopic subacromial decompression.
abstract: BACKGROUND
  This study investigated the clinical and radiographic factors that influence outcome after arthroscopic subacromial decompression (ASAD) for shoulder impingement syndrome. The goal was to develop a new preoperative scoring system to identify patients who would have a prompt and sustained benefit from ASAD.
  
  
  METHODS
  We prospectively reviewed 112 consecutive patients with impingement syndrome who subsequently underwent ASAD. The Oxford Shoulder Score (OSS) was recorded preoperatively and 3 and 12 months postoperatively. A statistically significant improvement in OSS at 3 months after surgery was considered a good outcome.
  
  
  RESULTS
  The variables associated with good outcome were shoulder pain with overhead activities, persistent symptoms for more than 6 months, symptoms persistent despite a 3-month course of supervised physiotherapy, consistently positive Hawkins test result, radiologic changes of impingement on both acromion and humerus in the subacromial region, and improvement for more than 1 week after a steroid injection. These 6 criteria were combined into a single score for this study, termed the preoperative score (PrOS). Sixty-two patients who had been symptomatic for 1 year with a preoperative score of 5 to 6 showed significant improvement in OSS at 3 months after surgery (P < .001). Thirty-eight patients with a score 3 to 4 had no statistically significant improvement in OSS at 3 months but had a further slight improvement at 1 year. Twelve patients with a score of ≤2 had no significant improvement in OSS at 3 months or 1 year.
  
  
  CONCLUSIONS
  This scoring system can identify patients who would have a prompt benefit from ASAD. The impact of surgery in patients with a PrOS of ≤4 points is questionable.
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK. Electronic address: hpsinghjk@gmail.com.
authors.forename: Harvinder Pal
authors.initials: HP
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
authors.forename: Saurabh Sagar
authors.initials: SS
authors.lastname: Mehta
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK.
authors.forename: Radhakant
authors.initials: R
authors.lastname: Pandey
mesh_terms: D000174:Acromion / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D019299:Decompression, Surgical; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D020069:Shoulder Pain / Q000601:surgery
keywords: Arthroscopic subacromial decompression; impingement syndrome; scoring system