title: [Surgical treatment of anterosuperior impingement of the shoulder].
abstract: OBJECTIVE
  Therapy of intraarticular lesions and elimination of structural risk factors for those suffering from clinical manifest anterosuperiorer impingement (ASI) of the shoulder. This includes as a maximum version the arthroscopic repair of supraspinatus (SST) and subscapularis tendon (SCT) tears with subsequent subpectoral tenodesis of the long head of the biceps tendon (LBT) and arthroscopic coracoplasty.
  
  
  METHODS
  Clinical manifest anterosuperiorer impingement of the shoulder with anterior shoulder pain, failed conservative treatment and clear intraarticular damage in radiological imaging. This involves in detail lesions of the SST, SCT and damage to the LBT.
  
  
  METHODS
  Lack of structural intraarticular lesions or massive osteoarthritis. Persistent dysfunction of active and passive glenohumeral and scapulathoracal motion, due to neurologic deficits or stiff shoulder. A hypertrophic or deformed healed coracoid process is seen as a structural risk factor for suffering from ASI and should be addressed surgically when causing impingement.
  
  
  METHODS
  Arthroscopic tenotomy of the LBT with subsequent repair of the SST and SCT. Arthroscopic coracoplasty if indicated and subpectoral tenodesis of the long head of the biceps.
  
  
  METHODS
  No biceps activity and intermittent immobilization in sling for 6 weeks. Limitation of abduction, flexion and external rotation for 6 weeks depending on rotator cuff tendon repair. Start of sport-specific training after 3 months, over-head sports 6 months postoperatively.
  
  
  RESULTS
  The arthroscopic repair of anterosuperior rotator cuff tears provides reliable results for improvement in function, decreases in pain and improvement in shoulder scores. The overall rate of adverse events is low.
authors.affiliation: Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Pogorzelski
authors.affiliation: Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Beitzel
authors.affiliation: Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. a.imhoff@lrz.tu-muenchen.de.
authors.forename: A B
authors.initials: AB
authors.lastname: Imhoff
authors.affiliation: The Steadman Clinic, Vail, CO, USA.
authors.forename: P
authors.initials: P
authors.lastname: Millett
authors.affiliation: Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Braun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D053656:Tenodesis / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Arthroscopic surgery; Rotator cuff; Shoulder pain; Subscapularis tendon; Tenodesis