Arthroscopic shoulder decompression development and application

The purpose of this study was to critically evaluate the results of 80 consecutive subacromial decompressions in 76 patients with impingement syndrome and to assess the value of arthroscopy for subacromial decompression. The average followup was 32 months. The charts, radiographs, and clinical findings of all patients were reviewed. There were 57 males and 19 females, with a mean age of 41 years. Subjective, objective, and functional results were assessed. The greatest improvement was seen in the areas of pain with activity, pain at night, and use of medications. Impingement signs had decreased significantly at final followup. The procedure allowed an early return to work and competitive athletics. Repeat surgery was necessary in eight cases: three full thickness rotator cuff repairs, two stabilization procedures, two open debridements, and one biceps tenodesis and excision of the distal clavicle. An important finding was the number of unsuspected diagnoses that were made during arthroscopy. Twelve patients had significant labral tears, seven patients had complete rotator cuff tears, four patients had biceps tendon fraying, and two patients had loose bodies in the glenohumeral joint. In most of these shoulders the intraarticular lesions would not have been diagnosed by open subacromial decompression. Radiographic evaluation suggested that the "outlet view" can be helpful in determining depth of bony resection and may be a prognostic indicator. Patients who underwent simple decompression rather than bony resection tended to be younger and had less Stage III impingement changes, and they generally had a slightly better final outcome. Patients who had compensation injuries generally had a poorer outcome. In reviewing our results, it appears that arthroscopic subacromial decompression can be a successful alternative to open decompression. The key to success for closed decompression is related to 1) accurate diagnosis, 2) selective treatment, 3) adequate bone resection when required, and 4) repair of full thickness rotator cuff tears in the active patient. Postoperative rehabilitation, which includes early range of motion, is critical.