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Shoulder impingement syndrome larissa 2016
This document provides an overview of subacromial impingement syndrome and subacromial decompression surgery. It discusses the etiology of impingement, including extrinsic factors like outlet stenosis and intrinsic factors like rotator cuff degeneration. It reviews the history and techniques of arthroscopic subacromial decompression surgery, including bursectomy, acromioplasty, and potential distal clavicle resection. Long-term studies on the efficacy of decompression are presented, with varying results on outcomes and re-tear rates.
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Shoulder impingement syndrome larissa 2016
- 1. Subacromial Impingement Syndrome Subacromial Decompression Aaron Venouziou OrthopaedicSurgeon St. Luke’s Hospital Thessaloniki
- 2. Introduction ü Ill-defined term for a variety shoulder disorders that manifest as antero-lateral shoulder pain ü Nonspecific diagnosis üNumerous types of shoulder impingement ü Only a small proportion of these necessitate decompression
- 3. Etiology üExtrinsic – Primary Impingement • Ouletstenosis – Secondary Impingement • Instability üIntrinsic – Degeneration • Aging • Avascularity
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- 5. ü Spurs and bony changes on the undersurface of the anterior 1/3 of the acromion correlated with rotator cuff tears ü 90% of pts treated by acromioplastyhad significant pain reduction, full use of shoulder, <20o of overhead limitation, and at least 75% normal strength ü RC injury is a result of primary impingement Primary Impingement Neer, 1972
- 6. ü Popularized the theory of “extrinsic” impingement, stating that acromial changes were primary as opposed to secondary changes—causing impingement ü 70% of full-thickness RC tears in type III acromion üNever been proven or peer reviewed Primary Impingement Bigliani, 1986
- 7. üGlenohumeral Instability – Common in the overhead throwing athlete –Cocking => strain on the static stabilizers occur • Early phase (45º abd, ER) - MGHL • Late phase (90º abd, ER) – IGHL ü Anterior soft tissue deficiency ü Anterior translation of humeral head Secondary Impingement Jobe and Kvitne, 1989
- 8. üInternal Impingement – Common in the overhead throwing athlete – Cocking => tension on the posterosuperior articular surface of the supraspinatus and compression between the humeral head and adjacent glenoid rim •posterior superior synovitis • partial under-surface tears Secondary Impingement Walch, 1992
- 9. üGlenohumeral internal rotation deficit (GIRD) – Common in the overhead throwing athlete –Posteroinferior capsular contracture – Posterosuperior humeral head translation – SLAP – Internal impingement Secondary Impingement Morgan and Rajan, 2004
- 10. üScapulothoracic Dyskinesis – Functional scapular instability –Increased distance from spinous process to medial border of the scapula – Loss of acromial elevation Secondary Impingement
- 11. ü Tendon degeneration (and fibers failure) is the most important etiologic factor of symptoms (and cuff tears) in the subacromial space and not the impingement syndrome üPartial thickness tears are most often on the articular side ü Articular side of cuff is hypovascularized Intrinsic Factors Ozaky 1988, Ogata & Uhthoff 1990
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- 20. Historical background Ellman, 1987 ü Technically demanding procedure üIf a cuff tear is present you cannot repair it
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- 25. Lateral portal ü 3 cm lateral to acromion ü Spinal needle üTriangulation ü Underneath the anterior half of the acromion ü Parallel to it Skin marking bisects mid AC
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- 27. ü From the undersurface of the acromion ü From the distal clavicle üExcise the C-A ligament Use an electrocautery to remove soft tissues
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- 35. • Scope lateral / instruments anterior – Best access to distal clavicle –70° arthroscope – 8-10 mm excision of the distal clavicle Distal Clavicle Resection
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- 38. Arth group: Revision acromioplasty in 6 patients Open group: Revision acromioplastyin 3 patients Good excellent results in 77% Better results with arthroscopic acromioplasty Odenbring et al Arthroscopy 2008
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- 42. Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review. • 354 patients: SAD and Scope Cuff Repair •4 Studies: 2 Level I and 2 Level II • Conlusions: – “does not support the routine use of partial acromioplasty or CA ligament release in the surgical treatment of rotator cuff disease” – “in some instances, partial acromioplasty and release of the CA ligament can result in anterior escape and worsening symptoms” Familiari et al. J Orthop Traumatol 2012
- 43. “Functional outcome of patients with calcific tendonitis after arthroscopic bursectomy and debridement of the calcific deposit is not influenced if performed in combination with or without a subacromial decompression.” Clement et al. Arthroscopy 2015 (September) Short-Term Outcome After Arthroscopic Bursectomy Debridement of Rotator Cuff Calcific TendonopathyWith and Without Subacromial Decompression: A Prospective Randomized Controlled Trial 13 MONTHS FOLLOW-UP
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