Outcome Of Arthroscopic Subacromial Decompression Research Articles

Evaluation of early functional outcome of arthroscopic decompression in chronic primary sub-acromial impingement syndrome

<b>Background:</b> Sub-Acromial Impingement Syndrome (SAIS) spectrum ranges from acute inflammation to chronic degeneration of the bursa and of rotator cuff tendons in sub-acromial space. It may lead to a full-thickness tear of rotator cuff tendons and degenerative joint disease of the shoulder girdle leading to functional loss and disability if not treated early and adequately. This study aimed to determine the early functional outcome of arthroscopic sub-acromial decompression in chronic SAIS due to mechanical causes.<br /> <b>Material and methods:</b> This was a prospective cohort study. Patients were operated on arthroscopically for sub-acromial decompression between September 2018 and March 2020. Thirty-five patients with a range of 20 to 65 years of age diagnosed clinically with primary chronic sub-acromial impingement syndrome meeting the inclusion criteria were included in this study. All the patients under study were initially kept for at least four weeks of a course of conservative treatment and persisted in having symptoms were treated surgically with arthroscopic sub-acromial decompression. The UCLA (The University of California at Los Angeles) shoulder rating scale was used to assess shoulder function. The assessment was done in the pre-operative period, four weeks, 12 weeks, and 16 weeks post arthroscopic sub-acromial decompression surgery.<br /> <b>Results:</b> Compared to pre-operative UCLA shoulder function score at the end of non-operative conservative treatment, the patients under study showed a statistically significant improvement at the end of the 16th week of post-arthroscopic subacromial decompression (p<0.0001).<br /> <b>Conclusion:</b> This study concludes that arthroscopic sub-acromial decompression provides a good functional outcome in patients having primary shoulder impingement due to extrinsic mechanical causes such as shape and slope of the acromion in the absence of significant (total or near total) rotator cuff tear after 16 weeks of follow-up.

Functional outcome of arthroscopic subacromial decompression at the AGDAL’s clinic in Rabat

Functional outcome of arthroscopic subacromial decompression at the AGDAL’s clinic in Rabat

Patients perception of outcome in arthroscopic subacromial decompression using proms scores

Subacromial impingement syndrome (SIS) is the most common cause of shoulder pain, with higher incidence in middle age and elderly population; this will have an impact upon their activities of daily living and quality of life. Aim was to assess the outcome of Arthroscopic subacromial decompression (ASAD) based on patient’s perception of their outcome using patient reported outcome measure scores (PROMs). 50 patients with SIS, who underwent ASAD from April 2015 to January 2017 at NHS Tayside, who were part of Tayside Upper Limb Evaluation Programme (TULEP) were included in this study. Improvement in mean postoperative PROMs scores at 6 months and 1 year postoperative was observed, with maximum improvement at 6 month postoperative period, however, less improvement was noted from 6 months to 1 year postoperatively which was statistically significant. Improvement in PROMs postoperatively was better appreciated inpatients aged less than 50 years, females, low BMI, and left shoulder pathology. Patients who were dissatisfied at 6 months postoperatively had continued to score less at 1 year postoperative. Pain was the most common reason for dissatisfaction. This study suggested that ASAD for impingement gives a high patient satisfaction with significant improvement in function and quality of life.

Functional outcome of arthroscopic subacromial decompression in primary shoulder impingement syndrome due to extrinsic mechanical causes

Background: The purpose of this study was to determine the role of arthroscopic subacromial decompression in primary shoulder impingement due to secondary mechanical causes in terms of functional outcome. Materials and Methods: Patients undergoing arthroscopic subacromial decompression at JSS Medical College, Mysore between September 2014 and May 2016 were studied prospectively. A total of 20 patients diagnosed with primary shoulder impingement meeting the required criteria were included in the study. The patients were put on a 6 week course of physiotherapy as initial trial with non-operative treatment. None of the patients responded to this treatment and persisted to have symptoms. These patients were treated surgically with arthroscopic subacromial decompression. The University of California Los Angeles (UCLA) shoulder rating scale was used to assess shoulder function. Assessment was done at pre-operative, 4 weeks, 8 weeks, 12 weeks, 6 months, 9 months and 12 months post arthroscopic subacromial decompression. Results: Patients had statistically significant improvement in shoulder function after arthroscopic sub acromial decompression (p

Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression

To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years. We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery. Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate. Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears. Level IV, therapeutic case series.

Clinical and radiological outcomes of arthroscopic subacromial decompression for stage-II impingement of shoulder

BackgroundShoulder impingement is described as a mechanical impingement of the rotator cuff tendon beneath the antero inferior portion of the acromion, especially when the shoulder is placed in the forward-flexed and internally rotated position. It is a common cause of recurrent shoulder pain and disability. AimThe aim of the present study was to study the clinical and radiological outcomes of arthroscopic sub acromial decompression for stage II impingement of the shoulder. MethodsAll adults with type 2 impingement of the shoulder having positive impingement signs and unimproved pain after a course of conservative treatment of at least 3 months were included in the study. Glenohumeral arthroscopy was performed under general anaesthesia in lateral position followed by subacromial decompression. Postoperatively a sling was given initially for support but to prevent adhesions, passive mobilization of the shoulder was initiated as early as possible. Active exercises were started at 2 weeks’ time and cuff strengthening exercises at 6 weeks’ time.Patients were followed up at 3 weeks, 6 weeks, 9 weeks, 3 months and 6 months. Post-operative assessment was performed using the UCLA shoulder rating scale and radiological assessment of acromiohumeral distance was made. Results and conclusionThose patients who had failed conservative treatment were benefited by the procedure. The pain decreased, functional capacity of the shoulder increased, range of motion increased, strength of forward flexion increased and almost 90% patient reported that their symptoms had improved and were feeling better and satisfied. The cost of the treatment was low because no implants were used. Duration of procedure was short. Post-operative return to activities was quick. Number of days absent from work was less as patients returned to normal activities soon and were discharged either next day or a day after surgery. Pre, intra and post-operative complications were nil in our study and are also otherwise rare.

Long-Term Longitudinal Follow-up of Mini-Open Rotator Cuff Repair

Rotator cuff tears are a common clinical problem, and few long-term studies concerning the outcomes of rotator cuff repairs have been performed. The purpose of this study was to report the fifteen-year outcomes of arthroscopic subacromial decompression with mini-open rotator cuff repair. The study included seventy-nine patients who had undergone arthroscopic subacromial decompression with mini-open rotator cuff repair from 1993 to 1996. Outcomes were reviewed in 1997, 2002, and 2010. At the final review, forty-nine patients (forty-nine shoulders) were available or were suitable for evaluation. There were eight large tears, forty medium tears, and one small tear. The patients were assessed with the University of California, Los Angeles (UCLA) score at each evaluation. The mean age of the patients at the time of follow-up was 70.1 years, and the mean follow-up period was 15.6 years. At the time of final follow-up, the outcome was good or excellent in thirty-four patients (69%), fair in seven, and poor in eight. Three patients required a reoperation. Between the two and fifteen-year evaluations, twenty-nine patients (59%) had maintained their good or excellent result; the overall raw scores had deteriorated for fifteen patients (31%), and they had improved for twenty-four (49%). Forty-one patients (84%) were satisfied with the final outcome of the shoulder surgery. This study shows that arthroscopic subacromial decompression with mini-open rotator cuff repair can provide a lasting, durable, and satisfactory outcome for a large proportion of patients fifteen years after surgery. Patient satisfaction at the final evaluation did not necessarily correspond with a good or an excellent UCLA score.

Outcome of Arthroscopic Subacromial Decompression for Shoulder Impingement Syndrome after a Whiplash Type Injury

IntroductionRoad traffic accident (RTA) particularly with whiplash type injury has been associated with impingement syndrome of shoulder. However, the results of surgery for this group of patients have never been compared to the non accident group to see if the results are any different. In our study we aim to see if the results of these patients are worse after surgery as opposed to a group who did not sustain whiplash type injuries.BackgroundTo investigate the association between patients who have been involved in a Road Traffic accident sustaining a whiplash type injury presenting with impingement and asses their outcome after surgery.MethodsThe study group consisted of 13 patients. All of them where involved in a RTA where they were rear shunted and sustained a whiplash type injury. Arthroscopic subacromial decompression (ASD) was performed in 2005–09 for impingement. The mean age was 49.5 years. All patients were assessed with Oxford shoulder score preoperatively and at least twice post op (once within 3 months and once around the year mark). This group were compared with cohort of 13 consecutive patients (age and sex matched) done during the same period. Their scores were also assessed and analysed. Statistical tools were used to compare the results in the two groups.ResultsAll 13 patients had an improvement in their Oxford score over one year. While the improvement was only marginal ( p = 0.08) in the first three months it was better at the end of the year ( p = 0.04). Comparatively in the cohort who haven't been involved in RTA the improvement was more marked in the first three months ( p = 0.05) and this improvement was maintained over the year ( p = 0.03). The overall improvement in Oxford score was more in the cohort of patients who were not involved in a RTA as opposed to our study group.ConclusionThe results of the study show that even though there was an improvement in shoulder scores after an Arthroscopic Subacromial decompression it was much slower and overall results were far poorer in the study group as opposed to the controls. We conclude that caution should be used when offering ASAD for patients with Impingement following an RTA with a whiplash type injury more conservative measure should be pursued in these circumstances and if surgery is to be performed patients to be warned of prognosis.

POSTOPERATIVE OUTCOMES OF ARTHROSCOPIC SUBACROMIAL DECOMPRESSION FOR ROTATOR CUFF TEAR WITH SHOULDER STIFFNESS

Some patients with rotator cuff tear have shoulder stiffness preoperatively. Concomitant preoperative shoulder stiffness may affect postoperative outcomes of arthroscopic subacromial decompression (ASD) for rotator cuff tear. The purpose of this study was to compare postoperative outcomes for ASD between rotator cuff tear patients with and without preoperative shoulder stiffness and to analyze the serial change in functional scores, range of motion (ROM), and pain intensity of the 2 groups after operation. 60 shoulders of 58 patients who underwent ASD for rotator cuff tear were studied. Arthroscopic release was performed for the stiffness group. The results were assessed before surgery and 1, 3, 6, 12 and 24 months after surgery, and the results in the stiffness group and non-stiffness group were compared. No differences in serial changes for postoperative outcomes of ASD were seen in terms of the Japanese Orthopaedic Association shoulder scoring system (JOA scores) and the visual analog scale (VAS scores) for pain at night and pain during motion between the stiffness group and non-stiffness group. However, compared to the non-stiffness group, forward flexion and abduction angles were significantly smaller for the stiffness group at 1 and 3 months after surgery. External rotation and internal rotation angles were significantly smaller at 1 month after surgery for the stiffness group than for the non-stiffness group. Preoperative shoulder stiffness does not affect improvement of postoperative JOA scores and VAS scores of ASD. When measured 6 months after surgery, ROM in the stiffness group and the non-stiffness group was similar.

(i) Degenerative rotator cuff disease and impingement

Abstract Impingement and tears of the rotator cuff are common. 2.5% of the population of the United Kingdom seek advice for a shoulder complaint each year. 70% of these referrals are due to rotator cuff related pathology. Codman and Neer both initially postulated that impingement and tendinopathy were due to extrinsic factors with the antero-lateral acromion ‘impinging' on the superior surface of the rotator cuff. This view has subsequently been modified and the general consensus now agrees that it is a multifactorial condition with both extrinsic, intrinsic and environmental factors all playing a role. A clear history and examination findings are crucial to exclude subtle causes of impingement that are atypical, e.g. instability. This review clearly describes the general shoulder examination and specific tests. The benefits and disadvantages of ultrasound and magnetic resonance imaging are discussed in the diagnosis of rotator cuff pathology. The treatment options for proven impingement vary from analgesia and physiotherapy, injection therapy to surgical intervention, both open and arthroscopic. The treatment needs to be tailored to the individual patient and is often dictated by the initial response to injections and radiological findings as well as examination findings. Outcomes of arthroscopic subacromial decompression are favourable in most studies and evidence does suggest that the surgery reduces the incidence of rotator cuff tears when compared to an unoperated cohort. There are however contradictory studies claiming physiotherapy is comparable to subacromial decompression.

Long-term patient satisfaction and functional outcome 8–11 years after subacromial decompression

The aim of this investigation was to evaluate the long-term outcome of arthroscopic subacromial decompression (ASD) in patients with primary impingement syndrome stage II and early stage III. Ninety-five patients (105 shoulders, 48 female), mean age 54 years (range 26-69), who had undergone surgery between 1996 and 1999, were included. Pain intensity during activity and at rest, patient satisfaction, active range of motion (ROM), muscular strength and shoulder function using the Constant score were evaluated. Fifty-three (50%) shoulders were pain-free (Visual Analogue Scale < or = 10 mm) during activity and 72 (68%) shoulders were pain-free at rest. Sixty-one (58%) patients stated that they were very satisfied and 27 (25%) were quite satisfied with regard to their current shoulder function. Shoulders were divided into Group 1: Pain-free patients (n = 53), Group 2: Patients with shoulder pain and no arthropathy (n = 41) and Group 3: Patients with shoulder pain and arthropathy (n = 11). The groups had average active ROM of 157 degrees, 135 degrees and 117 degrees, respectively, in abduction and 97 degrees, 79 degrees, and 68 degrees in external rotation. The average strength in elevation in the scapular plane was 7.4, 5.8 and 3.9 kg, respectively, whereas the mean value in external rotation was 8.4, 7.9 and 5.3 kg, respectively. The Constant score had a mean value of 87, 69 and 59 points in the three groups, respectively. Eleven shoulders have undergone re-operation, one after a new trauma. We conclude that ASD is a valuable procedure. Patients expressed a high degree of satisfaction with shoulder function 8-11 years after ASD.

Short-term outcome of arthroscopic subacromial decompression and arthroscopic capsular release for subacromial impingement syndrome

Short-term outcome of arthroscopic subacromial decompression and arthroscopic capsular release for subacromial impingement syndrome

CONSTITUTIVE MODELLING AND PARAMETERS IDENTIFICATION FOR INELASTIC BEHAVIOUR OF CORTICAL BONE TISSUE

To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years.We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery.Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate.Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears.Level IV, therapeutic case series.

Arthroscopic Subacromial Decompression for Stage-II Impingement

To evaluate outcomes of arthroscopic subacromial decompression for stage-II impingement. Records of 42 consecutive patients with stage-II impingement treated by arthroscopic subacromial decompression from January 2000 to February 2002 were reviewed. Clinical outcomes were measured using the UCLA shoulder rating scale, and radiological outcomes using anteroposterior and supraspinatus outlet shoulder radiographs. The mean follow-up period was 14.6 (range, 12-30) months. Using the UCLA scale, 14 (33%) patients had an excellent result, 21 (50%) had a good result, 4 (10%) had a fair result, and 3 (7%) had a poor result. Mean component scores for the UCLA scale were: 8.0 for pain, 8.8 for function, 4.5 for forward flexion, and 4.5 for strength. The mean extent of resection was 2.9 mm in the anteroposterior and 2.0 mm in the supraspinatus outlet radiographs. There was no correlation between the extent of acromial resection and the UCLA shoulder rating scores. Short-term results of arthroscopic subacromial decompression for stage-II impingement are favourable.