Surgical Management of the Subacrornial Arch: Arthroscopic Techniques for Subacromial Decompression,Acromioplasty, and Distal Clavicle Resection

摘要

As the population ages and remains active, orthopedic surgeons will increasingly encounter patients with shoulder pain. Impingement syndrome comprises an increasing proportion of the diagnoses in the over 40 age group. A classic history of anterosuperior shoulder pain with radiation down to the deltoid insertion exacerbated with overhead activities is the rule. Physical examination is positive for impingement with possible rotator cuff and acromio-clavicular (AC) joint findings as well. Radiographs may show spurring of the anterior acromion and/or narrowing and sclerosis of the AC joint. Magnetic resonance imaging with gadolinium enhancement is an essential tool in the management of impingement syndrome because it allows the surgeon to critically asses the status of the rotator cuff and surrounding structures and assists in the decision-making process regarding nonoperative versus operative management. Treatment depends on the amount of disability and the extent of involvement of the cuff tendons. It ranges from nonoperative management with nonsteroi-dal anti-inflammatories, physical therapy, and steroid injections to subacromial decompression, acromioplasty, distal clavicle resection, and rotator cuff repair. It is imperative for the practicing surgeon to correctly identify the problem, rule out other potential causes, and be well versed in nonoperative and operative treatment algorithms.