Shoulder Arthroscopy (Decompression-Acromioplasty)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Primary shoulder impingement with associated subacromial spur formation

CONTRAINDICATIONS
  • Local skin infection or disease
  • Systemic infection
  • Other medical illness that increases surgical risk
EQUIPMENT
  • Arthroscopy tower and arthroscope
  • Arthroscopy set and cannulas
  • Balanced shoulder suspension device
  • Spinal needles
  • Full-radius resector
  • Acromionizer
  • Thermal probe
  • Electrocautery
  • Sling
ANATOMY

Arthroscopic subacromial anatomy

  • Biceps tendon is used as landmark for orientation.
  • Lateral decubitus position: with camera in normal upright position, glenoid is horizontal
  • Evaluate biceps tendon as far as possible into the rotator interval.
  • Directing lens superiorly allows view of rotator cuff and insertion into greater tuberosity.
  • Rotator cuff arch, just medial to tendinous insertion
  • Small vessels enter inferior to the cuff in a bare area (no articular cartilage covering).
  • Subacromial burse extends at least 2 cm anterior to the anterior edge of the acromion and to the midacromion posteriorly.
  • Medially, you can see the acromioclavicular joint and coracoacromial ligament as it ascends under the acromion.
  • The subdeltoid bursa is approximately 4 cm from the acromial edge, with the axillary nerve always lateral to the bursa, on average 0.8 cm.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Arthroscopic Acromioplasty
  • Post-Procedure: Chockblock Method for Acromioplasty

Post-Procedure: Arthroscopic Acromioplasty

POST-PROCEDURE CARE
  • Sling until comfort permits removal.
  • Exercises:
    • Codman pendulum exercises first day
    • Active-assisted range-of-motion and isometric strengthening the first week
    • Resistance exercises with elastic tubing second week
    • Continue strengthening for 3 months.
  • Activities of daily living as tolerated
  • Return to sports when they have achieved full pain-free range of motion and strength.
COMPLICATIONS
  • Failure of the procedure and/or persistent symptoms (most common complication)
  • Neurologic injury
  • Infection
  • Subclavian vein thrombosis
ANALYSIS OF RESULTS

Arthroscopic acromioplasty has been shown to have very satisfactory results even long-term in patients with shoulder impingement. In the presence of a rotator cuff tear, the success is dependent on the degree of tear.

OUTCOMES AND EVIDENCE
  • Sampson et al: 90% good and excellent
  • Altcheck et al: 92% were satisfied; 76% return to sport
  • Ellman: 88% satisfactory
  • Gartsman: 88% improvement if no rotator cuff tear, 75% improvement if partial rotator cuff tear, 56% improvement if full-thickness rotator cuff tear
  • Stephens et al: 81% good to excellent at 8 years follow-up
Procedure: Arthroscopic Acromioplasty

Post-Procedure: Chockblock Method for Acromioplasty

POST-PROCEDURE CARE
  • Sling until comfort permits removal.
  • Exercises:
    • Codman pendulum exercises first day
    • Active-assisted range-of-motion and isometric strengthening the first week
    • Resistance exercises with elastic tubing second week
    • Continue strengthening for 3 months.
  • Activities of daily living as tolerated
  • Return to sports when they have achieved full pain-free range of motion and strength.
COMPLICATIONS
  • Failure of the procedure and/or persistent symptoms (most common complication)
  • Neurologic injury
  • Infection
  • Subclavian vein thrombosis
ANALYSIS OF RESULTS

Arthroscopic acromioplasty has been shown to have very satisfactory results even long-term in patients with shoulder impingement. In the presence of a rotator cuff tear, the success is dependent on the degree of tear.

OUTCOMES AND EVIDENCE
  • Sampson et al: 90% good and excellent
  • Altcheck et al: 92% were satisfied; 76% return to sport
  • Ellman: 88% satisfactory
  • Gartsman: 88% improvement if no rotator cuff tear, 75% improvement if partial rotator cuff tear, 56% improvement if full-thickness rotator cuff tear
  • Stephens et al: 81% good to excellent at 8 years follow-up
Procedure: Chockblock Method for Acromioplasty
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