Shoulder Arthroscopy (Decompression/Acromioplasty)

Primary shoulder impingement with associated subacromial spur formation

• Local skin infection or disease
• Systemic infection
• Other medical illness that increases surgical risk

• Arthroscopy tower and arthroscope
• Arthroscopy set and cannulas
• Balanced shoulder suspension device
• Spinal needles
• Full-radius resector
• Acromionizer
• Thermal probe
• Electrocautery
• Sling

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.

• 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

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