Arthroscopic Sub-acromial Decompression in Impingement Syndrome of Shoulder – A Clinical Study
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 12
Abstract
The shoulder is the most versatile joint in the body having a wide functional range of motion, including arm elevation to 180°, rotation to 150° and horizontal (sagittal) plane rotation of 1701, 2. By combining the coordinated glenohumeral and scapulothoracic motion with contributions from the acromioclavicular and sternoclavicular joints, the shoulder can retain stability without compromising mobility. Shoulder pain is a frequent complaint; with prevalence in the general population ranging from 70 to 260 per 10003, 4. According to a recent state-of-the-art review, the annual incidence of shoulder disorders is estimated at 7%, its 1-year period prevalence at 50% and its lifetime prevalence at 10%5. Of all new episodes of shoulder disorders presenting to primary care, symptoms may persist for up to 1 year in 40% of patients. It 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 position9. This disorder can present in many forms, ranging from inflammation to degeneration of the bursa and rotator cuff tendons of the subacromial space. Curved or hooked shape of the acromion, osteophytes under the acromioclavicular joint, subacromial bursitis, thickened coracoacromial ligament, degenerative or a traumatic cuff failure and calcific rotator cuff tendinitis are some of the reasons for impingement of the shoulder. The underlying causes of rotator cuff impingement may be subdivided into intrinsic disorders of the rotator cuff and extrinsic pressure from the coracoacromial arch. In intrinsic disorders, the tendon is thickened and inflamed at areas of calcification, swollen at the site of partial cuff tears, or covered by a chronically inflamed and indurated subacromial bursa. In extrinsic cases, the shapes of the acromion, the attachment of the coracoacromial ligament and changes in the acromioclavicular joint have been implicated. It is often stated that in most instances overuse of the affected arm is the basic cause of impingement. Neer CS18 described the following 3 stages in the spectrum of rotator cuff impingement: • Stage 1- commonly affecting patients younger than 25 years, is depicted by acute inflammation, edema, and hemorrhage in the rotator cuff. This stage usually is reversible with nonoperative treatment. • Stage 2- usually affects patients aged 25-40 years, resulting as a continuum of stage 1. The rotator cuff tendon progresses to fibrosis and tendonitis, which commonly does not respond to conservative treatment and requires operative intervention in the form of open / arthroscopic sub acromial decompression. • Stage 3 commonly affects patients older than 40 years. As this condition progresses, it may lead to mechanical disruption of the rotator cuff tendon and to changes in the coracoacromial arch with osteophytes along the anterior acromion. Surgical anterior acromioplasty and rotator cuff repair is commonly required. Non surgical management of subacromial impingement syndrome (SIS) continues to be successful in many patients. The most common interventional modalities include modification of activities, the use of non-steroidal anti-inflammatory medications, subacromial injection of steroids and physical therapy programs11. It has been demonstrated that exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength19. A systemic review was conducted, aiming to compare conservative versus surgical treatment for subacromial impingement syndrome. The conclusion was that no high quality RCTs are available to provide possible evidence for differences in the outcome; therefore, no confident conclusion could be drawn21. The goal of subacromial decompression is to arrest the inflammatory process and prevent progressive degenerative changes in the soft tissues comprising the subacromial space. The purpose of present study was to evaluate the functional results of arthroscopic subacromial decompression (ASD) in patients suffering from impingement syndrome of shoulder.
Authors and Affiliations
Dr. Davinder Singh
Keywords
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