C Schwartz1, F Atemkeng, T Messaoudi. 1. Service d'orthopédie et de traumatologie, Hôpitaux Civils de Colmar, 68024, Colmar Cedex, France, schwartzop@aol.com.
Abstract
INTRODUCTION: The shoulder pain has been reported as the third most common site after low back pain and knee pain, mostly caused by impingement and rotator cuff syndromes. Surgery is indicated when non-operative treatment fails and can be open and/or arthroscopic. Are Neer's acromioplasty results still good? Are they modified when it is a professional disease (PD)? If yes is there any explanation? MATERIALS AND METHODS: It is a retrospective hospital-based study, including all cases of Neer's acromioplasty done from 2006 to 2011, by the same senior surgeon for subacromial impingement syndrome (SIS). Medical files were consulted and an auto Disabilities of the Arm, Shoulder and Hand (DASH) score file completed by patients. We compared two groups: "with PD" and "without PD". RESULTS: We had 41 patients (21 males/20 females). Mean age: 54 (34-79) years. The majority was workers those requiring force (29.3 %) or working in abduction situations (7.2 %). The two groups were otherwise comparable (clinical, imaging and surgery findings). Aggressive acromia were found in 15 cases (36.6 %), and there were 19 (46.3 %) rotator cuff perforations. A Neer's acromioplasty and bursectomy was done in all the cases. Eighteen perforations were sutured and one (the largest) was just released. Mean follow-up: 4 (2-9) years. Of the 26 (63.4 %) patients that could return to work, 16 (61.5 %) were not PD. This return was later in the "PD group" (p < 0.05). The DASH score elements in the "without PD" group were better, compared to the PD group: (a) 16 (79.2 %) very good results on the pain against 6 (30 %), (b) 13 (61.9 %) very good results concerning the strength against 3 (15 %), (c) 14 (66.7 %) very good results in the ability to work against 4 (20 %). The DASH global mean score was 35.1 over 100. The global scores for daily life, sport and professional activities were, respectively, 33, 37.8 and 48.2 over 100. In the PD group, the mean DASH score was 53.7 against 17.44 in the non-PD what is more than three times worst. DISCUSSION: Neer's mini-open acromioplasty is still an excellent pain killer operation and should not be abandoned. Very good results on the SIS pain after a mean follow-up of 4 years were observed. Its results are very good in the "without PD" group with 76.19 % of return to previous work after a mean period of 8 months. Earlier return to a new work or to the same work with accommodations is possible. We found no anatomical explanation for the differences between the two groups.
INTRODUCTION: The shoulder pain has been reported as the third most common site after low back pain and knee pain, mostly caused by impingement and rotator cuff syndromes. Surgery is indicated when non-operative treatment fails and can be open and/or arthroscopic. Are Neer's acromioplasty results still good? Are they modified when it is a professional disease (PD)? If yes is there any explanation? MATERIALS AND METHODS: It is a retrospective hospital-based study, including all cases of Neer's acromioplasty done from 2006 to 2011, by the same senior surgeon for subacromial impingement syndrome (SIS). Medical files were consulted and an auto Disabilities of the Arm, Shoulder and Hand (DASH) score file completed by patients. We compared two groups: "with PD" and "without PD". RESULTS: We had 41 patients (21 males/20 females). Mean age: 54 (34-79) years. The majority was workers those requiring force (29.3 %) or working in abduction situations (7.2 %). The two groups were otherwise comparable (clinical, imaging and surgery findings). Aggressive acromia were found in 15 cases (36.6 %), and there were 19 (46.3 %) rotator cuff perforations. A Neer's acromioplasty and bursectomy was done in all the cases. Eighteen perforations were sutured and one (the largest) was just released. Mean follow-up: 4 (2-9) years. Of the 26 (63.4 %) patients that could return to work, 16 (61.5 %) were not PD. This return was later in the "PD group" (p < 0.05). The DASH score elements in the "without PD" group were better, compared to the PD group: (a) 16 (79.2 %) very good results on the pain against 6 (30 %), (b) 13 (61.9 %) very good results concerning the strength against 3 (15 %), (c) 14 (66.7 %) very good results in the ability to work against 4 (20 %). The DASH global mean score was 35.1 over 100. The global scores for daily life, sport and professional activities were, respectively, 33, 37.8 and 48.2 over 100. In the PD group, the mean DASH score was 53.7 against 17.44 in the non-PD what is more than three times worst. DISCUSSION: Neer's mini-open acromioplasty is still an excellent pain killer operation and should not be abandoned. Very good results on the SIS pain after a mean follow-up of 4 years were observed. Its results are very good in the "without PD" group with 76.19 % of return to previous work after a mean period of 8 months. Earlier return to a new work or to the same work with accommodations is possible. We found no anatomical explanation for the differences between the two groups.