S Lerch1, S Elki2, M Jaeger2, T Berndt2. 1. Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland. solveig.lerch@krh.eu. 2. Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland.
Abstract
OBJECTIVE: Coracoacromial ligament release to widen the subacromial space, resection of the anterior undersurface of the acromion and, if needed, caudal exophytes at the acromioclavicular joint. INDICATIONS: All types of outlet impingement after 3 months of conservative treatment. CONTRAINDICATIONS: Impingement syndrome with instability/muscular imbalance, massive rotator cuff tear, unstable os acromionale, posterior-superior impingement, joint infection, freezing phase of a secondary frozen shoulder. SURGICAL TECHNIQUE: Lateral decubitus position with traction device for the arm. Diagnostic arthroscopy of the glenohumeral joint via standard portals. With arthroscope moved to the subacromial space, bursectomy, electrosurgical release of coracoacromial ligament, resection of acromial hook through standard posterior portal. POSTOPERATIVE MANAGEMENT: Physiotherapy or self-exercises on postoperative day 1, pain-adapted analgesia to avoid shoulder stiffness. RESULTS: Several studies present positive long-term results compared to conservative treatment (and open acromioplasty) for partial rotator cuff tears and for elderly patients. With a 20-year follow-up, successful results have been achieved for all patients with isolated impingement syndrome.
OBJECTIVE: Coracoacromial ligament release to widen the subacromial space, resection of the anterior undersurface of the acromion and, if needed, caudal exophytes at the acromioclavicular joint. INDICATIONS: All types of outlet impingement after 3 months of conservative treatment. CONTRAINDICATIONS: Impingement syndrome with instability/muscular imbalance, massive rotator cuff tear, unstable os acromionale, posterior-superior impingement, joint infection, freezing phase of a secondary frozen shoulder. SURGICAL TECHNIQUE: Lateral decubitus position with traction device for the arm. Diagnostic arthroscopy of the glenohumeral joint via standard portals. With arthroscope moved to the subacromial space, bursectomy, electrosurgical release of coracoacromial ligament, resection of acromial hook through standard posterior portal. POSTOPERATIVE MANAGEMENT: Physiotherapy or self-exercises on postoperative day 1, pain-adapted analgesia to avoid shoulder stiffness. RESULTS: Several studies present positive long-term results compared to conservative treatment (and open acromioplasty) for partial rotator cuff tears and for elderly patients. With a 20-year follow-up, successful results have been achieved for all patients with isolated impingement syndrome.
Authors: Oscar Dorrestijn; Martin Stevens; Jan C Winters; Klaas van der Meer; Ron L Diercks Journal: J Shoulder Elbow Surg Date: 2009-03-14 Impact factor: 3.019