Shoulder impingement syndromes in athletes and their surgical management.

The painful arc syndrome may be produced by impingement of the supraspinatus tendon, the biceps tendon, or the greater tuberosity of the humerus against the coracoacromial arch. Where conservative measures have failed, surgical intervention may provide considerable symptomatic relief by decompressing the coracoacromial arch. In 20 cases surgically treated for biceps or supraspinatus impingements, 17 patients have returned to sporting activities without symptoms. The painful arc syndrome persists in three patients but they are symptomatically improved. Six patients with complete rotator cuff tears and subsequent impingement of the greater tuberosity of the humerus against the coracoacromial arch underwent widespread decompression. Five of the patients have returned to sporting activities much improved. Failure to recognize the associated acromioclavicular joint pathology is a frequent cause of failure of surgical treatment.