Orthopedics & Orthopedic Surgery
Area of Focus: Arthroscopy and Shoulder & Upper Extremity
Arthroscopic subacromial decompression for rotator cuff impingement syndrome was first described by Ellman in 1987. Now, arthroscopic techniques have largely supplanted open decompression, because the arthroscopic technique avoids violating the deltoid origin and allows the surgeon to visualize and treat any associated intra-articular pathology. Arthroscopic subacromial decompression has proven to be a valuable and successful treatment modality for impingement syndrome of the shoulder. Careful attention to surgical technique can optimize results and minimize complications.
In this video, Drs. Hasan and Cordell review the pertinent anatomy of the coracoacromial arch, show the technique of arthroscopic subacromial decompression, and discuss the indications for the technique as well as the strategies for minimizing potential complications. Additionally, they review the preoperative imaging studies and explain how an understanding of the bony anatomy is important to guiding the amount of bony resection and avoiding the potential complications of excessive bone removal, deltoid origin detachment, or an incomplete decompression.
To begin the procedure, the coracoacromial ligament is released from the anterior acromion. At this point, complete bony exposure of the acromion anterior to the posterior margin of the clavicle is important and will facilitate an accurate bone resection. The bony decompression is performed in two steps, initially resecting the anterior leading edge of the acromion through the lateral portal. The burr is then brought in from the posterior portal, and the cutting block technique--as originally described by Caspari--is used to complete the decompression.