RATE OF RECOVERY AFTER ARTHROSCOPIC SUBACROMIAL DECOMPRESSION FOR SHOULDER IMPINGEMENT SYNDROME

Abstract

Arthroscopic subacromial decompression for shoulder impingement syndrome is one of the commonest procedures performed by the shoulder surgeon. Although much has been written on this procedure since Ellman published in 1985, very little work has been carried out on the rate of recovery after surgery, despite this being one of the main concerns of the patient. This prospective study describes the early functional results after this procedure and the rate of recovery seen.

Sixty-eight patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome between January and November 2000. All patients had suffered pain for at least six months prior to surgery, and all were diagnosed on the basis of clinical findings, radiographic evidence, and a positive response to Neer’s impingement test, i.e. abolition of pain after an injection of local anaesthetic into the subacromial space. All patients were evaluated preoperatively, at three weeks and three months post operatively using the Constant score to obtain an objective assessment of shoulder function. Surgery was carried out via an arthroscopic technique using the Dyonics power shaver with the 4.5 mm Helicut blade (Smith & Nephew). Immediate post operative physiotherapy was allowed, together with the encouragement of activities of daily living.

Sixty-eight patients with a mean age of 45 years (range: 30–77 years) underwent surgery over a 10 month period. Male: female ratio was 60:40, and the lateral clavicle was affected in 33 cases, resulting in the need for an acromioclavicular joint resection to be performed arthroscopically at the same sitting. Mean preoperative Constant score was 46.5 (34–67), at three weeks 65.8 (40–86), and at three months 82.4 (50–99). Sixty-five out of 68 patients returned to full activities, including heavy manual work where necessary, by three month review. There was no correlation between the impingement grade, presence of a cuff tear, or acromioclavicular joint involvement, and a significantly poorer outcome. In particular, no patient was made worse by surgery, and at the latest review of the cohort the improvement seen has not deteriorated.

Arthroscopic subacromial decompression is a reliable method of improving the functional ability of patients with subacromial impingement syndrome, with a 20 point increase in the Constant score at three weeks post surgery, rising to a 40 point increase at three months. Patients can therefore be counseled that they will make a significant functional improvement in a short time after surgery.