Background. Several orthopaedic studies have found significant correlation between pre-operative psychological status and post-operative outcomes. The majority of research has focused on patients requiring lower limb and spine surgery. Few studies have investigated the effect of psychological status on the outcome of upper limb operations. We prospectively investigated the association between pre-operative psychological status and early postoperative shoulder pain and function in patients requiring arthroscopic subacromial decompression (ASAD) for impingement syndrome. Methods. A consecutive series of patients in 2009/10 completed questionnaires 2 weeks pre-operatively and 3 and 6 weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the Oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively. Data was analysed using non-parametric statistical methods. Results. Thirty-one patients participated (21 women; 10 men; mean age 54.6 years; age range 21–89 years). Preoperative anxiety was significantly associated with pre-operative shoulder pain (P < 0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P < 0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P < 0.05) regardless of pre-operative psychological status. Conclusion. Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. Our results from a total of 31 patients suggest there is no justification for routinely assessing psychological status in patients with ‘uncomplicated’ impingement syndromes that require ASAD. The majority of patients benefit from ASAD both physically and psychologically regardless of psychological state. Therefore abnormal pre-operative psychological status should not be a justifiable reason for delaying or denying this effective operation

Aims

The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness.

Arthroscopic subacromial decompression was carried out in one hundred and four consecutive patients who had stage II subacromial impingement with failed conservative treatment. The results were assessed preoperatively and at follow up using the UCLA score. After an average of 8.4 years follow up, the final results were as following; fifty-seven shoulders (55%) in excellent, twenty-five (24%) in good, sixteen (15%) in fair and six (6%) in poor. Late full thickness tears developed in 9% of patients and can be treated with an open repair of rotator cuff. Arthroscopic subacromial decompression was very effective for stage II impingement syndrome. To assess the long term results of arthroscopic subacromial decompression in stage II subacromial impingement. Arthroscopic subacromial decompression was very effective for stage II impingement. Late full thickness tears developed in 9% of patients and can be treated with an open repair of rotator cuff. This technique is a viable treatment for the condition. This is a prospective cohort study carried out in a University setting. Arthroscopic subacromial decompression was carried out in one hundred and twenty consecutive patients who had stage II subacromial impingement with failed conservative treatment. Sixteen were lost to follow up. The results were assessed preoperatively and at follow up using the UCLA score. After an average of 8.4 years follow up, the final results were fifty-seven shoulders (55%) excellent, twenty- five (24%) good, sixteen (15%) fair and six (6%) poor. All parameters – pain, function, muscle strength and motion – were improved significantly (p< 0.001). In the six poor results, two had late rotator cuff tears, three had recurrence of impingement with degenerative change and one had reflex sympathetic dystrophy. Late full thickness rotator cuff tears developed in ten shoulders after decompression. Re-operations were performed in four shoulders – three late open repairs of the rotator cuff tear resulted in good results with one poor rating. Arthroscopic subacromial decompression was very effective for stage II impingement syndrome. Late full thickness tears developed in 9% of patients and can be treated with an open repair of rotator cuff

Purpose: To review the results of simple arthroscopic subacromial decompression in patiens with impingement syndrome and rotator cuff tears without repairing the tears. Type of Study: prospective study. Material and Methods: From 1998 to 2003, 160 patients (168 shoulders) had arthroscopic subacromial decompression for impingement syndrome with a torn rotator cuff without repairing the tear of the cuff (120 males and 40 females). The average patient age was 64 years and the average follow up was 24 months. With increasing use of arthroscopy in the treatment of shoulder disorders, tears of the rotator cuff have been well described. Management of rotator cuff tears should include consideration of tear size, patient age and activity level, and tear etiology. Operative treatment of impingement syndrome in elderly less active lower demand patients with small and moderate tears involves decompression with and without repairing the cuff. We evaluated the clinical outcome of arthroscopic subacromial decompression and debridement in 160 patients ( 168 shoulders ) with impingement syndrome with small and moderate tears of the rotator cuff without repairing the cuff. Rotator cuff tears are graded arthroscopically as small (< 1 cm), moderate (> 1 cm < 3 cm ), large (> 3 cm < 5 cm ), and massive rotator cuff tears (> 5 cm ). Results: At follow up 96 patients (60%) were rated excellent or good , 56 patients (35%) were rated fair and 8 patients (5%) were rated poor. The average “Constant” score was 62 preoperative compared with 82 postoperative in the improved group (152 patients) . The 8 patients who showed no improvement had average postoperative “Constant” score of 64. Conclusions: Arthroscopic subacromial decompression without suture of the cuff in elderly less active lower demand patients with impingement syndrome with small and moderate tears of the cuff is a legitimate method of treatment for their shoulder pain and limitation of function. The main advantages were: immediate physiotherapy and return of function since there is no need for immobilization

Introduction. The purpose of this study was to assess the rate of revision subacromial decompression and identify different pathologies. Materials/Methods. We analysed the patients who underwent Revision Arthroscopic Subacromial decompression from our prospective database of shoulder patients. Between April 2003 and Dec 2010, 797 patients underwent arthroscopic subacromial decompression. Patients who underwent any other procedure i.e. biceps tenotomy, capsular release, cuff repair were excluded from the study. Of these, 37 underwent a revision subacromial decompression (Revision rate 4.6%). The indication for revision procedure was persistent pain or restricted movements not responding to physiotherapy and injections. Results. We found that 1) Patients having cuff pathology i.e. partial tear or degenerate cuff were more likely to need a revision procedure (11/37 and 92/797, p = 0.001). 2) The rate of ACJ excision done for residual pain after primary subacromial decompression was similar to the rate of ACJ excision at the time of the primary procedure (7/37 vs. 100/797, p= 0.5). 3) Presence of Calcific deposits did not have any influence on the risk of having a revision procedure (2/37 and 12/797, p= 0.1). 4) Patients found to have synovitis in the primary procedure were more likely to need revision procedure (10/37 and 81/797, p = 0.001). 5) Presence of biceps tendonitis did not significantly affect the risk of having a revision procedure after arthroscopic subacromial decompression (3 /37 and 21 /797, p = 0.5). Conclusion. Our revision rate is similar to those published in literature. In our failed cases there was a trend for patients to have an associated partial rotator cuff tear and synovitis

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

68 patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome. Patients were evaluated preoperatively, at 3 weeks and 3 months post operatively using the Constant score. Mean preoperative Constant score was 46. 5 (34–67), at 3 weeks 65. 8 (40–86), and at 3 months 82. 4 (50–99). There was no correlation between the impingement grade, presence of a cuff tear or acromioclavicular joint involvement, and a significant poorer outcome. 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 3 weeks post surgery, rising to a 40 point increase at 3 months. Patients can therefore be counselled that they will make a significant functional improvement in a short time after surgery

The purpose of the study was to determine the prevalence of rotator cuff tears at long-term follow-up after arthroscopic subacromial decompression. Between 1991 and 1994, arthroscopic subacromial decompression was done on 42 shoulders for impingement syndrome. None exhibited signs of a rotator cuff tear. The patients were re-evaluated at a mean postoperative follow-up time of 10 years. At follow-up, the mean age of the patients was 54 years (33 to 69). The evaluation consisted of a clinical examination (including the Constant shoulder score) and an ultrasonographic examination. Only seven patients were found to have developed rotator cuff tears and only one needed a repair procedure. Their mean Constant score was 95. The mean Constant score of 34 patients was 97. One patient refused follow-up owing to a subjective poor result. There were no complications. We conclude that this is an effective intervention for impingement syndrome, protecting the rotator cuff

Introduction. Whiplash injury following rear shunt Road traffic accident (RTA) has been associated with impingement syndrome of shoulder. However, the results of arthroscopic subacromial decompression (ASAD) for this group of patients have never been compared to the non accident group. In our study we aim to compare the results of ASAD in these patients to a group who did not sustain whiplash injury. Materials/Methods. Thirteen patients with impingement syndrome following rear shunt RTA were followed up (2004–09). After failed conservative management for at least 6 months ASAD was performed. This group was compared with a control group (not involved in an RTA) of 13 consecutive patients (age and sex matched). All patients were assessed with Oxford shoulder score preoperatively and twice post operatively (within 3 months and at one year). Results. In the RTA group all 13 patients showed improvement in their oxford score over one year. While the improvement was only Marginal (p= 0.08) at three months it was better at the end of a year (p=0.04). Comparatively in the cohort without the whiplash injury the improvement was more marked in the first three months (p=0.05) with significant improvement at the end of the year (p=0.03). The overall improvement in Oxford score was more in the cohort of patients who were not involved in a RTA as opposed to the RTA group (p= 0.05). Conclusion. The results of the study show that even though there was an improvement in shoulder scores after an arthroscopic subacromial decompression it was much slower and overall results were inferior in the RTA group as opposed to the controls and hence prognosis should be guarded when offering ASAD for patients with whiplash injury

Introduction. The conservative management of Sub-Acromial Impingement Syndrome (SAIS) of the shoulder includes both physiotherapy treatment and subacromial injection with local anaesthetic and steroids. The outcome from injection treatment has rarely been evaluated scientifically. Methods. Patients attending a designated shoulder clinic and diagnosed by an experienced shoulder surgeon as having a SAIS between January 2009 and December 2011 were considered for inclusion in the study. 67 of 86 patients screened completed the study (3 did not meet inclusion criteria; 9 declined to participate; 3 lost to follow-up; 4 developed frozen shoulder syndrome). Each patient had a pre-injection Oxford Shoulder Score (OSS) and was given one subacromial injection of 10ml 0.25% levobupivacaine(Chirocaine) + 40 mg triamcinolone(Kenalog) through the posterior route. Radiograph imaging was also assessed. Follow-up was carried out at 6 to 12 weeks post injection when OSS was repeated. A 6 month follow-up assessment to assess if the patient's improvement in functionality and absence of symptoms indicated that a subacromial decompression operation was not necessary. The percentage of patients showing improvement in OSS was calculated and the difference in OSS pre- and post-injection assessed using a Wilcoxon Signed Rank test. Results. The median OSS pre-injection was 29 (range 2–43) and post-injection was 40 (range 2–48) (p=< 0.001; z=−6.0; r=−0.5). 45/69 (71%) of patients benefited significantly from subacromial injection at 6 to 12 weeks post-injection. However only 28/53 (53%) benefited significantly from injection by 6 months post-injection. These results support the continued use of sub-acromial corticosteroid injections in the treatment of SAIS. 31% of these patients were subsequently treated with an arthroscopic subacromial decompression operation. Previous injection history had no impact on the results. Conclusions. We recommend that all patients with SAIS should be offered at least one subacromial injection before being considered for an arthroscopic subacromial decompression operation

There is concern that intra-articular electrosurgical ablation may cause thermal soft tissue damage, particularly chondrolysis, if excessive temperatures are reached. The aim of this study was to determine whether the intra-articular temperature during arthroscopic subacromial decompression using a monopolar electrosurgical ablator remains below a safe level. Data was collected prospectively from consecutive shoulder arthroscopic subacromial decompressions performed at our institution. Shoulder arthroscopy was performed using three standard portals. Evaluation of the glenohumeral joint and subacromial space was performed in a standard manner. Soft tissue resection of the subacromial bursa was performed using a monopolar electrosurgical ablator probe with continuous integral suction. Additional procedures such as acromioclavicular joint excision and rotator cuff debridement or repair were performed as appropriate. Bone resection, if required was performed using an arthroscopic burr. The temperature of the fluid within the shoulder and subacromial space was continuously monitored using a sterile digital temperature probe. The surgeon performing the procedure was blinded the collection of data. Data from thirty subacromial decompressions has been collected. 8 patients had full thickness cuff tears of which 6 were debrided, and 2 repaired arthroscopically. 13 patients had acromioclavicular joint excision. Mean operating time was 46 minutes (30–107). The infusion pressure ranged from 40 to 65 mmHg. The median volume of infused fluid was 3900 ml (1500 to 9000). The starting temperature ranged from 18.3 to 21.9. The mean maximum temperature reached was 27.6 (range 22.7 to 41.8 °C). The results suggest that the intra-articular temperature is maintained within safe levels when a monopolar electrosurgical ablator with integral suction is used to perform soft tissue subacromial decompression

The purpose of this study is the evaluate the net promotor score of arthroscopic subacromial decompression and rotator cuff repair. The Friends and Family Test, a variant of the Net Promoter Score, was adapted for the National Health Service to evaluate overall patient satisfaction and how likely patients are to recommend an intervention. It ranges from −100 to 100. Positive scores indicate good performance. This study quantifies the scores in 71 patients at 1 year following arthroscopic sub acromial decompression and rotator cuff repair. All of the procedures were performed by 1 consultant shoulder specialist. The patient filled out a shoulder questionnaire pre-operatively, at 6 months and 1 year. The score was 72 for subacromial decompression (n = 32) and 85 for rotator cuff repair +/− decompression (n = 39). Oxford shoulder score was also taken and had a rise of 4.3 and 6.9 respectively. Our study indicates that these procedures are highly valued and are recommended by patients according to the Friends and Family Test. The results of the Friends and Family Test correlated well with postoperative functional improvement and satisfaction. We conclude from this study that a compound score based on the Friends and Family Test is a useful addition to traditional measures of patient satisfaction

Background: Subacromial decompression surgery is associated with significant postoperative pain. We compared the effect of intrascalene block (ISB) and sub-acromial bursa block (SBB) with simple opiate based analgesia. Methods: In a prospective, randomised controlled trial, fifty-three (n = 53) patients scheduled for arthroscopic subacromial decompression were randomised into three groups receiving Intrascalene block (n =19), Subacromial Bursa block (n =19) or neither of the two blocks (n =15 controls). Patients with cuff pathology were excluded. ISB was performed preoperatively with 20 mls of 1% Prilocaine and 10 mls of 0.5 % Bupivacaine. SBB was given with 20 mls of 0.5% Bupivacaine postoperatively. All patients received standardised general anaesthetic and postoperative analgesia. Pain, sickness and sedation scores were noted at 1, 2, 4, 8, 12 and 24 hours postoperatively. The postoperative consumption of morphine and the time when the first bolus of morphine was required were also noted. Results: The visual analogue pain scores in the ISB and SBB group were lower than the control group in the first twelve hours postoperatively achieving statistical significance but there were no significant differences between the SBB and ISB groups. The controls consumed more morphine postoperatively (mean 32.3 mls) than SBB (21.21 mls) and ISB groups (14.00 mls) (p < 0.001). The time for first bolus was earlier in the controls (mean 30.2 mins) as compared to both SBB (72.7 mins) and ISB groups (105.8 mins) (p< 0.001). The oral analgesic intake was less in the SBB and ISB groups than the controls (p = 0.004), but there was no difference between the two treatment groups. Conclusion: Whilst intrascalene block remains the gold standard where expertise is available for its administration, subacromial bursa block is a safe alternative in patients with intact rotator cuff undergoing arthroscopic subacromial decompression

This investigation was performed to determine whether MRI would provide any additional diagnostic information to the clinical evaluation and diagnostic arthroscopy of the shoulder. The study was performed in patients with shoulder impingement syndrome booked for an arthroscopic subacromial decompression. Although there was significant discordance between the MRI and arthroscopic findings, the MRI did not change the diagnosis or treatment plan in a clinically important way. To determine whether the radiologist’s MRI report provided to an arthroscopist upon completion of a standard diagnostic shoulder arthroscopy would result in changes to the initial arthroscopic findings. Despite high percentage of discordance between MRI and arthroscopy, the MRI information modified the initial arthroscopic diagnosis in a much smaller percentage of cases. In only one patient, did the change in diagnostic information have an impact on the planned treatment. MRI adds minimal clinically important information to diagnostic shoulder athroscopy in patients with impingement syndrome. The percentage discordance between MRI and arthroscopy for each structure of interest was calculated along with the percentage change in diagnosis based upon the arthroscopic re-evaluation and the consequence of the change. Supraspinatus 55.2% discordance(n=32/58), 18.8% change in diagnosis(n=6/32), in 1 patient a change in the planned operation occurred from subacromial decompression to mini-open rotator cuff repair. Infra-spinatus 44.8% discordance(n=26/58), 3.8% change in diagnosis(n=1/26), and no consequence to planned treatment. Subscapularis 37.9% discordance(n=22/58), no change in diagnosis. Biceps tendon 62.3% discordance(n=33/53; five patients not adequately visualized on MRI), no change in diagnosis. Fifty-eight patients presenting with shoulder impingement syndrome underwent a standardized MRI prior to planned arthroscopic subacromial decompression. A standard diagnostic arthroscopy was performed. The anatomic and pathologic findings were documented intra-operatively by an independent observer. The arthroscopist was initially blinded to the MRI information. MRI results were then revealed to the surgeon. An arthroscopic re-evaluation was performed to resolve discrepancies between MRI and arthroscopy

Introduction. Adhesive capsulitis is a common condition causing painful limitation of shoulder movements. Hydrodistension is one of the techniques, is well recognised and has shown good outcomes. However, the results of hydro distension release in secondary adhesive capsulitis are not clear. Patients and Methods. This is a retrospective study on patients undergoing hydro distension release. Patients who had any surgical intervention were classed as secondary whilst the rest were included in the primary group. The hydro distension is a standard technique where in the senior author locates the gleno humeral joint using radio opaque dye, followed by injection of 20 mls 0.5% L-bupivacaine and 80 mg of Triamcinolone, this is followed by use of 60 mls saline to perform the hydro distension. Results. We included 86 shoulders in 80 patients who underwent the procedure. There were 46 females and 34 males, with average age of 51.07 years (range 35 – 75). Left side was involved in 42 shoulders and right in 44. 25 patients showed associated risk factors of which 17 patients had diabetes, 12 had hypercholesterolemia and 5 had underactive thyroid. 65 of the shoulders were in the primary group whilst 21 in the secondary group. In the secondary group the procedures included 8 arthroscopic subacromial decompression with ACJ excision, 7 had rotator cuff repairs, 4 had biceps labral procedure and 2 ORIF clavicle. 3/21 patients required further intervention in secondary group, whilst 10/65 in the primary group required further intervention. Patients who have history of inflammatory arthritides were found to have higher incidence of revision surgery and poorer outcomes. 85% patients in both groups had improvement in their function and range of movements and were happy with the outcome. Conclusion. Hydrodistension provides safe and predictive results in both primary and secondary adhesive capsulitis and should be considered as an option before any invasive procedure

The incidence of frozen shoulder (FS) as a complication of simple arthroscopic shoulder surgery has yet to be defined. A single-surgeon case series of patients undergoing arthroscopic subacromial decompression (ASD) or ASD with arthroscopic acromioclavicular joint (ACJ) excision was analysed to establish FS rate, this cohort was then compared to a matched group of primary FS patients. Retrospective analysis of 200 consecutive cases was undertaken. All procedures listed, performed and reviewed by the senior author. 96 underwent ASD and 104 underwent ASD and ACJ excision. 6-months follow-up minimum. Incidence of frozen shoulder was 5.21% (ASD) and 5.71% (ASD+ACJ excision). Mean age was 52.3 years (95% CI: 47.4 to 57.2) of the patients that developed FS, compared to 57.2 years (95% CI: 55.2 to 59.2) in the patients who did not and 52 years (95% CI: 50.7 to 53.3) in the primary FS cohort (n=136). 9.1% of post-operative FS were diabetic compared to 17.1% of primary FS. 63.6% were female in the post-operative FS group, 47.1% in the primary FS group. Our results suggest that the risk of FS following simple arthroscopic procedures is 5%, with no increased risk if the ACJ is also excised. This cohort has the same average age as a primary FS. There is a trend toward female sex and diabetes does not increase the risk

Aims. To determine whether a correlation exists between the clinical symptoms and signs of impingement, and the severity of the lesions seen at bursoscopy. Methods. Fifty-five consecutive patients who underwent arthroscopic subacromial decompression were analysed. Pre-operatively patients completed an assessment form consisting of visual analogue pain score, and shoulder satisfaction. The degree of clinical impingement was also recorded. At arthroscopy impingement was classified according to the Copeland-Levy classification. Clinical assessment and scoring was performed at 6 months post-operatively. Linear regression coefficients were calculated to determine if the degree of impingement at arthroscopy correlated with pre-operative pain, satisfaction and clinical signs of impingement. Results. Pre-op pain levels, shoulder satisfaction and the degree of clinical impingement did not correlate with severity of the lesions of the acromion and cuff. (Average Correlation co-efficient r2 = 0.018). There was no correlation between the improvement in the shoulders post-operatively and the severity of lesions (r2 = 0.008). Conclusion. There is no significant correlation between pain, clinical signs, or satisfaction and the severity of lesions seen at arthroscopy

Purpose Of The Study: To compare the Coblation technology Vs standard diathermy regarding surgical time & cost in arthroscopic subacromial decompression. Methods & Results: This prospective randomized comparative study between Coblation technology Vs standard monopolar diathermy in ASD. 40 patients with chronic impingement syndrome prospectively randomized 20 patients in each group. Procedure time & cost per case were accurately calculated. Results show that the Coblation group had an average 8 minutes shorter procedure time per case P value: 0.0001. The cost saving as a result was about £64 per case P value: 0.01. Conclusion: Use of Coblation technology for soft tissue debridement & resection in ASD reduces procedure time by 38% and the cost by an average of 18% per case (£64) compared with the use of a shaver and diathermy probe

Two surgeons performed arthroscopic subacromial decompression (ASD) on 302 shoulders between January 1995 and January 1999. The mean age of patients was 49.6 years (28 to 81). The mean follow-up period was 36 months (4 to 62). Evaluated using the modified UCLA scoring system, 91% of patients had a good to excellent result at short-term follow-up. However, patients reviewed for two years or longer showed a 98% successful outcome. The commonest delay in improvement was stiffness, with six patients requiring surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator cuff impingement and accurate identification of arthroscopic impingement signs ensures a successful outcome. Our study confirms other reports that ASD leads to good results in carefully selected patients

From January 1995 to January 1999, the author performed arthroscopic subacromial decompression (ASD) on 220 patients. The mean age of patients was 47.4 years (28 to 72). The follow-up period ranged from 4 to 60 months. The modified UCLA scoring system was used to evaluate patients at four months and again at 24 to 60 months. At short-term follow-up, 91% of patients achieved good to excellent results. However, patients reviewed for two years or longer showed a 98% successful outcome. Stiffness was commonly the last thing to improve, and three patients required surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator cuff impingement and accurate identification of arthroscopic impingement signs ensures a successful outcome. This study confirms other reports that ASD produces good results in carefully-selected patients