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.

Introduction

Health Economists in Denmark have recently reported low and delayed return to work for patients treated for Sub-Acromial Impingement syndrome (SAIS) by Arthroscopic Sub-Acromial Decompression (ASAD). Surgeons however are reporting that patients achieve good pain relief and a high standard of activities of daily living (ADL) after surgery.

Summary. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienböck's Disease. Introduction. The purpose of this study was to investigate the outcomes of patients suffering from avascular necrosis of the lunate, or Kienböck's Disease, who received arthroscopic decompression to treat the ischemic lunate. Previous studies have demonstrated an elevated intraosseus pressure in the ischemic lunate, and it has been hypothesised that ischemia in the lunate is secondary to this elevated pressure and subsequent venous congestion, as opposed to diminished arterial supply. Based on this work we have used decompression of the lunate to prevent progression of the disease. Patients and Methods. 21 patients, (22 wrists), reported to a single surgeon with a chief complaint of unremitting wrist pain and the subsequent diagnosis was Kienböck's disease, stages I, II, IIIA or IIIB. Range of motion measurement and grip strength, as well as self-reported outcome measures such as Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo, were obtained preoperatively and post operatively at 2, 7 and 12 months. The patients were treated operatively with arthroscopic decompression of the lunate. The lunate was approached dorsally at the interosseous lunotriquetral and the scapholunate ligament areas with an arthroscopic shaver until brisk bleeding was achieved upon deflating the tourniquet. In some cases, the core of the lunate had to be penetrated with a 45 k-wire until bleeding was obtained. Of the 22 wrists treated arthroscopically with lunate decompression, 18 had both pre-surgical and post-surgical follow-up evaluations. Results. The patients who underwent lunate arthroscopic decompression surgery demonstrated a statistically significant improvement in DASH score at 7 and 12 months postoperatively (p<0.05). The preoperative DASH score average for this cohort was 51, while post-operative DASH scores averaged 23 and 17 at 7 and 12 months, respectively. The patients also demonstrated some overall improvement in pain, functionality, range of motion, and grip strength as demonstrated by the Modified Mayo wrist score. Notably, the patients demonstrated statistically significant improvement in grip strength post-operatively at 7-months (p<0.05) and 12-months (p<0.01). In addition, there was noted to be improvement in supination and ulnar deviation measurements post-operatively at 7 months and 12 months, respectively. Conclusion. This study demonstrates the clinical outcome of arthroscopic decompression of the lunate in patients suffering from Kienböck's Disease using the patient's subjective evaluations as well as range of motion and grip strength measurements. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienböck's Disease using a less invasive surgical intervention

Purpose of the study:. Improved technology, increasing experience and techniques warrant an analysis of cost effective ways of medical management in general and shoulder decompression specifically. The question raised was whether a less invasive technique is necessarily the most cost effective way or merely the surgeons' preferred technique. This is a retrospective study of patients at Tertiary Academic Institution who underwent an open or arthroscopic shoulder decompression in the past 3 years. The aim of the study is to do a cost analysis of shoulder surgery as private health care (medical aid) is demanding more cost effective procedures and we have limited funds in the Government setting. Methods:. We focused on the following: the surgeon; the procedure; operating time; inpatient time; intraoperative block; physiotherapy costs, time off work and the cost of instrumentation used. Patients had to comply with specific inclusion and exclusion criteria. Inclusion: All patients that had shoulder decompression surgery in the past three years by a qualified orthopaedic surgeon; Exclusion: sepsis, tumours, rotator cuff tears, conversion of an arthroscopic procedure to an open procedure intraoperatively, inadequate notes, multiple surgical procedure under the same anaesthetic (e.g. scope with a trapezium excision). Results:. We evaluated 260 patients. Only 147 complied with the inclusion and exclusion criteria, of which 54 were open decompressions and 73 were arthroscopic decompressions. Arthroscopic surgery was significantly more expensive than open surgery (p<0.0001). Conclusion:. With a 95% confidence level, we concluded that the total cost of an arthroscopic decompression can be between 257.5% and 285.0% higher than that of an open decompression. The outcome of this study has proven that we need to take the cost of every procedure into consideration as our patients can benefit more by the redistribution of funds for other possible procedures. Level of evidence:. Level III

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

We aimed to test the biomechanically predicted hypothesis that in massive rotator cuff tears irreparable by conventional methods the newly developed Nottingham Augmentation Device (NAD) would provide greater functional improvement than that gained from the gold standard of arthroscopic subacromial decompression. Thirty patients treated between 2001 and 2004 were assessed by pre- and six month post-operative Constant scoring. Fifteen underwent open acromioplasty and cuff reconstruction using the NAD (mean age 67.3), while 15 underwent a standard arthroscopic decompression (mean age 67.4). The two groups were matched retrospectively based on size of cuff tear, age and sex. Data was analysed using the student’s t-test at the 95% confidence interval. Both groups displayed a statistically significant increase in Constant score after surgery. The mean increase for NAD patients was 18.7 points compared with 17.6 points for those undergoing arthroscopic decompression. However there was no significant difference between the two groups’ improvement and this was even so in the power sub-category, where increased benefit was predicted with the NAD. The NAD requires greater surgical access, operating time and peri-operative analgesia, and no active mobilisation for six weeks. The arthroscopic technique is minimal access, rapid, involves no prosthesis or foreign body insertion and allows immediate mobilisation. However, with clear biomechanical benefits of the NAD seen in vitro, our results may simply reflect cuff tears in an older population group with irreversible tissue changes and less rehabilitative potential. A randomised prospective trial in a younger patient group with more acute tears and less tissue atrophy would appear the next step in determining the NAD’s place in the management of massive rotator cuff tears

The technique of arthroscopic decompression of patellar tendonitis was first undertaken in 1990. We report the 10 year experience of using this technique. Patients presenting with this condition were subjected to clinical, radiological and MRI assessment. The procedure was undertaken if the symptoms continued to be significant despite non-operative treatment. The procedure used a Dyonics shaver. The fat pad was elevated from the bare area of the patella to expose the non-articular inferior pole of the patella. The tendon fibres were then elevated from the anterior surface of the inferior pole, and the 5mm tip of the patella was excised taking particular care to ensure that the full AP thickness was removed. Seventy three knees underwent surgery with a minimum of one year follow up, in four cases a simultaneous bilateral procedure was performed and in 11 cases previous surgery had been performed elsewhere. The average age was 33 years, 64 of the cases were male. The average duration of symptoms was 20 months and all patients had undergone non-operative treatment prior to the index procedure for an average duration of 10 months. The average duration of follow up was 49 months. All patients experienced a significant improvement in the clinical grade of symptoms and function with 95% of the 62 primary cases resulting in a good or excellent result. The average time to return to work and driving was 2 weeks and to sport was 9 weeks. In the 11 revision cases, 9 (81%) were improved and 6 (55%) had a good result. The results of arthroscopic decompression for patellar tendonitis are superior to the other reported techniques. We conclude that excision of the inflammatory nodule and fat pad in this condition is unnecessary, other than to obtain visualisation of the inferior pole of the patella. The success of this procedure supports the suggestion that this condition is produced by a compression of the tendon and is best treated by decompression of the inferior patella pole

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

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

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

There is clear evidence to support removal of the calcific deposit in patients with calcific tendonitis, however, there is conflicting evidence as to whether concomitant subacromial decompression (SAD) is of benefit to the patient. The aim of this study was to conduct a prospective double blind randomised control trial to assess the independent effect of SAD upon the functional outcome of arthroscopic management of calcific tendonitis. During a four year period 80 patients (power calculation was performed) were recruited to the study who presented with acute calcific tendonitis of the shoulder. Forty patients were randomised to have SAD and 40 were randomised not to have a SAD in combination with arthroscopic decompression of the calcific deposit. All surgery was performed by the senior author who was blinded to the functional assessment of the patients. There were 21 male and 59 female patients with a mean age of 48.9 (32 to 75) years. The pre-operative short form 12 physical component summary (PCS) was 39.8 and the mental component summary was 52.6, disability arm should and hand (DASH) score was 34.5, and the Constant score (CS) was 45.7. Both groups had a significant improvement in the PCS, DASH, CS at 6 weeks and at one year compared to their pre-operative scores (p<0.001). There were no significant differences demonstrated between the groups for any of the outcome measures assessed at 6 weeks or at one year. SAD should not be routinely performed as part of the arthroscopic management of acute calcific tendonitis

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

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

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

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

The literature shows that interscalene anaesthesia (ISA) offers many advantages over general anaesthesia(GA) for arthroscopic surgery. There are benefits intra-operatively, a decrease in post-operative complications and a decrease in hospital stay. However patient satisfaction and acceptance of interscalene anaesthesia has not been fully assessed. We wanted to prospectively assess patient choice and satisfaction with interscalene anaesthesia compared to general anesthesia. Fifty patients undergoing subacromial arthroscopic decompression and suitable for either anaesthetic technique, were prospectively identified between August and December 2006. The anaesthetic team discussed the pros and cons of general anaesthesia versus interscalene anaesthesia and the patient choose the type of anaesthesia. The same anaesthetic team and senior author managed and operated on all the patients in the study. Post-operatively patients filled out a questionnaire, which assessed patient choice, experience and satisfaction with type of anaesthesia undertaken. Forty-sic patients successfully completed the questionnaire (27 female, 19 male, average age 59). Seventy-six percent of patients felt that they really understood the pros and cons of each anaesthetic type. Seventy-eight percent of patients felt that they really had the choice in determining their anaesthesia. Twenty-six choose ISA and twenty choose GA. Post-operative complications were less in the ISA group versus the GA group; pain(5.23ISA, 5.75GA), nausea(11%ISA, 35%GA), vomiting(0 ISA, 1GA), and drowsiness(19% ISA, 70%GA). Hospital stay was shorter in ISA patients compared to GA patients. All patients claimed to be satisfied with their choice and none would in retrospect change it. Patients who choose interscalene anaesthesia had less post-operative pain, nausea, vomiting, drowsiness and shorter hospital stays then those patients who choose general anaesthesia for their shoulder surgery. This is consistent with the literature. All patients claimed to be fully satisfied with their hospital experience irrespective of the type of anaesthesia undertaken and none would have chosen differently

This study looks at the outcomes of 112 full thickness rotator cuff tears treated by arthroscopic decompression, without repair of the rotator cuff, from 1994. The decision not to repair the tear was taken only if four criteria were met. First, if there was no clinical weakness on manual testing of the individual rotator cuff muscles, secondly, if there was full abduction, thirdly, if there was no riding up of the humeral head on the anteroposterior radiograph and fourthly, if there was well-developed ‘cable’ on arthroscopic visualisation of the rotator cuff. The mean age of the patients, 38% of whom were men, was 62 years (47 to 83). In 44% the right shoulder was operated on. There were 32% type-II acromions and 68% type-III. There were 58% C2 tears and 42% C3 tears. All had arthroscopic acromioplasty and acromioclavicular joint excision. Later, three required an open acromioclavicular joint excision with one open cuff repair. At a mean follow-up time of 71 months (11 to 110), the clinical and surgical notes and radiographs were reviewed and a modified Simple Shoulder Test (SST) used to evaluate outcomes by telephone. The mean postoperative SST was 11.5 out of 12 (3 to 12). Complete relief was reported in 84% of cases. These subjective results suggest that, with careful selection, not all full thickness tears of the rotator cuff need repair

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