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The Journal of Bone and Joint Surgery, Vol 75, Issue 3 409-424, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Shoulder impingement syndrome: diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty
CA Rockwood and FR Lyons
Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78284-7774.
Seventy-one patients who had shoulder impingement syndrome were managed
operatively with a modified Neer acromioplasty: thirty-seven, who had an
intact rotator cuff, had a modified acromioplasty, and thirty-four, who had
a torn cuff, had a modified acromioplasty and repair of the cuff. In the
classic anterior acromioplasty as described by Neer, emphasis is placed on
resection of the inferior prominence of the acromion. We believe that the
removal of only the inferior prominence is insufficient, as often too much
of the anterior aspect of the acromion protrudes beyond the anterior border
of the clavicle. This portion of the acromion continues to irritate the
subacromial bursa and the rotator cuff and to produce symptoms of
impingement. Our modified acromioplasty is done in two steps: the portion
of the acromion that projects anteriorly beyond the anterior border of the
clavicle is resected vertically and then an anteroinferior acromioplasty is
performed. We studied the results in patients who had been operated on by
the senior one of us and who had been followed clinically for a minimum of
two years. At the most recent follow-up visit, no difference in terms of
pain and function was found between the patients who had had the modified
acromioplasty only (Group I) and the patients who had had the modified
acromioplasty and repair of the rotator cuff (Group II); thirty-three (89
per cent) of the patients in Group I and thirty (88 per cent) of those in
Group II had a good or excellent result.
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