APEX Shoulder Mastering Surgical Techniques for Clinical Success-SAD: Should We Ever Do It? Indications and Tips

Video Transcription

Video Summary

Dr. William Ciccone gives a presentation on arthroscopic subacromial decompression. He begins by discussing the etiology of subacromial impingement, which can occur from both intrinsic and extrinsic mechanisms. The extrinsic theory states that impingement occurs from the compression of the rotator cuff between the humeral head and the acromion. The traditional treatment for this has been acromionectomy, but the anterior inferior acromioplasty technique has shown better outcomes. The intrinsic theory states that impingement is not related to acromial morphology, but rather to rotator cuff weakness and degeneration. Understanding the subacromial anatomy is important for surgical intervention. It involves removing the anterior edge of the acromion and the undersurface of the anterior acromial process. Knowledge of subacromial vessels is crucial to avoid complications during surgery. The treatment for subacromial impingement has often been physical therapy, but surgical intervention may be necessary if conservative management fails. Proper preoperative planning and positioning are important for successful surgery. Dr. Ciccone demonstrates two arthroscopic techniques for acromioplasty: the scope posterior and burr lateral technique, and the scope lateral and burr posterior technique. The outcomes of subacromial decompression vary, as some studies show no clinical difference with acromioplasty. Different criteria and tests may help determine which patients will benefit from surgery. Dr. Ciccone also discusses the concept of the critical shoulder angle and its association with rotator cuff disease and glenohumeral arthritis. Lateral acromioplasty may be considered in patients with an elevated critical shoulder angle. Overall, the indications and necessity of subacromial decompression remain controversial.

Asset Caption

William Ciccone, MD

Keywords

subacromial impingement

acromioplasty techniques

rotator cuff

critical shoulder angle

surgical intervention