Arthroscopy update #3. Chronic impingement syndrome. The role of ultrasonography and arthroscopic anterior acromioplasty.

Diagnosis of advanced rotator cuff impingement syndrome has been difficult due to dependence on plain radiographs and arthrography, which in the absence of complete tears are frequently inconclusive. Advances in ultrasonography have enabled accurate diagnosis of the more enigmatic partial thickness tears of the rotator cuff. Until recently, advanced impingement syndrome resistant to conservative therapy has been managed by open anterior acromioplasty as described by Neer. This has required a prolonged postoperative rehabilitation program before return to normal activities of daily living and athletic participation. Precise diagnosis with ultrasonography and refined arthroscopic techniques have enabled us to identify 50 patients with resistant impingement syndrome and partial thickness tears of the rotator cuff, and surgically decompress the subacromial space via arthroscopic resection of the coracoacromial ligament and anterior-inferior leading edge of the acromion. Postoperatively there has been minimal pain. Return of nearly full passive range of motion has been achieved in all but two patients within the first week. Active range of motion exercises are begun on the first postoperative day and resistive exercises commence two weeks after surgery. Mean return of normal functioning in activities of daily living has been two months, while return to prior level of athletic activity has averaged five months.