Subacromial space

Abstract

Symptomatic outlet impingement (bony narrowing of the subacromial space by acromial spurs, Bigliani type II and III acromion morphology [. Fig. 2.1], inferior AC joint osteophytes) after failure of conservative treatment trials or with concomitant rotator cuff lesions.

Widening of the subacromial space and creating a flat inferior acromion surface by arthroscopic resection of the anteroinferior acromion with preservation of the coracoacromial ligament (Fig. 2.2). Optionally, concomitant resection of AC joint osteophytes (Coplaning).

• Symptom-specific history: pain character (with load, at rest, at night), location and radiation of pain, previous infiltrations and operations.

• Symptom-specific examination: lower “painful arc” (60–120°), Neer sign, Hawkins-Kennedy sign and if applicable subacromial infiltration test.

• X-rays of the shoulder in three views (true AP, y-view, axial) for evaluation of the acromion shape acromiohumeral distance and the undersurface of the AC joint (osteophytes)

• MRI scan to differentiate between intrinsic and extrinsic causes of impingement and to evaluate the rotator cuff tendons and other possible concomitant pathologies

Specific operative risks: nerve injury (brachial plexus), injury of the subclavian artery, fracture of the acromion or clavicle

• Beach chair position

• Positioning of the patient arm in arm holder