Subacromial Impingement: Is there Correlation between Symptoms, Arthroscopic Findings and Outcomes?

Abstract

Background To determine whether a correlation exists between the clinical symptoms and signs of impingement, and the severity of the lesions seen at bursoscopy. Methods Fifty-five patients who underwent arthroscopic subacromial decompression were analyzed. Pre-operatively patients completed an assessment form consisting of visual analogue pain score, and shoulder satisfaction. The degree of clinical impingement was also recorded. At arthroscopy impingement was classified according to the Copeland-Levy classification. Post-operatively the shoulder assessment was repeated. Statistical analysis was carried to determine if the degree of impingement at arthroscopy correlated with pre-operative pain, satisfaction and clinical signs of impingement. Results Pre-operative pain level, shoulder satisfaction and degree of clinical impingement did not correlate significantly with severity of the lesions of the acromion and cuff. (average correlation coefficient r2 0.018.) There was no correlation between the improvement in the shoulders post-operatively and the severity of lesions (r2 0.008). Conclusion There was no correlation between pain, clinical signs or outcomes of subacromial decompression and the severity of impingement lesions seen at arthroscopy.

An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it?

“…Yet research into subacromial decompression surgery in which the subacromial bursa is excised has shown that outcomes of this procedure, whether done with or without acromioplasty, are no different (Budoff et al, 2005;Henkus et al, 2009). This would support the notion that the morphology of the acromion has no bearing on subacromial impingement syndrome and this view is supported by numerous authors (Gill et al, 2002;Snow et al, 2009). …”

Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?

“…At the 6 month follow-up no significant correlation between pain and satisfaction and the severity of structural pathology was identified. 42 Confirming this, after a study of 523 people undergoing arthroscopic or open shoulder surgery, Gill et al 43 reported no significant association between acromial shape and rotator cuff pathology in people over 50 years of age (n5192). A highly significant correlation between age and rotator cuff pathology existed and the researchers argued that a Type III hooked acromial represents a degenerative process rather than a morphological variation as described by Bigliani.…”

“…As discussed earlier there is a poor correlation between acromial radiological changes and symptoms. [41][42][43] In a study of 96 people without shoulder symptoms 28% or those aged between 40 and 60 years and 54% of those aged above 60 years had MRI evidence of a partial or full thickness rotator cuff tear. 114 Milgrom et al 115 reported in a study of 90 people (age range 30 to 99 without shoulder symptoms) that the incidence of full thickness rotator cuff tears identified by ultrasound increased with advancing age and that after the 5th decade approximately 50% of people had asymptomatic full thickness tears that did not affect function.…”

“…If the increased volume and resulting ligamentous strain occurs at a subclinical level from bursts of activity or sport a spur may develop over time but may remain asymptomatic over a lifetime and explain the poor correlation between acromial shape and symptoms. [41][42][43] Overuse tendinopathies involving the lateral epicondyle, patellar, adductor and Achilles tendons may occur without impingement from external structures such as adjacent bony surfaces, and this may also be the case for the rotator cuff. It is possible that the external irritation accentuates the tendon failure [37][38][39]124 but it is unlikely that it is the primary cause.…”

Rotator cuff related shoulder pain: Assessment, management and uncertainties

“…Bigliani et al, (1986) described three distinct acromial shapes (flat, curved and hooked) attributing the differences to morphological variations and argued those with a Type III or hooked acromion would be more likely to experience subacromial pain symptoms and suffer a RC tear. Definitive causation has not been established and there appears to be a poor correlation between acromial shape and symptoms (Gill et al , 2002, Snow et al , 2009, Worland et al , 2003 further challenging the acromial model of RC tendinopathy. In addition, if the acromion is the cause for impingement and this eventuates in RC tears, a SAD should halt this process.…”