Functional, clinical and radiological outcomes of arthroscopic subacromial decompression in treating shoulder impingement syndrome

Abstract

Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by anterior third of the acromion process and has been classified into 3 stages. Treatment option varies depending on grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and have shown to have good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of functional, clinical and radiological parameter in treating SIS in aging population in Kuantan, Pahang, Malaysia. This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and IIUM Medical Centre from May 2018 until June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeon (ASES) score taken at preoperative, 6 weeks, 3 months and 6 months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at 6 months post-operation. Radiological outcomes were measured by comparing Acromiohumeral distance pre- and post-operation on antero-posterior (AP) view radiograph of the affected shoulder. A total of 28 patients were collected. On functional outcome, there was a significant effect of time on the ASES Scoring System (p-value <0.05). On clinical outcome, the Constant score at 6 months showed 13 patients have excellent score, 10 good and 5 fair. There was a statistically significant difference in mean values of all categories (p-value <0.05). In term of radiological outcome, this study observed a significant increase in patients’ subacromial space on x-ray from preoperative and postoperative treatment stage. In this study we also observed that there was no significant difference of outcomes between partial and intact RC tears at six-month post-operation. In conclusion, arthroscopic subacromial decompression was found in this study to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in term of functional, clinical and radiological.