AANA Lab Course 915 - Foundations in Arthroscopy-ARTHROSCOPIC SUBACROMIAL DECOMPRESSION-John Orwin, M.D.

ARTHROSCOPIC SUBACROMIAL DECOMPRESSION-John Orwin, M.D.

Pdf Summary

This document discusses two related arthroscopic shoulder procedures: Arthroscopic Subacromial Decompression (ASAD) and Arthroscopic Mumford, focusing on indications, techniques, controversies, and key principles.

<strong>Indications:</strong>  
- ASAD is mainly indicated for chronic impingement syndrome and rotator cuff repair.  
- Arthroscopic Mumford is typically performed alongside ASAD to address distal clavicle pain or isolated acromioclavicular (AC) joint pain such as osteolysis.

<strong>Controversies:</strong>  
There is debate on whether distal clavicle excision (Mumford) should always accompany ASAD. Some surgeons advocate for routine excision with ASAD, while others suggest it only if the AC joint is confirmed as a pain source.

<strong>Pre-operative Planning:</strong>  
Careful planning is critical, including appropriate radiographs: AP Neer, AP AC joint, acromial arch view, and axillary view. These help identify acromial morphology and rule out anatomical variants such as Os acromiale, which could affect surgical strategy.

<strong>ASAD Technique:</strong>  
- The goal is thorough decompression of the subacromial space to relieve impingement.  
- The procedure uses multiple portals for visualization to ensure complete resection of the acromion, especially flattening the acromion in two planes to avoid fractures.  
- Decompression should extend medially to the AC joint, including the medial facet, without destabilizing it.  
- The "cutting block method" creates troughs on the acromion to guide resection depth.  
- A complete glenohumeral evaluation is done prior to decompression, and the coracoacromial (CA) ligament is carefully cut.

<strong>Arthroscopic Mumford Technique:</strong>  
- Typically performed after ASAD by resecting the distal clavicle from inferior to superior using anterior and posterior portals.  
- The procedure involves removing enough bone circumferentially to free the distal clavicle while protecting superior and posterior capsule structures critical for AC joint stability.  
- Visualization adjustments and portal redirection are techniques used to access different parts of the clavicle.

<strong>Post-operative considerations:</strong>  
- Radiographs should be obtained post-operatively to document the adequacy of decompression and resection.  
- Surgical judgment on the necessity of clavicle excision varies; no definitive consensus exists.

Overall, this presentation emphasizes meticulous pre-op planning, thorough decompression with ASAD, judicious use of Mumford procedure, and careful protection of shoulder joint stability during arthroscopic management of impingement and AC joint pathologies.

Keywords

Arthroscopic Subacromial Decompression

ASAD

Arthroscopic Mumford

Distal Clavicle Excision

Acromioclavicular Joint Pain

Impingement Syndrome

Rotator Cuff Repair

Pre-operative Radiographs

Cutting Block Method

Shoulder Joint Stability