APEX Shoulder Mastering Surgical Techniques for Clinical Success-SAD_ Should We Ever Do It

Video Transcription

Video Summary

Dr. William Ciccone discusses arthroscopic subacromial decompression (ASD) for subacromial impingement syndrome, reviewing its etiology, surgical anatomy, techniques, and outcomes. He contrasts the extrinsic theory, where impingement results from rotator cuff compression against the acromion, and the intrinsic theory, attributing symptoms to rotator cuff degeneration without acromial involvement. Two primary arthroscopic techniques—posterior scope with lateral burr and lateral scope with posterior burr (“cutting block”)—aim to smooth the acromion undersurface and remove bursae. Outcomes vary, with some studies showing no clear advantage of ASD over physical therapy or bursectomy alone, highlighting challenges in patient selection. Ciccone emphasizes preoperative planning, including assessing acromial morphology and the critical shoulder angle (CSA), which influences rotator cuff pathology risk. A lateral acromioplasty may benefit patients with elevated CSA by reducing biomechanical stress. Indications for surgery remain controversial; conservative management is first-line, with careful consideration before surgical decompression.

Asset Caption

William Ciccone, MD

Keywords

arthroscopic subacromial decompression

subacromial impingement syndrome

rotator cuff pathology

acromial morphology

critical shoulder angle