The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy. Hypothesis/Purpose: The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS.
![abduction anatomy abduction anatomy](https://geekymedics.com/wp-content/uploads/2019/03/Abduction-Adduction-Circumduction-Movements-Anatomy.jpg)
The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated. Level of evidence − Case-control study, level III Several patient-specific factors predicting worse outcomes were identified. Major improvements in pain/function were seen at mid- to long-term after isolated arthroscopic subacromial decompression and combined decompression/rotator cuff repair. None in the decompression group had undergone later rotator cuff repair. Age above 55 at surgery predicted better VAS of function (P = 0.04) while acute onset of symptoms predicted better QuickDASH in the combined group (P = 0.03).
![abduction anatomy abduction anatomy](https://i.pinimg.com/736x/42/a1/8c/42a18c4200403527cb1be46519b1e263--thigh-muscles-white-art.jpg)
No differences in outcomes were seen between groups (n.s.). Baseline characteristics were related to outcomes to investigate predictors of good/poor outcome.Ī general improvement from baseline was seen − from 51 to 14 (QuickDASH) in the combined group and from 53 to 16 in the decompression only group. New surgery and complications were recorded. Matched case-controls undergoing arthroscopic rotator cuff repair combined with subacromial decompression (N = 180) or subacromial decompression only (N = 180) were evaluated pre- and 7.5 years postoperatively using QuickDASH score, VAS of function, VAS of pain and VAS of satisfaction. Few studies have compared long-term outcomes after these two procedures. One could therefore theorize arthroscopic subacromial decompression and rotator cuff repair as interventions at different stages of a degenerative shoulder disease. Some studies suggest a common degenerative path might contribute to a range of shoulder diseases involving subacromial pain syndrome and full-thickness rotator cuff tears. In addition to providing greater understanding of the basic anatomy of the RC unit, these findings also provide clarity for surgeons with the goal of improving and enhancing surgical methods for better post-operative patient outcome. Functions of one RC muscle are not necessarily isolated but instead can be influenced by surrounding muscles as well. The fact that the RC unit is more complex in its structure and attachment places importance on the biomechanical stresses encountered after repair. Collectively, these findings indicate and strengthen evidence towards the notion that the RC muscles/tendons and the internal capsule are one complete and inseparable unit/complex. No statistical significant difference between left and right (p = 0.424) was noted, but a significant difference between males and females (p = 0.000) was. Once the insertions were exposed and documented, the RC muscle footprint (articular surface area) was measured and recorded, using AutoCAD 2016. Reverse dissection was performed to better visualise the RC unit exposing the interdigitated rotator hood (extension insertions), as well as the complete RC unit (tendons + internal capsule) separated from the scapula and humerus. The fresh shoulders were received from the National Tissue Bank, and ethical clearance was obtained (239/2015).
![abduction anatomy abduction anatomy](http://1.bp.blogspot.com/_N9c__Pf4VsI/TMHZM0kS79I/AAAAAAAABcQ/JxgYzy2lKtA/s1600/abduction+%26+adduction+arm+darker.jpg)
Twenty shoulders (16 cadaveric and 4 fresh) were used in the study. Therefore, the purpose of this project was to visualise and define the RC footprint and extension insertions with the aim of enhancing and improving knowledge of the basic anatomy in the hopes that this will be considered during orthopaedic repair. This results from old-fashioned knowledge of the anatomy of the RC complex and its functional aspects. The general principles of RC surgery remain a controversial subject, due to various available techniques, surgeon experience and preference, and the contradicting success rates. Current surgical repair methods (especially arthroscopic techniques) rarely mention or consider these connections during repair and suture anchor implantation. However, clear fusion of the RC tendon fibres exists with prior studies showing this interdigitation forming a common, continuous insertion onto and around the lesser and greater tubercles (LT and GT) of the humerus. The rotator cuff (RC) insertions according to most anatomical texts are described as being separate from one another.