Arthroscopic Acromioplasty

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Arthroscopic Acromioplasty

• Angela Whittington

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DEFINITION

• Bursitis or tendonitis ? impingement
• Causes the tissues underneath the AC joint to be
  pinched against the bone
• Produces irritation and pain
• MOI
• Rotator cuff muscles become stretched ? laxity
• Arm abducted gt 90?
• head drops longhead biceps tendon/supraspinatus
  becomes impinged

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ACROMION PROCESS

• Three types (shapes of acromion processes)
• Type I Flat Figure A
• Type II Gently curved Figure B
• Type III Sharply hooked Figure C

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Patient History

• Female 20 y/o
• Division I Collegiate Volleyball athlete
• S/S pain with overhead activity
• Dec ROM
• Crepitus w/ GH motion
• Pain w/ GH ABD FLEX
• Decreased rotator cuff strength
• Special Tests
• () Neer Impingement Hawkins Impingement

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PATIENT HISTORY CONT.

• Image Findings
• Radiographs confirm Type III Acromion Process

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Imaging
Torn Rotator Cuff
Normal Rotator Cuff
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• Patient chose conservative treatments at first
• Rest
• Ice
• NSAIDs
• Rehabilitation
• Conservative treatment failed to return her to
  preinjury level
• Surgical intervention recommended

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ARTHROSCOPIC ACROMIOPLASTY

• Ellman (1987) introduced technique for
  subacromial decompression
• Meant for pts who did not respond to
• Six mo. of conservative treatment
• NSAIDS, steroid injections
• Physical therapy
• Three small skin portals
• Spares deltoid muscle ? post-op movement
  restriction

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SURGICAL INTERVENTION

• Goal is to smooth ANT acromial undersurface
• Subacromial space and bursa is debrided
• Acromioplasty performed
• Recommended anterior-inferior acromioplasty
• Detaching deltoid muscle from ANT subacromial
  process AC joint
• Osteosome removes ANT undersurface of acromion
  process
• Portion of coracoacromial ligament removed to
  decompress the space
• Arthroscopic acromioplasty preferred

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PROCEDURE

• Orthosports - Orthopaedic Sports Medicine
  Physicians - Shoulder Impingement

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REHABILITATION PHASE 1

• Goals
• Limit Pain
• Restore Motion
• Reduce Swelling

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TREATMENT RECOMMENDATIONS

• Ice
• Sling (if necessary)
• E-Stim
• Joint Mobilization (grade 1 and 2)
• Rom (passive and active assisted pain free)
• Pendulum Exercises

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REHABILITATION PHASE 2

• Goals
• Eliminate Pain
• Restore full active motion
• Restore good glenohumeral and scapulohumeral
  rhythm
• 4/5 strength or upper extremity muscles

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TREATMENT RECOMMENDATIONS

• Continue modalities as needed
• Start with active range of motion
• Add isometrics below shoulder level
• Flexibility of cervical, shoulder, and scapular
  muscles

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PRECAUTIONS

• All active and isometric exercises should be
  muscle specific
• All movements and activity increasing symptoms
  should be eliminated
• Isometrics are modified if patients symptoms are
  made worse

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REHABILITATION PHASE 3

• Attain full pain free ROM
• Achieve 5/5 strength in all shoulder girdle
  muscles
• Full pain free resistive range of motion
• Negative Neer Sign
• Negative Hawkins Sign
• Symmetrical scapulohumeral rhythm

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TREATMENT RECOMMENDATIONS

• Continue use of ice as necessary
• Continue with previous exercises
• Progress resistance to overhead and above
  horizontal
• Add resistance to scapular exercises
• Work on quality of motion and not just resistive
  training
• Work on balance of rotator cuff muscles
• Start with sport/work specific exercises
• Water resistive activities

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PRECAUTIONS

• Do not neglect the rest of the body!

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REHABILITATION PHASE 4

• Goals
• Full pain free ROM
• 5/5 strength in all upper extremity and scapular
  muscles
• Normal scapulohumeral rhythm w/ and w/o
  resistance
• Able to complete throwing sport specific or work
  tasks pain free, and w/o signs of instability or
  impingement

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PRECAUTIONS

• It should be noted that time frames for these
  phases overlap time frames for these phases cant
  be given. It is based on exercise intensity,
  pain, underlying instability, healing time, and
  strength
• Rehab should be progressive always achieving and
  then maintaining a pain free state

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TREATMENT RECOMMENDATIONS

• Continue use of ice as necessary
• Continue with previous exercises
• Progress resistance to overhead and above
  horizontal
• Add resistance to scapular exercises
• Work on quality of motion and not just resistive
  training
• Work on balance of rotator cuff muscles

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THINGS TO REMEMBER

• Core Strengthening
• Cardio Workouts
• Team involvement
• If athlete is sore after exercises, bring down
• Do not progress or overwork!

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FUNCTIONAL EXERCISE
Practice defense and going to the floor after a
dig. Use groups of three or four. Line starts
at middle back position. Coach hits a ball to
the right. Player must read coach's shoulders
and dig ball. After the dig the player must
roll. Coach alternates hits right and
left. Continue for a set number of digs for each
player.

• Dig Roll

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FUNCTIONAL EXERCISE



To practice digging balls a good distance away from the net and from different angles. Hitters alternate hitting balls at the defenders. The defenders dig the balls to the target. After the defender digs the ball they alternate lines. Repeat until a set number of digs is

• Cross Court Digging

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FUNCTIONAL EXERCISE

• No Fear Defense

Teach aggressiveness on defense.Teach defenders
to get under balls hit down Coach stands on a
box in the middle of the net, where they can hit
the ball down inside 10' line. Coach
continuously hits balls to the defenders. After
a set number of hits the defender can only exit
the drill when they can pass a ball straight up
and catch it.