Subacromial Smoothing.
Last updated Wednesday, January 26, 2005
Figure 1 - "Abrasion" sign About subacromial smoothing
This is the information which might be shared with patients prior to
subacromial smoothing. Before it can be applied to a specific clinical
situation, however, it needs to be tailored to the patient, the
problem, and the surgeon.Smooth shoulder sliding One of the important aspects of shoulder function is the smooth
sliding of the upper arm bone (humerus) and the tendons attached to it
(the rotator cuff) beneath an arch made of bone and ligaments. This
smooth sliding may be interrupted by changes in the mechanics of the
joint, by shoulder tightness, by muscle weakness, or by changes in the
bone structure. In most instances much of the function of the shoulder
can be regained if you carry out a quality stretching and strengthening
exercise program.
For shoulders in which a diligent course of quality exercises does
not restore a satisfactory level of function, a surgical approach to
the area of roughness may be considered. Who should consider surgery If a persistent and proper rehabilitation effort fails to restore
functional humeroscapular smoothness, consideration may be given to a
surgical approach to the problem.
Surgical smoothing is likely to be of functional benefit only if the
patient's functional problem can be clearly localized. This procedure
is not appropriate for poorly defined shoulder pain, for cuff strain,
for partial thickness cuff tears, or for shoulder stiffness. If
stiffness is not resolved preoperatively, subacromial surgery is likely
to make the shoulder function worse.
We have found that surgical treatment of subacromial roughness is
most likely to be successful in a well-motivated patient over the age
of 40 whose problem has been refractory to a good home program effort
and who has a positive "abrasion" sign: rotation of the arm elevated to
the horizontal position reproduces the crepitance that the patient
recognizes as the primary problem in his or her shoulder.
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