Arthroscopic Subacromial Decompression

Subacromial impingement is a common cause of shoulder pain initiated by abnormal compression between the rotator cuff tendons and the undersurface of the acromion. This compression leads to an inflammatory response within the subacromial space, which manifests as anterolateral arm pain that increases with overhead activity. Nearly all cases of subacromial impingement should be managed conservatively with interventions including physical therapy, activity modification, nonsteroidal anti-inflammatory medications, and corticosteroid injections. Surgical intervention, either through open or arthroscopic approaches, may be indicated in patients who fail a 3- to 6-month course of nonsurgical management. The arthroscopic approach to subacromial decompression provides adequate visualization and access to the acromial undersurface, and its advantages over an open approach include deltoid preservation, decreased blood loss, lower levels of postoperative pain, and faster recovery.