Can Acromioplasty Result in Impairment?
J. Mark Melhorn
Search for other papers by J. Mark Melhorn in
Current site
Google Scholar
PubMed
Close
,
Charles N. Brooks
Search for other papers by Charles N. Brooks in
Current site
Google Scholar
PubMed
Close
, and
James B. Talmage
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

To determine if an acromioplasty is impairing, an evaluator must know shoulder anatomy, the diagnosis or diagnoses, what treatment was provided, and the patient's present status. Over time, the earlier classification of shoulder impingement has been modified, and the current classification was adopted in 1994. At present, acromioplasty often is not the primary surgery but rather is one component of subacromial decompression with or without concomitant rotator cuff and/or intra-articular shoulder surgery. Until the sixth edition, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) did not address the question whether acromioplasty itself constitutes an impairment. In the fourth and fifth editions of the AMA Guides, although open or arthroscopic acromioplasty commonly results in temporary shoulder pain, stiffness, and weakness, the surgical procedure itself, barring complication, results in no permanent impairment. According to the AMA Guides, Sixth Edition, if an acromioplasty eliminated impingement and resulted in no pain or significant objective findings at maximal medical impairment, no impairment occurred. Diagnosis-based impairment is considered the rating method of choice, but range of motion is used primarily in the physical examination adjustment grid. Further, surgical error and/or complications may result in ratable motion and/or strength deficits. The AMA Guides, Fourth and Fifth Editions, also provide a means to rate impairment due to any concomitant distal clavicular resection.

  • 1.

    Meyer AW. The minuter anatomy of attrition lesions. JBJS Am. 1931;13:341-348 and Meyer AW. Chronic Functional Lesions of the Shoulder Arch Surg. 1937;35:646-674.

    • Search Google Scholar
    • Export Citation
  • 2.

    Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am.1972;54-A:41-50.

  • 3.

    Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

    • Search Google Scholar
    • Export Citation
  • 4.

    Wilk KE, Andrews JR. The Athlete's Shoulder. Edinburgh: Churchill Livingstone; 1994.

  • 5.

    Andrews JR. Diagnosis and treatment of chronic painful shoulder: review of nonsurgical interventions. Arthroscopy. 2005;21:333-347.

  • 6.

    Arroyo JS, Hershon SJ, Bigliani LU. Special considerations in the athletic throwing shoulder. Orthop Clin North Am. 1997;28:69-78.

  • 7.

    Drakos MC, Rudzki JR, Allen AA, Potter HG, Altchek DW. Internal impingement of the shoulder in the overhead athlete. J Bone Joint Surg Am. 2009;91:2719-2728.

    • Search Google Scholar
    • Export Citation
  • 8.

    Kvitne RS, Jobe FW. The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop Relat Res. 1993;107-123.

  • 9.

    Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003;18:369-379.

    • Search Google Scholar
    • Export Citation
  • 10.

    Park HB, Yokota A, Gill HS, El Rassi G, MCFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87:1446-1455.

    • Search Google Scholar
    • Export Citation
  • 11.

    Wolff AB, Sethi P, Sutton KM, et al. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg. 2006;14:715-725.

  • 12.

    Safran MR. What's hot, what's not: 1. Attributing all impingement to acromial morphology, 2. arthroscopic subacromial decompression, shoulder and humerus, AAOS 2010 Annual Meeting, Orthopaedic Review Course; 248-260.

    • Search Google Scholar
    • Export Citation
  • 13.

    Edelson JG. The “hooked” acromion revisited. J Bone Joint Surg Br. 1995;77-B:284-287.

  • 14.

    Brooks CN. Acromioplasty: is it an impairment? The Guides Newsletter. May/June 2002; 35:1-5.

  • 15.

    Wiater BP, Neradilek MB, Polissar NL, Matsen FA 3rd. Risk factors for chondrolysis of the glenohumeral joint: a study of three hundred and seventy-five shoulder arthroscopic procedures in the practice of an individual community surgeon. J Bone Joint Surg Am. 2011;93(7):615-625.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1134 1134 82
Full Text Views 25 25 0
PDF Downloads 0 0 0
Save