Abstract

Acromioplasty can be performed open or arthroscopically and removes the spurred, curved, or hooked portion of the acromion. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has not addressed whether acromioplasty itself constitutes an impairment. On the one hand, if impairment is defined as “a loss, loss of use, or derangement of any body part, organ system, or organ function,” then acromioplasty is an impairment because of the loss of a small portion of the scapula. On the other hand, acromioplasty generally results in improved function (ie, no or negative impairment) and may increase rather than decrease an individual's ability to perform the activities of daily living. This does not indicate that patients who undergo acromioplasty have no impairment whatsoever, and remaining motion deficits should be rated according to existing criteria in the AMA Guides. For example, failure to properly reattach the deltoid muscle or excessive acromial resection may result in deltoid weakness or strength. Often during acromioplasty, the removal of the clavicular spur is accomplished via excision of distal clavicle (resection arthroplasty), which is a permanent impairment. Acromionectomy, which is functionally similar to distal clavicular resection, and transposing the 10% upper extremity impairment rating for distal clavicular resection to a total acromionectomy appears to be justified.

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