不同类型肩峰下骨赘对肩袖肌腱病关节镜治疗的影响

目的观察肩峰外侧骨赘对关节镜下肩峰成形术治疗肩袖肌腱病临床疗效的影响。 方法对2016年1月至2016年12月在中山大学孙逸仙纪念医院行肩峰成形术的68例肩袖肌腱病患者进行回顾性研究。依据患者肩关节X线检查将其肩峰下骨赘分为外侧型骨赘和前侧型骨赘两大类。采用视觉模拟评分法（visual analogue scale/score,VAS）、Constant肩关节评分、12条生存质量量表（12-items the short form health survey questionnaire, SF-12）评分进行术前及术后3个月评分。 结果68例患者中26例为外侧型,42例为前侧型。术前外侧型患者的VAS、Constant、SF-12评分明显劣于前侧型患者（P<0.05）。术后3个月,外侧型患者VAS评分降低（3.64 ± 0.54）分,前侧型患者VAS评分降低（2.61±0.09）分,外侧型患者VAS评分改善显著（P<0.05）。其Constant、SF-12评分改善也更为明显（P<0.05）。 结论肩峰下骨赘的形态短期内影响肩袖肌腱病的临床效果。外侧型骨赘的患者临床症状更严重,但手术效果改善也较为明显。     

肩峰形态影像学分型在肩袖损伤诊治中的应用价值研究

目的 ：提出一种肩峰撞击理论以及肩关节Rockwood位片的肩峰形态分型法,探讨该分型法在肩袖损伤诊治中的应用价值。方法：回顾性分析2017年1月至2017年12月因肩峰撞击症或肩袖撕裂行肩关节镜手术的101例患者,其中男34例,女67例;年龄34～76(56.31±9.63)岁;病程2～12个月,平均6个月。术前常规拍摄肩关节“三位片”,包括肩关节前后位、Rockwood位以及冈上肌Outlet位。基于肩峰撞击理论以及Rockwood位片将肩峰形态分为3型：Ⅰ型（平坦型）、Ⅱ型（隆起型）、Ⅲ型（撞击型）。两位观察者分别对101例患者的肩关节Rockwood位片按照新分型法、对冈上肌Outlet位片按照传统肩峰形态分型法进行分类统计;冈上肌腱损伤依据关节镜下所见分为无撕裂、部分撕裂、全层撕裂。分别对新分型法、传统分型法进行一致性检验（Kappa值）,采用秩和检验比较新肩峰分型法3种肩峰形态的平均肩肱距（acromiohumeral distance,AHD）,采用Spearman秩相关性检验以及Gamma法分析比较新肩峰分型法与冈上肌腱撕裂程度之间的相关性。结果：观察者间一致性检验新肩...     

肩峰撞击征合并肩袖损伤的关节镜下治疗

目的分析关节镜下肩峰减压成形术及肩袖修复的临床效果。方法自2005年初始,我院对11例肩峰撞击征并肩袖损伤行关节镜下肩峰减压成形术,部分行肩袖修复术,其中男5例,女6例,年龄21～57岁,平均40岁,8例无外伤史,3例有外伤史。患者均有肩关节疼痛、肌肉萎缩、活动受限、上举困难、疼痛反射弧阳性、撞击注射试验阳性,Neer征阳性;5例有患侧卧位痛。X线提示肱骨大结节骨赘9例和肩峰骨刺2例,A—H间隙距离变小,小于1．0cm8例、小于0．5cm3例。MRI扫描均示肩袖结构T1为强信号,如关节积液T2相强信号。关节镜检查可见肩袖大撕裂（30～50mm）4例,中撕裂（10～30mm）5例,小撕裂（小于10mm）2例。行关节镜下肩峰下减压成形术,其中8例行缝合锚钉肩袖修复术。分别在术前及最终随访时采用美国肩肘外科医师（American Shoulder and Elbow Surgeons,ASES）和Constant—Murley评分进行功能评估。结果术后随访22．5个月（13～34个月）。患者手术前平均ASES评分为62．4分（47～76分）,VAS评分平均为5．8分（3～8分）,Constant—Murley评分为66．7分（42～79分）,平均外展35．5°（30°～50°）,平均外旋为28．4°（0°～45°）;终末随访时平均ASES评分为94．6分（79～100分）,其中VAS评分为0．6分（0～2分）,Constant—Murley评分为93．6分（77～100分）,肩关节外展160°（80°～180°）,平均外旋30．2°（20°～55°）。8例患者冈上、下肌萎缩恢复,ASES评分优良率为81．8％,Constant—Murley评分优良率为90．9％。术后各项评分均存在显著性差异（ASES：P〈0．001,t一12．324;VAS：P〈0．001,t=14．765;外展：P〈0．001,t=15．236;外旋：P〈0．01,t=7．967;Constant—Murley：P〈0.001,t=16．647）。结论a）肩峰撞击征、肩袖损伤是关节镜手术的适应证;b）对肩袖单纯修复是不够的,必须同时解决撞击因素;c）不宜将肩峰切除过多,以免发生骨折;d）尽管镜下手术技术难度较大,但镜下视野广、创伤小、术后及早进行功能锻炼,功能可以得到很好恢复,故镜下进行肩袖损伤、肩峰成形等手术应值得提倡。     

肩袖撕裂与肩峰骨棘之间关系的临床研究

目的回顾性分析肩袖撕裂患者术前肩关节X线片显示的肩峰骨棘的形态学变化,探讨与其合并肩袖撕裂的关系。方法依据1970年5月至1998年3月间,日本信原病院1068例肩袖撕裂患者的1121个肩关节正位X线片和其临床患者资料。分别测量X线片上超过1mm的肩峰骨棘大小(A级为≥1～5mm,B级为≥5～10mm,C级为≥10mm)及肩峰下间隙(又称作肩峰与肱骨头间距离,AHI)。临床患者资料分析包括患者的年龄、性别、肩关节疾病史及既往病史,治疗、手术经过等。结果根据肩峰骨棘的形态学变化,本文将肩峰形态分为六型,Ⅰ型(正常肩峰47.6%),Ⅱ型(肩峰下平面的骨棘16.5%),Ⅲ型(外侧肩峰的骨棘3.3%),Ⅳ型(喙肩韧带方向的骨棘11.9%),Ⅴ型(肩锁关节的退变20.4%),Ⅵ型(肩峰的双边征象17.8%);其中534肩(47.6%)无肩峰骨棘(12～87岁,平均54.1岁);587肩(52.4%)有肩峰骨棘(17～83岁,平均59.4岁);肩峰骨棘的患者中467个肩(41.7%)的骨棘为A级,112个肩(10%)为B级,8个肩(0.7%)为C级。801个肩(71.5%)的肩袖撕裂是由创伤所致;不明原因的肩袖撕裂有201个肩(17.9%);过度使用、积累性劳损的是119个肩(10.6%)。AHI的平均值为(8.7±2.6)mm,男性患者为(8.8±2.6)mm,女性患者为(8.4±2.7)mm,在有肩峰骨棘患者群中AHI为(8.4±2.7)mm,无肩峰骨棘患者群中AHI为(9.1±2.5)mm(t=2.93,P0.05),而男性与女性患者间的AHI差异无统计学意义(P0.05)。肩峰骨棘患者群中51～60岁年龄组与61岁以上各年龄组间都有统计学差异(2=64.64,P0.05)。结论肩关节X线片上肩峰骨棘的形态学分类,有助于医师认识和确诊患者患有肩峰骨棘。本研究认为肩峰骨棘与肩袖撕裂有明确相关性。随着患者年龄的增大,肩袖肌腱和肩峰骨质退行性变的发生,轻微的创伤都有可能导致肩袖撕裂。50岁以上的肩关节患者合并有肩峰骨棘,都应考虑其有肩袖撕裂的可能。     

关节镜下肩峰成形术治疗肩峰下撞击综合征

目的探讨关节镜下肩峰成形术治疗肩峰下撞击综合征的方法和临床疗效。方法肩峰下撞击综合征患者15例,男9例,女6例;年龄32~54岁,平均47岁。右肩10例,左肩5例。Ⅰ度3例,Ⅱ度4例,Ⅲ度8例。术前UCLA评分平均为(18.5±8.2)分。所有患者均有外伤史或慢性劳损,均有不同程度的肩周疼痛和夜间痛。疼痛弧试验阳性12例,撞击征阳性13例。术前13例行MR检查,5例行肩关节造影。术前常规拍摄肩关节正位和冈上肌出口位X线片。平坦肩峰4例,弧形肩峰5例,钩状肩峰6例。关节镜下肩峰成形术手术步骤:采用常规后入路做盂肱关节腔检查,排除或治疗肩关节内病变;用刨削打磨器清理切除肩峰下滑囊壁;用钩刀或钬激光切断或部分切除喙肩韧带;用打磨钻切除(或磨平)肩峰前外侧部分;最后探查肩锁关节,磨去骨赘。4例做肩袖修补术。术后早期行肩关节功能锻炼。结果15例患者均获得随访,平均15个月。终末随访时的UCLA评分平均为(31.7±6.5)分,其中优8例,良4例,可2例,差1例;和术前评分比较,差异有显著性(t=3.35,P<0.05)。结论肩峰下撞击综合征是肩关节疼痛和功能障碍的常见原因。关节镜下肩峰成形术是治疗肩峰下撞击综合征的有效方法,创伤小,术后恢复快,术后早期即可进行功能锻炼。     

关节镜下微创治疗肩袖钙化性肌腱炎

目的 探讨关节镜下微创钙化灶清除保留喙肩韧带预防性肩峰成形术治疗肩袖钙化性肌腱炎的适应证、手术方法及疗效.方法 2006年1月至2011年6月间采用肩关节镜下手术治疗肩袖钙化性肌腱炎12例,男3例,女9例;左肩5例,右肩7例;年龄32～72岁,平均54.6岁;病程3个月～2.5年,平均12个月.术前对患者肩关节功能按照加利福尼亚大学洛杉矶分校(universityofCalifornia at Los Angeles,UCLA)评分法进行评估,平均(16.14±2.10)分.本组患者常规进行预防性肩峰成形术.对于本身存在肩峰下骨赘的患者充分去除增生骨质,而对于无明显骨赘的患者则仅做轻度的肩峰成形,去除2 mm左右的骨质,并且保护喙肩韧带完整,从而保护了肩关节上方的被动稳定性结构.对4例钙化灶特别巨大、在彻底清除病灶及被钙化灶侵蚀和破坏的肩袖组织后,评估肩袖缺损深度超过肌腱厚度的50％者使用了锚钉行肩袖修补术.结果 术后随访6～25个月,平均16.4个月.术后疼痛程度及功能评分均有显著提高.肩关节活动范围明显改善.对手术前后UCLA各项进行配对t检验,两组差异有统计学意义(t=37.08,P＜0.01).结论 关节镜下钙化灶清除及保留喙肩韧带的预防性肩峰成形术,是治疗经保守治疗无效的肩袖钙化性肌腱炎患者一种安全有效的方法,具有损伤小、恢复快的优点.     

肩峰指数与非创伤性肩袖全层撕裂的相关性研究

目的 探讨通过肩峰指数预测非创伤性肩袖全层撕裂的临床价值。方法 回顾性分析自2019-01—2021-06诊治的111例肩关节疾病,58例确诊为非创伤性肩袖全层撕裂（观察组）,53例肩袖完整（对照组）,比较观察组与对照组的肩峰指数,比较观察组男性与女性患者的肩峰指数,比较观察组小型、中型、大型、巨大型肩袖撕裂患者的肩峰指数。结果观察组的肩峰指数值较对照组大,差异有统计学意义（P<0.05）。观察组男性与女性患者肩峰指数比较差异无统计学意义（P>0.05）。观察组小型、中型、大型、巨大型肩袖撕裂患者肩峰指数比较差异无统计学意义（P>0.05）。Spearman相关性分析结果显示非创伤性肩袖全层撕裂类型与肩峰指数之间无相关性（r=-0.171,P=0.199）。结论 肩峰指数可在一定范围预测非创伤性肩袖全层撕裂的发生,但其无法预测肩袖撕裂的范围。     

锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位

目的探讨锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位的临床疗效。 方法回顾性分析本院骨科自2008年1月至2018年12月收治的15例肩峰骨折合并肩锁关节脱位患者的临床资料，其中男13例、女2例；患者年龄范围18 ~ 60岁，平均年龄（34.67±15.53）岁；致伤原因：交通伤8例，摔伤2例，坠落伤3例，运动伤2例。肩峰骨折分型，OgawaⅠ型5例，OgawaⅡ型10例；肩锁关节脱位分型，TossyⅡ型7例，TossyⅢ型8例。治疗方案均为肩峰骨折采用切开复位空心钉内固定治疗，肩锁关节脱位采用切开复位锁骨钩钢板内固定治疗。术后1年根据患者患侧肩关节活动范围及肩关节Constant-Murely评分对患者进行功能评价。 结果所有患者均获得至少1年以上随访，平均随访时间（21.60±9.83）个月，术后患者切口均一期愈合，未发生伤口感染、骨折愈合不良、骨折脱位复位丢失、肩峰下撞击、钢板螺钉松动等情况。术后1年肩关节活动范围：外展90° ~ 145°，平均（114.00±19.29）°；上举100°～180°，平均（136.67±27.10）°；后伸30° ~ 60°，平均（42.00±10.66）°；外旋30° ~ 45°，平均（38.00±6.76）°。术后1年Constant-Murely评分70 ~ 96分，平均（85.73±7.26）分，优5例，良7例，可3例，优良率80％。 结论锁骨钩钢板联合空心钉内固定治疗肩峰骨折合并肩锁关节脱位操作安全、简单、疗效确切，术后患者功能恢复满意，值得在临床中应用。     

肩峰下撞击征的治疗进展

肩峰下结构与典型滑膜关节的结构非常相似,其中喙突、喙肩韧带、肩峰构成的穹隆状结构类似臼窝;肱骨大结节类似关节突;位于肩峰和喙肩韧带、冈上肌之间的肩峰下滑囊类似关节滑囊;冈上肌肌腱在肩峰与肱骨大结节间穿过,肱二头肌长头腱在其深面穿越肱骨头上方。因此,肩峰下结构又被称为“第二肩关节”。肩峰前外侧形态异常、骨赘形成,肱骨大结节骨赘形成,肩锁关节增生以及其它可能导致肩峰－肱骨头间距减小的原因均可造成肩峰下结构的挤压与撞击,即由于与肩峰底面的前 1/3、喙肩韧带和肩锁关节下面的反复异常碰撞,滑囊、肩袖及肱二头…     

肩峰切线位片的应用研究

目的　通过肩峰前缘骨赘发生率及骨赘增生程度与临床表现相关性比较 ,探讨肩峰前后切线位 X线射片的临床应用价值。方法　 371个有慢性肩部疼痛史或有肩部阳性体征的肩作为实验组 ,16 9个无肩痛史无肩部阳性体征的肩作为对照组。两组同时行肩峰前后切线位 X线摄片 ,按大小及形态特征将骨赘分为 0°、 °、 °、 °。根据骨赘分度分布情况进行统计 ,两组行秩和检验。两组骨赘发生率、 ° °所占比率及 °所占比率分别行 X2 检验。结果　实验组与对照组秩和检验有高度显著性差异 (P <0 .0 1) ,两组骨赘发生率 X2 检验有高度显著性差异 (P <0 .0 1) , ° °骨赘所点比率 X2 检验有高度显著差异 (P <0 .0 1)。 °骨赘所占比率 X2 检验有高度显著性差异 (P <0 .0 1)。结论　肩峰前缘骨赘发生率及骨赘增生程度与临床表现密切相关。肩峰前后切线位 X线摄片能清楚显示肩峰前缘骨赘 ,可作为慢性肩部疼痛的常规检查方法     

Classification and Clinical Significance of Acromial Spur in Rotator Cuff Tear: Heel-type Spur and Rotator Cuff Tear

Acromial spurs reportedly relate to the impingement syndrome and rotator cuff tears. We classified the morphologic characteristics of the acromion (shape and thickness) and acromial spurs and determined whether they correlated with rotator cuff tears. We measured acromial shape and thickness using simple radiography and MR arthrography or CT arthrography in 106 patients with full-thickness rotator cuff tears and in 102 patients without tears. Acromial spurs could be classified morphologically into six types: heel, lateral/anterior traction, lateral/anterior bird beak, and medial. We found acromial spurs in 142 of the 208 patients (68%), and their incidence increased with age. The acromial spur was more common in the cuff tear group. The heel type was most common and detected in 59 patients (56%) in the cuff tear group and in 36 patients (35%) in the control group. The flat acromion was more common (60%) than curved and hooked acromion; however, there was no major difference between acromial shape and cuff tear. The mean acromial thickness was 8.0 mm, and the cuff tear group had thicker acromion. These data suggest acromial spurs can be classified according to the distinct morphology, and the most common heel-type spur might be a risk factor for full-thickness rotator cuff tears.     

Is Acromioplasty Ever Indicated During Rotator Cuff Repair?

Based on data from a national healthcare insurance carrier in the United States between 2010 and 2012, orthopedic surgeons performed an acromioplasty procedure on 73 to 76% of their arthroscopic rotator cuff repairs. This has remained a prevalent arthroscopic adjunct despite the controversies disputing the role and etiology of external impingement on symptomatic rotator cuff disease. Within the past decade, several randomized studies have demonstrated negligible benefits with acromioplasty performed alongside rotator cuff repair, with no significant differences in either patient-reported outcome scores or retear rates). Conversely, other authors have suggested higher rates of reoperation with rotator cuff repair alone. Critical shoulder angle, an objective measure of lateral acromion extension and glenoid inclination that is considered a gauge of external impingement, has demonstrated an association with rotator cuff tears; Despite this, patient-reported outcomes do not consistently correlate with critical shoulder angle or other variants in acromial morphology after arthroscopic full-thickness rotator cuff repair. Evidenced-based data is currently lacking to support routine use of acromioplasty in all cases of rotator cuff repair. However, the current available studies do present design flaws, namely statistical underpowering, particularly in type III acromion morphology; inadequate short-term follow-up; lack of imaging data to assess cuff healing; and insensitive outcome measures to capture the theorized benefits of subacromial decompression. Additionally, several relevant merits of acromioplasty have been reported, including decreased abrasive wear with prominent type III acromial morphology, release of natural growth factors to improve rotator cuff healing, and improved visualization during rotator cuff repair. Further evaluation is needed to determine the correct indications for acromioplasty in the setting of cuff repair. Current data would indicate that acromioplasty can be used safely at the discretion of the operating surgeon based on preoperative and intraoperative findings.     

The relative importance of acromial morphology and age with respect to rotator cuff pathology

The purpose of this study was to examine the relationship between patient age, acromial morphology, and rotator cuff pathology. Data on 523 patients who had arthroscopic and/or open shoulder surgery were reviewed. Acromial morphology was classified by the system of Bigliani. All patients were categorized by postoperative diagnosis as having tendinitis of the rotator cuff, partial rotator cuff tear, complete rotator cuff tear, and non-rotator cuff-related pathology. Univariate analysis results for acromial morphology (P <.001), age (P <.001), and gender (P =.019) showed a significant association with rotator cuff pathology. Fifty percent of patients with rotator cuff tendinitis had type I acromions, and 58% of patients with full-thickness rotator cuff tears had type III acromions. Stratified univariate analysis revealed no significant association between acromial morphology and rotator cuff pathology in patients who were over 50 years old. Patients with full-thickness rotator cuff tears were significantly older than those with partial-thickness tears or tendinitis. A larger proportion of male patients than female patients had full-thickness rotator cuff tears. Multivariable logistic regression analysis identified acromial morphology, age, and gender as independent multivariate predictors of rotator cuff pathology. Age, acromial morphology, and gender all have an independent association with rotator cuff pathology.     

Histological analysis of the coracoacromial arch: Correlation between age-related changes and rotator cuff tears

The purpose of this study was to analyze age-related changes in the coracoacromial arch and correlate these degenerative changes with rotator cuff tears. We obtained 80 shouldes from 40 cadavers. The mean age at death was 58.4 years. We performed a gross examination of the rotator cuff and the acromion and histological examination of the coracoacromial ligament. The statistical significance of any difference for each group considered was determined by Student's t-test. The rotator cuff was normal in 66 specimens; there was an articular-side partial tear in 4 cases, a bursal-side partial tear in 6 cases, and a full-thickness tear in 4 cases. Age was correlated with increasing incidence and severity of cuff tears. We noted age-related degenerative changes in the coracoacromial ligament, degeneration of the acromial bone-ligament junction, and acromial spur formation. Anterior acromial spur was not related to the morphology of the acromion. We observed an increased incidence of bursal-side and complete cuff tears when the acromion was curved or beaked. Degenerative changes in the undersurface of the acromion were also present when the rotator cuff was normal. Bursal-side and complete cuff tears were associated with severe degenerative changes in the acromion in 100% of cases. Articular-side cuff tears were not related either to acromial morphology or degenerative changes in the coracoacromial arch. The association between cuff tears and acromial spur was more evident in the presence of a type III acromion. Our results would suggest that the incidence and severity of rotator cuff tears are correlated with aging and with the morphology of the acromion. Rotator cuff tears that involve the bursal side are often associated with changes in the coracoacromial ligament and the undersurface of the acromion. However, degenerative changes in the coracoacromial arch are always related to aging, also in the presence of a normal rotator cuff. Articular-side partial tears do not cause damage to the undersurface of the acromion.     

Editorial Commentary: Classic Arthroscopic Anterolateral Acromioplasty Does Not Translate to Clinically Meaningful Differences in Lateral Acromial Overcoverage

Despite its time-honored tradition, the classic Neer acromioplasty has come under increased scrutiny in the recent literature, particularly when performed in the absence of rotator cuff repair. The American Medical Association Current Procedural Terminology Committee has transitioned the acromioplasty procedure, and definition of the related Current Procedural Terminology code 29827, to a procedure that is “added-on” to shoulder arthroscopy. Several authors have sought to investigate the true value of arthroscopic subacromial decompression for extrinsic sources of impingement. Common indications for acromioplasty include bursal-sided tears, prominent type III hooked acromial morphology, calcified coracoacromial ligament, and severe rotator cuff tendinopathy. However, the classic arthroscopic acromioplasty may not meaningfully address lateral outlet impingement and acromial overcoverage, as measured by an elevated critical shoulder angle or acromial index, thereby leading to persistent abduction impingement and mechanical abrasion. In these cases, lateral acromial resection of up 5 to 10 mm may be preferentially considered to decrease the pathologic critical shoulder angle (>35°) and reduce the risk of primary or secondary rotator cuff tendon failure.     

Characterization of acromial concavity. An in vitro computer analysis

Variations in the shape and orientation of the anterior acromion have been implicated as predisposing factors for the development of rotator cuff problems. We determined and analyzed by computer digitization the anterior and posterior acromial slopes for 141 cadaver shoulders (whose rotator cuff status had been previously assessed). No significant differences in either the anterior or posterior angle were found between the intact and rotator cuff tear groups. Frequency histograms of both angles demonstrated continuous, normal distributions. The individual acromions were consistently asymmetric in that the anterior slope was larger than the posterior slope. However, the anterior slope distribution did not reveal groupings indicative of the specific acromial types previously reported. These results suggest that acromial classification into flat, curved, and hooked types does not accurately describe the actual anatomical findings.     

Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale

Ten patients with painful, massive (greater than 5 cm), complete rotator cuff tears involving primarily the supraspinatus were treated with arthroscopic acromioplasty and rotator cuff debridement. All patients except one had normal active motion and strength preoperatively. All patients had roentgenographically normal acromiohumeral distance and an anterior-inferior acromial osteophyte. The goal was to obtain pain relief without loss of motion of strength. This was accomplished in all patients. This study shows that normal shoulder function is possible with a massive unrepaired tear of the rotator cuff. Normal function in the face of an unrepaired cuff tear can occur only if there is a balance of two important force couples, one in the coronal plane and the other in the transverse plane. This balance depends upon the functional integrity of the anterior cuff, the posterior cuff, and the deltoid. In patients whose cuff tears satisfy these anatomic and biomechanical criteria, the achievement of pain relief through arthroscopic debridement and decompression seems to be all that is necessary for normal pain-free function.     

Arthroscopic subacromial decompression

In 1983, Ellman reported the first subacromial decompression by arthroscopy as an alternative to open acromioplasty which described by Neer in 1972. Subacromial decompression combinates a removing of the antero lateral part of the acromion, a release of the coraco acromial ligament and a subacromial bursectomy. The principal indication is a chronic anterior impingement after failure to medical treatment. This subacromial decompression can be associated to cuff debridement, cuff repair, tenotomy or tenodesis of the biceps tendon or repair intraarticular lesion (SLAP, labrum...). The contraindications are massive cuffs tear with a superior migration of the humeral head or if the acromion is flat. Then, acromioplasty and release of the CA ligament could create a superior and anterior migration of the humeral head responsable to a pseudo paralytic shoulder. If we compare to open acromioplasty, arthroscopic decompression has some advantages; no split deltoid or desinsertion of anterior deltoid fibers, small cicatrices, less postoperative pain allowing immediate physiotherapy and possibility to explorate and to repair intra articular lesion during the same operation.