Houston Methodist. Leading Medicine

Shoulder FAQ

Question:

Well, I'm ready to throw the towel in. Despite massage, acupuncture, and six-months with an osteopath, my shoulder is still painful from an impingement problem. Surgery is the next step. But the question is: do I go with the surgeon who does arthroscopic surgery or the one who does open incisions? Does it even matter?

Answer:

Ever since arthroscopic surgery became a possibility for shoulder surgery, surgeons have been debating and comparing the open incision technique against arthroscopy for shoulder impingement syndrome. Which one is better? Does it even matter in the end? The results of a recent meta-analysis may be able to answer the question once and for all for acromioplasty. Acromioplasty is the removal of the end of the acromion, the round end of a curved piece of bone that comes from the back of the scapula (shoulder blade) over the top of the shoulder. Some of the shoulder muscles of the rotator cuff pass under the acromion as they travel from the scapula to the humerus (upper arm bone). And for various reasons, the rotator cuff can get pinched there causing the painful problem you have called subacromial impingement syndrome. Subacromial just means under the acromion. A meta-analysis has the power to end debates because it provides enough subjects to reach some final conclusions. After searching all the medical literature published from 2000 to 2007 plus all the presentations made on the topic at four major orthopedic meetings held during that time, the authors were able to come to shed some light by comparing results between the two procedures. They found nine studies that directly compared arthroscopic versus open acromioplasty surgeries. It turns out that by the end of 12 months (one full year), patients had equal results in terms of complications after surgery and final outcomes such as range-of-motion, pain, and function. And patients reported equal levels of satisfaction with either procedure. It's what happens during those 12 months that's of significance. For example, patients undergoing the arthroscopic procedure were able to leave the hospital faster and go back to work sooner. On average, patients having the arthroscopic procedure were back at work two weeks before patients in the open acromioplasty group. And the open acromioplasty took longer, so combined with lost wages from a delay in return-to-work, there was more expense for operative time with the open technique. The authors of the meta-analysis concluded that although arthroscopic acromioplasty isn't superior to open incision surgery in every way, it does have some important socioeconomic advantages to consider. A. David Davis, MD, et al. Arthroscopic Versus Open Acromioplasty. In The American Journal of Sports Medicine. March 2010. Vol. 38. No. 3. Pp. 613-618.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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