Subakromiyal Sıkışma Sendromunda Artroskopik Dekompresyon Sonuçlarımız

Amaç: Rotator cuff kaslarının sıkışmasına bağlı oluşan Subakromial Sıkışma sendromu (SSS) omuz ağrısının sık sebeplerindendir. Biz fonksiyonel ve radyolojik açıdan SSS nedeniyle artroskopik dekompresyon cerrahisi öncesi ve sonrası bulguları karşılaştırılmasını amaçladık.Gereç ve Yöntemler: SSS nedeniyle artroskopik dekompresyon yapılan ortalama yaşı 49 (21-76) olan 40 (22 Erkek/18 Kadın) hasta çalışmaya dahil edildi. Ortalama takip süresi 12 ay idi. Ameliyat öncesi ve sonrası fonksiyonel ve radyolojik açıdan değerlendirme yapıldı. Omuz fonksiyonlarını değerlendirmede Constant omuz skorlaması kullanıldı. Omuz sagittal manyetik rezonans görüntüleme kesitlerinden her iki omuzda subakromiyal mesafe ölçüldü. Ayrıca preoperatif travma öyküsü olan 15 (%37,5) ve kronik hastalığı olan 14 (%35) hastanın preoperatif ve postoperatif costant omuz skorları diğer hastalarla ayrı ayrı karşılaştırıldı.Bulgular: Preoperatif 39 (%97,5) hastada Neer ve Hawkins testi pozitifken, ameliyat sonrası 2 (%5) hastada pozitif olarak saptandı. Preoperatif subakromiyal mesafe medyan değeri 9,3 (8,6-9,8), postoperatif ölçümlerde ise medyan değer 10,9 (9,9-11,8) idi. Constant omuz skoru tüm hastalarda preoperatif medyan değeri 11,5 (5-21), postoperatif medyan değeri 80 (61,2-85,5) olarak ölçüldü. Preoperatif 36 (%90) hastada gece ağrıları var iken postoperatif hiçbir hastada gece ağrısı görülmedi. Preoperatif ve postoperatif tüm bu değerler birbirleriyle karşılaştırıldığında istatistiksel olarak anlamlı olduğu görüldü (p

Arthroscopic Decompression in Subacromial Impingement Syndrome: An Overview of Our Outcomes

Objective: Subacromial Impingement syndrome (SIS) is a common cause of shoulder pain due to compression of rotator cuff muscles. We aimed to compare preoperative and postoperative functional and radiological features after arthroscopic decompression in patients with SIS. Materials and Methods: Forty patients (22 male/18 female) with mean age of 49 (21-76) undergone arthroscopic decompression for SIS. The mean follow-up length was 12 months. Before and after the surgery functional and radiological evaluations were performed. Constant shoulder scoring technique was used for evaluating the shoulder functions. The subacromial distance was measured on the sagittal magnetic resonance imaging sections. In addition, preoperative and postoperative Constant shoulder scores of 15 (37.5%) patients with a history of preoperative trauma and 14 (35%) patients with chronic disease were compared separately with the other patients. Results: Neer and Hawkins tests were positive in 39 (97.5%) patients preoperatively and only 2 (5%) patients had positive results postoperatively. The median score of the preoperative subacromial distance was 9.3 (8.6-9.8) while the median score was 10.9 (9.9-11.8) in the postoperative measurements. The preoperative median value of the Constant shoulder score in all the patients was 11.5 (5-21) and the postoperative median value was 80 (61.25-85.5). While 36 (90%) patients had night-time pain preoperatively, no patients had postoperatively. These values were significantly decreased after surgery (p

PDF

___

1. Matsen FA, Arntz CT. Subacromial Impingement. In: Rockwood C.A, 1990; 2: 5-15.
2. Greenfield B, Catlin PA, Coats PW, Green E, McDonald JJ, North C. Posture in patients with shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther 1995; 21: 287-95.
3. Cyprien JM, Vasey HM, Burdet A, Bonvin JC, Kritsikis N, Vuagnat P. Humeral retrotorsion and glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation. Clin Orthop Relat Res 1983; 175: 8-17.
4. Neer CS 2nd. İmpingement lesions. Clin Orthop Relat Res 1983; 70-7.
5. Petterson G. Rupture of the tend aponeurosis of the shoulder joint antero-inferior dislocation. Acta C Scand (Suppl) 1942; 77: 1-187.
6. Rockwood CA. Surgical treatment of the shoulder impingement. A modification of the Neer anterior acromioplasty in 71 shoulders. Orthop Trans 1990; 14: 251.
7. Neer CS, Marberry TA. On the disadvantages of radical acromionectomy. J Bone Joint Surg Am 1981; 63: 416-9.
8. Frieman BG, Albert TJ, Fenlin JM Jr. Rotator cuff disease: a review of diagnosis, pathophysiology and current trends in treatment. Arch Phys Med Rehabil 1994; 75: 604-9.
9. Glousman RE. Instability versus impingement syndrome in the throwing athlete. Orthop Clin North Am 1993; 24: 89-99.
10. Wasilewski SA, Frankl U. Rotator cuff pathology. Artroscopic assesment and treatment. Clin Orthop Relat Res 1991; 267: 65- 70.
11. Karabulut M. Subakromiyal sıkışma sendromu konservatif tedavisinde lazerin etkinliğinin araştırılması. Uzmanlık tezi. İstanbul 2006.
12. Conroy DE, Hayes KW. TheEffect of Joint Mobilization as a Component of Comprehensive Treatment for Primary Shoulder İmpingement Syndrome. J Orthop Sports Phys Ther 1998; 28: 3-14.
13. Post M, Cohen J. İmpingement syndrome -A review of late stage II and early stage III lesions. Clin Orthop 1986; 207: 126-32.
14. Ellman H. Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy 1987; 3: 173-81.
15. Atalar AC, Demirhan M, Kocabey Y, Akalyn Y. Artroskopik subakromiyal dekompresyon: 1-7 yıllık sonuçlar. Acta Orthop Traumatol Turc 2001; 35: 377-81.
16. Ellman H, Kay SP, Wirth M. Arthroscopic treatment of full thickness rotator cuff tears: 2- to 7-year follow-up study. Arthroscopy1993; 9: 195-200.
17. Stephens SR, Warren RF, Payne LZ, Wickiewicz TL, Altchek D W. Arthroscopic acromioplasty: a 6- to 10-year follow-up. Arthroscopy 1998; 14: 382-8.
18. Bezer M, Aydin N, Erol B, Kocaoğlu B, Güven O. Late results of arthroscopic and open anterior acromioplasty. Acta Orthop Traumatol Turc 2004; 38: 115-9.
19. Spangehl MJ, Hawkins RH, McCormack RG, Loomer RL. Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study. J Shoulder Elbow Surg 2002; 11: 101-7.
20. Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 2000; 59: 44-7.
21. Andrews JR, Carson WG Jr, Ortega K. Arthroscopy of the shoulder: techniqueand normal anatomy. Am J Sports Med 1984; 12: 1-7.
22. Rodeo SA, Forster RA, Weiland AJ. Neurological complications due to arthroscopy. J Bone Joint Surg Am 1993; 75: 917-26.
23. Ogilvie-Harris DJ, Boynton E. Arthroscopic acromioplasty: extravasation of fluid into the deltoid muscle. Arthroscopy 1990; 6: 52-4.
24. Lee HC, Dewan N, Crosby L. Subcutaneous emphysema, pneumomediastinum and potentially life-threatening tension pneumothorax. Pulmonary complications from arthroscopic shoulder decompression. Chest. 1992; 101: 1265-7.
25. D’Angelo GL, Ogilvie-Harris DJ. Septic arthritis following arthroscopy withcost/benefit analysis of antibiotic prophylaxis. Arthroscopy 1988; 4: 10-4.