Treatment of Chronic Rotator Cuff Impingement of Shoulder joint by Arthroscopic Subacromial Decompression

Abstract

The shoulder joint plays an integral role in many activities of the daily living. It is responsible for the positioning and posturing the hand and the upper extremity to do their target purposes.

In order to perform its role perfectly, the shoulder unit is considered a complex joint that • is composed of five functional articulations: the sternoclavicular joint, the acromioclavicular, the subacromial space, the glenohumeral, and the scapulothoracic joint. Those 5 articulations share -all together- in a different proportion in the shoulder movement.

Due to the importance of this complex many authers had studied the different shoulder problems that was found to be common among orthopedic practice. Many debates issued concerning these problems, till Neer in 1973, focused on the rotator cuff lesions and coined the term rotator cuff impingement that was found to constitute about 21% of all shoulder problems.

Actually many theories tried to explaine the rotator cuff lessions . The first theory -was more popular before Neer's opinion in 1973- were discussing the intrinsic factor, which was proposing that the primary problem always issued in the substance of th rotator cuff at a relatively hypovascular area near the insertion of the cuff, that is subsequently followed by a cascade of inflammatory process. The second theory (more accepted and more popular) firstly propsed by Neer 1973, the extrinsic theory, that accused the supraspinatus outlet which is boundered by the acromion and coracoacromial arch superiorly. The /''"''- coracoacromial arch is cabable to induce repeated minor traJrria to the rotator

cuff tendon underneath, resulted in (by time) different Piltpological process in \••••• the rotator cuff. While the third theory (the intermediate theory) proposed that,