Combined subcoracoid and subacromial impingement in association with anterosuperior rotator cuff tears: An arthroscopic approach

Purpose: The purpose of this study was to evaluate the surgical outcome of patients with combined subcoracoid and subacromial impingement with associated rotator cuff tears. Type of Study: Case series. Methods: Eight patients with a mean age of 63.6 (+/- 8.9) years were reviewed. All patients had combined subscapularis, supraspinatus, and infraspinatus tears of the rotator cuff with associated subacromial and subcoracoid impingement. All patients were treated with arthroscopic subacromial decompression, subcoracoid decompression, and rotator cuff repair. Results: At a mean follow-up of 8.8 months (range, 6-12 months), all patients were satisfied with the procedure. The mean University of California Los Angeles (UCLA) score increased from 11.0 +/- 2.6 preoperatively to 30.9 +/- 2.9 postoperatively (P <.00001). Preoperatively, all patients were in the poor category by UCLA criteria. Postoperatively, 2 patients had excellent results, 5 patients had good results, and I patient had a fair result. All patients had significant reduction in pain postoperatively, with 4 patients showing complete elimination of pain during all activities. No patient complained of pain anteriorly over the coracoid or had positive impingement signs postoperatively. Active forward elevation increased from a mean of 103.1 degrees +/- 46.5 degrees preoperatively to a mean of 155 degrees +/- 18.5 degrees (P <.02). Preoperatively, 4 patients had no active overhead function with positive Napoleon tests. Postoperatively, all showed improvement of the Napoleon test and regained active overhead function. Conclusions: Arthroscopic treatment of combined subcoracoid and subacromial impingement can lead to good results in this patient population. A high index of suspicion for these combined lesions, along with adequate surgical decompression and rotator cuff repair, is essential in providing pain relief and improved function.