The failed subacromial decompression: Further evaluation and treatment

Subacromial decompression is one of the most successful and common orthopedic procedures performed today. If there is continued pain and dysfunction after this procedure, the diagnostic work-up becomes challenging. Multiple sources of persistent pain exist including disorders both intrinsic and extrinsic to the shoulder. The list includes cervical spine disease, peripheral nerve pathology, disorders of the long head of the biceps, acromioclavicular joint arthrosis, instability, frozen shoulder, early osteoarthritis, and continued chronic impingement. A thorough history, physical examination, and review of the pre- and postoperative courses are essential. Diagnostic injections are particularly helpful in isolating the source of pain. Additional tests including magnetic resonance imaging of the shoulder and spine, ultrasound, and nerve conduction tests complete the evaluation. Successful operative or nonoperative treatment is predicated on an accurate diagnosis.