Wrede, (Wrede, 1912) who, on the basis of one surgical case and several cases in which X rays had revealed calcium shadows in the region of the greater tuberosity, was able to show that the calcium deposits were localized in the supraspinatus tendon.
Codman (Codman, 1984) made an important contribution to the question when he drew attention to the important role played by changes in the supraspinatus in the clinical picture of subacromial bursitis. Codman was the first to point out that many cases of inability to abduct the arm are due to incomplete or complete ruptures of the supraspinatus tendon.
With Codman's findings it was proved that humeroscapular periarthritis was not only a disease condition localized in the subacromial bursa, but that pathological changes also occurred in the tendon aponeurosis of the shoulder joint.
In 100 dissected scapulae, Neer found eleven with a "characteristic ridge of proliferative spurs and excrescences on the undersurface of the anterior process (of the acromion), apparently caused by repeated impingement of the rotator cuff and the humeral head, with traction of the coracoacromial ligament.
Without exception it was the anterior lip and undersurface of the anterior third that was involved." Neer emphasized that the supraspinatus insertion to the greater tuberosity and the bicipital groove lie anterior to the coracoacromial arch with the shoulder in the neutral position and that with forward flexion of the shoulder these structures must pass beneath the arch, providing the opportunity for abrasion.
In 1972 Neer described the indications for acromioplasty as:
(1) Long-term disability from chronic bursitis and partial tears of the supraspinatus tendon or
(2) Complete tears of the supraspinatus.
He pointed out that the physical and roentgenographic findings in these two categories were indistinguishable, including crepitus and tenderness over the supraspinatus with a painful arc of active elevation from 70 to 120 degrees and pain at the anterior edge of the acromion on forced elevation.
The proposed goal of acromioplasty was to relieve mechanical wear at the critical area of the rotator cuff. Surgery was not considered until any stiffness had resolved and until the disability had persisted for at least nine months. Even in patients who had had a previous lateral cromionectomy with continuing symptoms, Neer considered anterior acromioplasty, having found that many still had problems related to subacromial impingement.
Neer also reported that the rare patient with an irreparable tear in the rotator cuff could be made more comfortable and could gain surprising function if impingement were relieved, as long as the deltoid origin was preserved. (Neer, 1983)
Neer (Neer, 1983) recommended resection of small unfused acromial growth centers and internal fixation of larger unfused segments in a manner that tilted the acromion upwards to avoid impingement)
Additional approaches to subacromial abrasion have been proposed including coracoacromial ligament section, (Hawkins and Kennedy, 1980, Jackson, 1976, Kessel and Watson,
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