A preoperative scoring system to select patients for arthroscopic subacromial decompression

J Shoulder Elbow Surg. 2014 Sep;23(9):1251-6. doi: 10.1016/j.jse.2014.05.030.


Background: This study investigated the clinical and radiographic factors that influence outcome after arthroscopic subacromial decompression (ASAD) for shoulder impingement syndrome. The goal was to develop a new preoperative scoring system to identify patients who would have a prompt and sustained benefit from ASAD.

Methods: We prospectively reviewed 112 consecutive patients with impingement syndrome who subsequently underwent ASAD. The Oxford Shoulder Score (OSS) was recorded preoperatively and 3 and 12 months postoperatively. A statistically significant improvement in OSS at 3 months after surgery was considered a good outcome.

Results: The variables associated with good outcome were shoulder pain with overhead activities, persistent symptoms for more than 6 months, symptoms persistent despite a 3-month course of supervised physiotherapy, consistently positive Hawkins test result, radiologic changes of impingement on both acromion and humerus in the subacromial region, and improvement for more than 1 week after a steroid injection. These 6 criteria were combined into a single score for this study, termed the preoperative score (PrOS). Sixty-two patients who had been symptomatic for 1 year with a preoperative score of 5 to 6 showed significant improvement in OSS at 3 months after surgery (P < .001). Thirty-eight patients with a score 3 to 4 had no statistically significant improvement in OSS at 3 months but had a further slight improvement at 1 year. Twelve patients with a score of ≤2 had no significant improvement in OSS at 3 months or 1 year.

Conclusion: This scoring system can identify patients who would have a prompt benefit from ASAD. The impact of surgery in patients with a PrOS of ≤4 points is questionable.

Keywords: Arthroscopic subacromial decompression; impingement syndrome; scoring system.

Publication types

  • Clinical Trial

MeSH terms

  • Acromion / diagnostic imaging
  • Adult
  • Aged
  • Arthroscopy
  • Decompression, Surgical
  • Female
  • Health Status Indicators*
  • Humans
  • Humerus / diagnostic imaging
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Radiography
  • Shoulder Impingement Syndrome / diagnosis*
  • Shoulder Impingement Syndrome / diagnostic imaging
  • Shoulder Impingement Syndrome / surgery
  • Shoulder Pain / surgery