Impingement on the tendinous portion of the rotator cuff by the
coracoacromial ligament and the anterior third of the acromion is responsible
for a characteristic syndrome of disability of the shoulder. A characteristic
proliferative spur and ridge has been noted on the anterior lip and
undersurface of the anterior process of the acromion and this area may also
show erosion and eburnation. The treatment of the impingement is to remove the
anterior edge and undersurface of the anterior part of the acromion with the
attached coracoacromial ligament. The impingement may also involve the tendon
of the long head of the biceps and if it does, it is best to decompress the
tendon and remove any osteophytes which may be in its groove, but to avoid
transplanting the biceps tendon if possible. Hypertrophic lipping at the
acromio-clavicular joint may impinge on the supraspinatus tendon when the arm
is in abduction and, if the lip is prominent, this joint should be resected.
These are the principles of anterior acromioplasty.