الفهرس 
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Abstract
The shoulder complex is the functional unit that results in movement of the arm with respect to the trunk. This unit consists of the clavicle, scapula, and the humerus; the articulations linking them; and the muscles that move them (Oatis 2004).
The subacromial space can be roughly regarded as a rectangular space with an anterior-posterior extension that is twice the mediolateral dimension.
The primary function of the rotator cuff is to act as a humeral head depressor and dynamic stabilizer of the glenhumeral joint, creating a fulcrum from which the deltoid can elevate the arm.
The term impingement syndrome has been used to describe symptoms related to the rotator cuff in the absence of a full-thickness tear of the cuff. The abnormality of the rotator cuff may range in a severity from an acute strain or tendintis to frank tearing. In all but the most acute situations, the lesion is one of chronic tendinopathy or angio-fibroblastic hyperplasia rather than tendinitis (Budoff et al 1998).
The aetiology of impingement syndrome is still under debate but there is evidence that mechanical dysfunction plays a major role. Tendinopathy, impaired vascularity of the rotator cuff tendons and repetitive trauma also contribute to the disease process (Wülker and Vocke 2001).
According to the pathology of the rotator cuff, Neer differentiated three stages of the impingement syndrome;
Stage I; Oedema and haemorragic changes at the rotator cuff (reversible).
Stage II; Fibrosis and tendonitis (irreversible).
Stage III; Partial or complete rotator cuff defect with structural changes at the undersurface of the acromion ( Neer 1983).
The diagnosis of subacromial impingement is established if three of the following are present:-
• Tenderness lateral or anterior to the acromion.
• A positive painful arc sign during abduction of the arm.
• More painful active shoulder motion than passive shoulder motion.
• Pain relief following subacromial injection of local anaesthetic.
• Structural subacromial changes such as os acromial, osteophyte, partial or complete rotator cuff tear (Wulker and Vocke 2001).
All patients with subacromial impingement are initially treated non-operatively. Operative interference can always be delayed for several weeks or months until the patient undergone a thorough trial of non-operative management (Lee et al 1973).
If non-operative treatment fails to reduce symptoms, operative intervention may be indicated. Anterior acromioplasy with resection of the coracoacromial ligament can be performed with the use either the traditional open technique described by Neer or the arthroscopic method described by Ellman (Levine and William 1997).
The rate of complications after open acromioplasty is predictably quite low. Reported complications have included acromial fracture, persistent pain, post operative glenohumeral stiffness, lengthy rehabilitation, delayed return to work, weakness, superficial or deep wound infection, detachment of the deltoid, and dysfunction (Livine and William 1997).
Arthroscopic subacromial decompression ASD has become the mainstay of treatment for patients with impingement syndrome that has failed conservative management. Since its introduction in 1985, ASD has reliably produced clinical success, low morbidity, and early return of function (Johnson and Warren 2004).
Debridement of the rotator cuff without acromioplasty or coracoacromial ligament resection is an effective treatment for impingement syndrome with the advantage of addressing the pathoanatomy of the cuff while avoiding iatrogenic harm to the coracoacromial arch, including the likely destabilization of the glenhumeral joint secondary to disruption of the important stabilizing effect of the acromion and the coracoacromial ligament ( Budoff et al 1998).
Our study was performed in an attempt to evaluate the results of arthroscopic subacromial decompression by debridement of the rotator cuff and the bursa without acromioplasty or resection of the coracoacromial ligament and compare between the results of decompression with acromioplasty and without acromioplasty.
We did arthroscopic subacromial decompression by bursectomy and debridement without acromioplasty for twenty patients in the beach-chair position using posterior portal for visualization and antrolateral portal for instrumentation. After the operation, all patients did physiotherapy and we evaluated them three months and six months post operatively using the shoulder rating scale of the University of California at Los Angles.
Our results were excellent for eighty percent after three months, and eighty five percent after six months and these results were comparable with the results of the other authors.
On the bases of our results and the results of the others, we conclude that arthroscopic subacromial decompression with bursectomy and debridement and without acromioplasty or resection of the coracoacromial ligament, is a useful operation for patients suffering from impingement syndrome of the shoulder without rotator cuff tear, whose are not responding to conservative treatment for at least three months.
We recommend this operation especially for young patients whose are in need to leave the hospital as quickly as possible and whose are in need to be included in heavy work.