Symptoms :

• of the primarily night pains to the shoulder but also being able to occur the day after physical efforts ;
• a reduction in articular mobilities of the shoulder especially by impossibility of raising the arm, to be capped... (consecutive of retraction of the articular capsule which constitutes the envelope of the articulation which is touched by the inflammation).

The diagnosis :

• X-ray of the shoulder being able to show calcifications of space under-acromial translating an evolved, old form and a reduction height of this space translating a lesion of the tendons of the cap of the rotators ;
• a MRI giving of the precise details on the extent and the intensity of the lesion of the anatomical elements previously quoted.

The treatment must always be medical initially acting on the pain and the ignition; when the drugs are not enough, infiltrations (injection of a derived product cortisonic in space under-acromial), or physical rehabilitation and physiotherapy (using devices such infra-red type or ultrasounds or laser acting on the pain and the ignition) can be carried out.

If all these therapeutic did not generate improvement, the surgery can be discussed.

Its principle consists in removing :

• all inflammatory tissues being located space under-acromial and,
• osseous surface being under the acromion which is the seat of asperities and which is
  responsible for a friction with the tendons of the shoulder (tissue conflict).
• the acromio-coracoïdian ligament forming a genuine cord in front of the articulation and participant in this friction.

This operation was carried out with a large surgical approach using a direct opening of the shoulder. It can be currently carried out by endoscopic way (video-surgery) :

• principle : work in the space concerned without direct opening of the shoulder using the introduction of an optics connected to a mini-camera projecting the image on a screen monitor allowing to locate the lesions and to act using adapted specific instruments; in particular a rotary knife to aspire inflammatory tissues and a rotary cutter to level surface rubbing at the top of the shoulder (decompression of space under-acromial).
• advantages : any direct opening of the shoulder thus the post-operative care are simpler;
  rehabilitation is begun at once after the operation thus potentiating its results; it is not necessary to immobilize the arm…
• limits : be likely to be less effective in the advanced forms and the cases being accompanied by a wide rupture of the tendons of the shoulder. In certain cases, this inflammatory disease can develop in the long run in spite of obtaining a good result after the endoscopic intervention and have to require in this case the traditional intervention.