Can Acromioplasty Result in Impairment?

To determine if an acromioplasty is impairing, an evaluator must know shoulder anatomy, the diagnosis or diagnoses, what treatment was provided, and the patient's present status. Over time, the earlier classification of shoulder impingement has been modified, and the current classification was adopted in 1994. At present, acromioplasty often is not the primary surgery but rather is one component of subacromial decompression with or without concomitant rotator cuff and/or intra-articular shoulder surgery. Until the sixth edition, the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) did not address the question whether acromioplasty itself constitutes an impairment. In the fourth and fifth editions of the AMA Guides, although open or arthroscopic acromioplasty commonly results in temporary shoulder pain, stiffness, and weakness, the surgical procedure itself, barring complication, results in no permanent impairment. According to the AMA Guides, Sixth Edition, if an acromioplasty eliminated impingement and resulted in no pain or significant objective findings at maximal medical impairment, no impairment occurred. Diagnosis-based impairment is considered the rating method of choice, but range of motion is used primarily in the physical examination adjustment grid. Further, surgical error and/or complications may result in ratable motion and/or strength deficits. The AMA Guides, Fourth and Fifth Editions, also provide a means to rate impairment due to any concomitant distal clavicular resection.

Acromioplasty: Is It An Impairment?

Acromioplasty can be performed open or arthroscopically and removes the spurred, curved, or hooked portion of the acromion. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) has not addressed whether acromioplasty itself constitutes an impairment. On the one hand, if impairment is defined as “a loss, loss of use, or derangement of any body part, organ system, or organ function,” then acromioplasty is an impairment because of the loss of a small portion of the scapula. On the other hand, acromioplasty generally results in improved function (ie, no or negative impairment) and may increase rather than decrease an individual's ability to perform the activities of daily living. This does not indicate that patients who undergo acromioplasty have no impairment whatsoever, and remaining motion deficits should be rated according to existing criteria in the AMA Guides. For example, failure to properly reattach the deltoid muscle or excessive acromial resection may result in deltoid weakness or strength. Often during acromioplasty, the removal of the clavicular spur is accomplished via excision of distal clavicle (resection arthroplasty), which is a permanent impairment. Acromionectomy, which is functionally similar to distal clavicular resection, and transposing the 10% upper extremity impairment rating for distal clavicular resection to a total acromionectomy appears to be justified.