Prospective arthroscopic study of 89 patients with pulley lesions, classifying injury patterns and identifying which factors drive anterosuperior impingement (ASI). The central question: why do some pulley lesions progress to ASI while others do not? Answer: it is the subscapularis, not the supraspinatus, that determines impingement risk.
Anterior shoulder pain that does not respond to subacromial lidocaine injection is the clinical flag for ASI. Before this paper, the pathologic drivers were poorly defined and the condition was frequently misdiagnosed as outlet impingement or missed entirely.
When you see a pulley lesion at arthroscopy, the subscapularis articular surface is the structure that determines prognosis. A deep surface subscapularis partial tear shifts the probability of ASI from roughly 1-in-4 to nearly 3-in-4. Inspect it carefully in every case.
Dynamic arthroscopic testing in flexion, horizontal adduction, and internal rotation is required to confirm the diagnosis. A positive test plus an anterosuperior labral lesion meets the diagnostic criteria used in this study.
Radiographic AC arthritis in a patient with this symptom complex is not incidental — it is an independent risk factor (OR 4.98) and nearly doubles the background ASI rate. Add it to your preoperative mental checklist.
Prospective arthroscopic study of 89 patients with pulley lesions, classifying injury patterns and identifying which factors drive anterosuperior impingement (ASI). The central question: why do some pulley lesions progress to ASI while others do not? Answer: it is the subscapularis, not the supraspinatus, that determines impingement risk.
Anterior shoulder pain that does not respond to subacromial lidocaine injection is the clinical flag for ASI. Before this paper, the pathologic drivers were poorly defined and the condition was frequently misdiagnosed as outlet impingement or missed entirely.
When you see a pulley lesion at arthroscopy, the subscapularis articular surface is the structure that determines prognosis. A deep surface subscapularis partial tear shifts the probability of ASI from roughly 1-in-4 to nearly 3-in-4. Inspect it carefully in every case.
Dynamic arthroscopic testing in flexion, horizontal adduction, and internal rotation is required to confirm the diagnosis. A positive test plus an anterosuperior labral lesion meets the diagnostic criteria used in this study.
Radiographic AC arthritis in a patient with this symptom complex is not incidental — it is an independent risk factor (OR 4.98) and nearly doubles the background ASI rate. Add it to your preoperative mental checklist.