Neer's 1972 landmark paper names and defines the shoulder impingement syndrome for the first time. Using cadaveric dissection of 100 scapulae and operative findings from 50 shoulders, it localizes pathologic contact exclusively to the anterior third of the acromion. It describes anterior acromioplasty — targeted resection of the anterior acromion and coracoacromial ligament with deltoid preservation — as the surgical solution.
Every subacromial decompression performed today — open or arthroscopic. Follows the operative principles Neer defined in this paper: excise the anterior acromion, release the coracoacromial ligament, and preserve the deltoid origin.
Before this paper, surgery meant complete or lateral acromionectomy. Those procedures reliably weakened the deltoid, formed sinuses, and often failed to address the actual pathologic anterior margin. Producing the exact 36% satisfactory rate Neer documented in his revision series.
When you see a patient with persistent weakness and pain after a prior acromionectomy, look for deltoid deficiency first. Neer's data show this is nearly impossible to recover from: only 4 of 11 such patients had satisfactory outcomes even after revision anterior decompression.
For incomplete tears, symptoms must persist at least 9 months before surgery is indicated. A subacromial lidocaine injection that relieves pain is a useful predictor of what decompression will accomplish. A clinical test Neer described here and that remains in use today.
Neer's 1983 Clinical Orthopaedics paper extended this framework to three stages and is the companion reference for the full classification used on boards and in clinical practice.
Neer's 1972 landmark paper names and defines the shoulder impingement syndrome for the first time. Using cadaveric dissection of 100 scapulae and operative findings from 50 shoulders, it localizes pathologic contact exclusively to the anterior third of the acromion. It describes anterior acromioplasty — targeted resection of the anterior acromion and coracoacromial ligament with deltoid preservation — as the surgical solution.
Every subacromial decompression performed today — open or arthroscopic. Follows the operative principles Neer defined in this paper: excise the anterior acromion, release the coracoacromial ligament, and preserve the deltoid origin.
Before this paper, surgery meant complete or lateral acromionectomy. Those procedures reliably weakened the deltoid, formed sinuses, and often failed to address the actual pathologic anterior margin. Producing the exact 36% satisfactory rate Neer documented in his revision series.
When you see a patient with persistent weakness and pain after a prior acromionectomy, look for deltoid deficiency first. Neer's data show this is nearly impossible to recover from: only 4 of 11 such patients had satisfactory outcomes even after revision anterior decompression.
For incomplete tears, symptoms must persist at least 9 months before surgery is indicated. A subacromial lidocaine injection that relieves pain is a useful predictor of what decompression will accomplish. A clinical test Neer described here and that remains in use today.
Neer's 1983 Clinical Orthopaedics paper extended this framework to three stages and is the companion reference for the full classification used on boards and in clinical practice.