Article Text

Download PDFPDF
Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion?
  1. Jeremy Lewis1,2,3,4
  1. 1Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
  2. 2Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK.
  3. 3St George's Hospital NHS Healthcare Trust, London, UK.
  4. 4Central London Community Healthcare NHS Trust, London, UK.
  1. Correspondence to Dr Jeremy Lewis, Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hertfordshire AL10 9AB, UK; jeremy.lewis{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

In 1972 Charles Neer published a clinical commentary proposing that abrasion from the anteroinferior aspect of the acromion resulted in 95% of all rotator cuff (RC) pathology. The associated condition, termed subacromial impingement syndrome (SIS), has become the most commonly diagnosed musculoskeletal condition involving the shoulder. Others went on to suggest a causative relationship between acromial morphology and RC pathology, and clinical tests such as the Neer sign and the Hawkin's test were described to support a diagnosis. Acromioplasty, also known as subacromial decompression (SAD), is a surgical procedure widely used to eradicate the hypothesised source of the irritation. Between 1996 and 2006 the number of SADs increased in New York State (USA) by 254% and from 2001 to 2010 in England (UK) by 746%,1 with successful outcomes being reported in up to 80% of cases. There has been a concomitant 141% increase in the number of surgical repairs of the RC performed between 1996 and 2006. Embedded within this figure is a 600% increase in the number of repairs performed arthroscopically. Many physiotherapists and other health professional have embraced the SIS model describing how poor upper body posture, colloquially termed a forward head posture, is associated with an increase in the thoracic kyphosis with an imbalance of the shoulder girdle muscles. This results in an abnormal scapular posture (typically anterior tilt and downward rotation) resulting in impingement and RC pathology. The extent by which postural abnormalities follow a …

View Full Text


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles