Recent advances in shoulder surgery.

Major changes have taken place in the diagnosis and treatment of rotator cuff tears. It seems that magnetic resonance imaging alone as a diagnostic tool is still not sensitive enough, particularly in the diagnosis of partial tears. Arthrography and arthroscopy are still considered essential for an accurate preoperative diagnosis. To guarantee a better postoperative result, a carefully planned course of preoperative physiotherapy is mandatory. In experienced hands, arthroscopic surgery gives results comparable to those obtained with open procedures. A careful debridement, anterior acromioplasty, and decompression have replaced extensive surgical intervention in the treatment of massive tears. The first results in treating calcifying tendinitis with shock-wave therapy seem encouraging. A more refined diagnosis of the impingement syndrome is a prerequisite for a successful outcome because impingement is not caused by a narrowing of the subacromial space in all patients. Increase in contents of this space and instability are equally important factors.