Russ,
There's no doubt that long standing microtrauma is an issue AND that the hooked acromion can be a contributor. My point is that there's other stuff to go with it (the hooked acromion) that often is not addressed that may very well be "the cause".
For instance, you do the acromioplasty but never effectively address issues of shoulder girdle posture, effective stabilization strategies, program design, exercise technique, "muscle balance", fatigue patterns, dynamic instabilities, etc. What frequently happens if the patient goes back to prior activities without adequate instruction, re-education, restoration of ROM, movement patterns, and strength? More shoulder pain/impingement. Well, then was it the hooked acromion or something else?
Granted, therapy is supposed to address this but restrictions on frequency/duration and a blatant lack of knowledge on the part of PT's regarding the above issues (all therapy is not created equal) lends itself to more problems. There's also the patient's responsibility to follow-thru which is a huge part of successful rehab.
Not trying to blame anyone per se, just offering a perspective based on treating my share of patients "destined" for surgery who ended up not needing it, and those who have had the surgery and ended up back in therapy later on. There are certainly times for everything.
I'm pretty spoiled to work with a group of surgeons who'd rather exhaust rehab possibilities rather than do the surgery right away.
Bill
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