During the past various factors were quoted to be causative of a degeneration of the rotator cuff. In this study 122 shoulder specimen, aged 58-95 years, were dissected. A high correlation between severe degeneration of the ac-joint and rupture of the rotator cuff was found. The correlation was even higher between distally pointing osteophytes and cuff ruptures. The results demand to clearly define the degeneration of the ac-joint and the rotator cuff in patients suffering from shoulder pain. A simultaneous occurrence has to be considered. If conservative treatment fails in patients with cuff tear and ac-joint degeneration, surgical revision is recommended. This should comprise: 1. suture of the cuff-rupture 2. excision of the coraco-acromial ligament 3. anterior acromioplasty according to Neer 4. excision of the outer end of the clavicle
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