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Arthroscopic subacromial decompression surgery
Athroscopic subacromial decompression surgery
Arthroscopic subacromial decompression is a surgical procedure designed to increase the space available for soft tissue structures at the front of the shoulder. If there is not enough space for soft tissues at the front of the shoulder, they can become pinched between the humerus (arm bone) and part of the shoulder blade called the acromion process. This can lead to painful subacromial impingement of the tendons that connect to important shoulder stabilizing muscles (rotator cuff) or bursitis (irritation of a fluid filled sack between the tendons and bone). Arthroscopic subacromial decompression is one of the least invasive surgeries for the treatment of subacromial impingement. However, other non-surgical treatments are generally suggested before planning surgery. This hub outlines how subacromial impingement can occur, some alternatives to surgery, what happens during subacromial decompression surgery, risks, and expected recovery time after the surgery.
Cause of subacromial impingement
This video explains the cause of subacromial impingement syndrome that may result in the need for subacromial decompression surgery. There are several factors that can contribute to shoulder impingement. These generally relate to the complex muscle system and passive structures that hold the ball part of the shoulder (head of the humerus) in the socket. They include
- Mechanical strain of the rotator cuff muscles
- Full thickness tear or partial thickness tear of a rotator cuff tendon(s)
- Calcific tendinitis of the rotator cuff
- Overuse rotator cuff tendonopathy
- Labral tears (part of the socket)
- Abnormal muscle patterns of the shoulder
- Shape of the shoulder blade at the shoulder joint
Alternatives to surgery
Subacromial decompression surgery is usually only recommended by surgeons after non-surgical treatments have failed. Non-surgical treatments usually include physical therapy rehabilitation to improve the pattern of movement during arm elevation. This usually involves strengthening the rotator cuff muscles and other muscles that stabilise the shoulder blade (scapula). In addition to improving the mechanics of the shoulder other treatments include non-steroidal anti-inflammatory drugs (NSAIDS), and steroid injections into the shoulder joint.
What happens during the surgery?
During subacromial decompression surgery the patient usually receives a general anesthetic. Once the patient is asleep the surgeon will make a small incision and insert a special instrument to see inside the joint. This instrument is called an arthroscope. The surgeon will also insert some other special surgical instruments through small incisions to trim back the some bone from the shoulder blade to free up some space and 'decompress' the subacromial space. You can see these special instruments in action in this video which shows a subacromial decompression from the perspective of the surgeon. If the surgeon notices a tear in a rotator cuff tendon, they may choose to surgically repair the rotator cuff tendon tear. This may mean a larger cut is required to convert the operation to an 'open surgery' rather than an 'arthroscopic surgery.' However, wide availability of common modern imaging techniques (such as magnetic resonance imaging) mean that most surgeons will already be able to tell you whether this is likely to occur or not. The rehabilitation following a rotator cuff tendon repair is slower and more restricted than the usual rehabilitation and recovery following subacromial decompression surgery without a tendon repair.
The acromion is part of the shoulder blade
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Risks of surgery
All surgery carries risk. It is important that you discuss these risks with your doctor when considering any surgical procedure. The type and level of risk associated with surgery is different for every person. Therefore it is critical to discuss how any surgical risks apply to you. As with every procedure, there are some risks associated with subacromial decompression. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Some of the possible surgical risks for subacromial decompression include:
- Adverse and unexpected reaction to the the anaesthetic (or other medications)
- Blood clots, such as deep vein thrombosis (DVT)
- Accidental damage to surrounding structures (blood vessels, nerves, other soft tissues etc.)
- Fracture of the shoulder blade (if too much bone is removed from the shoulder blade)
Rehabilitation and physical therapy after athroscopic subacromial decompression surgery
Each surgeon and physical therapy rehabilitation team will have their own prescribed rehabilitation program after subacromial decompression surgery. However, provided that the surgery did not involve a repair of the rotator cuff, most surgeons and therapists are keen to get their patients shoulder moving and back to normal using some careful exercises. This usually involves a progression from wearing a sling through to active strengthening exercises. Patients are usually advised to:
- Wear a sling initially (maybe only a couple of days or a couple of weeks depending on your doctors orders).
- Other symptom management techniques (such as use of ice to minimize post-operative pain and swelling)
- Passive exercises to increase the range of shoulder movements (without using your own shoulder muscles)
- Then active exercises to increase the range of shoulder movements and begin strengthening key muscles.
Your surgeon and / or therapy team will usually be able to provide you with the specific exercises you are required to do, before the day of surgery.
Expected recovery after subacromial decompression surgery
In the immediate post-surgery period most patients experience substantial pain and discomfort for several days or more. However, this usually improves quite quickly and by the six week mark a return to most usual daily activities is allowed. The six to twelve week post surgery period is important for regaining strength and function in the arm. Some patients will have a speedier recovery, while others will take longer. Recovery after an arthroscopic subacromial decompression surgery tends to be quicker than most other surgical procedures for the shoulder (such as a rotator cuff tendon repair).