Arthroscopic subacromial decompression

Arthroscopic subacromial decompression

What is the aim of this surgery? The aim of this surgery is to remove just enough bone from the front and underside of the acromion (part of the shoulder blade) in order to prevent the bone digging into, or “impinging”, on the underlying rotator cuff tendons when the arm is elevated. The intended benefit is that you will experience an improvement or resolution of your impingement symptoms.

Who might benefit from this procedure? This surgery is typically recommended when non-operative measures such as steroid injections and physiotherapy, have failed to provide satisfactory relief for impingement symptoms, or is carried out during arthroscopic rotator cuff repair. When it is carried out during rotator cuff repair, it is done primarily to increase the working space for the surgery, to enable clear vision and unimpeded access to all areas of the shoulder.

Will I need to stay in hospital overnight? No, not usually. The surgery is typically done as a day case procedure under general anaesthetic with a supplementary nerve block (see other information regarding what to expect before surgery)

What does the procedure involve? A full keyhole (arthroscopic) assessment of your shoulder joint will first be carried out to exclude any problems within the joint itself that could have caused your symptoms. The camera will then be moved into the subacromial space, which is the space above the rotator cuff tendons. The bursa, which is a fluid filled membrane that glides between the ball of the shoulder and the acromion and can often be inflamed, will be removed with a shaver device. A high-speed rotating burr will then be used to remove a small amount of bone from the underside of the acromion (part of the shoulder blade). The rotator cuff tendons will then be inspected to look for any tears, the majority of which should have been picked up on your MRI scan prior to the surgery. If necessary, a repair of the tendon may be carried out, which will be performed at the same sitting

What are the chances of an improvement in my symptoms? The operation has a high chance of success, between 80-90%. Full benefit from the surgery will take at least 3-6 months and even longer than this potentially.

What can I expect after surgery? – Your shoulder will be sore, but is not usually very painful after the first few days. Some discomfort usually persists for at least 3 months after the surgery, since there is a raw bone surface that needs to heal. During the first 3 months after surgery, therefore, it is best to avoid any repetitive overhead activity or to lift anything to heavy, in order prevent aggravation of your shoulder and setbacks to your progress. A sling is not usually required for any more than a few days after the surgery and movement is as pain allows. Physiotherapy after the surgery is essential in order to restore a good range of motion. Most patients will achieve 80% of their final range of motion at 6 weeks after the surgery, and full range at 3 months following the surgery.

What are the potential complications or risks associated with this surgery?

Bleeding/bruising: Bleeding is typically minimal and occurs in the first couple of days after the surgery. This may necessitate a change of dressings if they come loose. Bruising can be significant but eventually will go away and does not cause any long term problems.

Infection: This is very rare with keyhole procedures and happens in less than 1 in 1,000 procedures. However, it is a potentially serious complication when it does happen. Usually the infection is superficial involving the keyholes and will settle with antibiotics but if it is a deeper infection, this will require further surgical procedures to wash out the shoulder.

Stiffness/frozen shoulder: The risk of developing a frozen (stiff, painful) shoulder after subacromial decompression surgery is significant. Research has found as many as 5% (1 in 20) of patients will develop a frozen shoulder after the surgery. This may necessitate further procedures, such as steroid injections or more invasive procedures such as an arthroscopic capsular release (see relevant information page on this procedure). In order to reduce the risk of developing a frozen shoulder, it is important to engage with the physiotherapy programme, and to avoid doing “too much too early” with your shoulder. Even despite these measures however, the risk of a frozen shoulder is still present.

Persistent pain: The causes of this may include a frozen shoulder, complex regional pain syndrome, or failure of the operation to achieve the intended result.

Blood clots in legs or lungs: These complications are very rare (less than 1 in 1,000) in keyhole shoulder surgery, but if you have a susceptibility to blood clots you will be given a blood thinning injection prior to discharge from the hospital as a precaution.

Anaesthetic risks: Modern anaesthesia is usually very safe, but there are small risks associated with general anaesthetics including airway problems and unexpected allergic reactions. There are separate risks associated with receiving the nerve block. The anaesthetist will be able to go through these risks with you prior to the operation.

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