Shoulder subacromial decompression surgery
Subacromial decompression of the shoulder may be considered as a surgical treatment option for those patients who have not responded to conservative (non operative) treatment and have an identified impingement of the rotator cuff tendons and subacromial bursa in the shoulder joint. These patients despite receiving treatment such as anti inflammatory medication, steroid injection, physiotherapy and activity modification continue to experience ongoing shoulder pain and dysfunction that impacts on their ability to do their usual daily tasks, leisure pursuits and work duties. The aim of shoulder subacromial decompression surgery is to minimise shoulder pain and restore shoulder function such as range of motion and strength. This allows patients to return to their usual activities and improve their quality of life.
Subacromial impingement is the most common cause of shoulder pain. It may be caused by a number of pathologies of the shoulder including tendonopathy (inflammation of the rotator cuff tendons of the shoulder), bursitis (inflammation of the bursa in the subacromial space), rotator cuff strain, rotator cuff partial or full thickness tear, and calcific tendonitis. When the arm is raised to shoulder height the rotator cuff tendons glide underneath the bursa (sac filled with fluid) that cushion the tendons from a part of the shoulder blade called the acromion. The acromion can develop a bony spur that encroaches on the subacromial space. Impingement occurs when the acromion spur pushes against the bursa and/or rotator cuff tendons when the arm is elevated and this causes inflammation and pain.
Subacromial decompression of the shoulder in most cases is performed arthroscopically (‘key hole’). This enables Dr Prodger to view the shoulder joint internally and inspect the soft tissues such as the rotator cuff tendons, biceps tendon, ligaments and muscles. This allows Dr Prodger to identify any pathology that was not evident on an MRI scan or ultrasound. Dr Prodger can then repair any identified pathology at this time and then smooth off the acromion spur to provide greater space for the bursa and tendons to glide when the arm is elevated to minimise the impingement on the rotator cuff.
Frequently Asked Questions
The aim of shoulder subacromial decompression surgery is to minimise shoulder pain and restore shoulder function such as range of motion and strength. This allows patients to return to their usual activities and improve their quality of life.
As with all surgery, there are risks, although small. Infection (<1%), nerve damage (rare) and numbness around the scars, and risks of a general anaesthetic as discussed between you and the anaesthetist. The risks and benefits of the procedure, as well as your specific questions, will be discussed if surgery is decided upon with Dr Prodger.
Arthroscopic subacromial decompression for most patients is a day procedure.
If the operation is being done as an open procedure (not through keyholes) as determined by Dr Prodger, a one-night stay is often necessary.
You will be discharged with adequate pain medication and physiotherapy exercises to begin at home.
It is important to keep the dressings clean and dry. If there are any concerns about the wounds or dressings before your first review it is important to contact your GP or Dr Prodger.
Pain management is crucial to a successful recovery and a variety of techniques are used that will be discussed with you by both Dr Prodger and the Anaesthetist before your surgery.
You will be reviewed by a physiotherapist before discharge and given simple exercises to begin. Arthroscopic subacromial decompression only requires the use of a sling for the first few days to help with post-operative pain. You will be given specific instructions by the physiotherapist and Dr Prodger before your discharge from hospital.
This is variable depending on your pathology (what is wrong with your shoulder), length of time you have had symptoms and any rehabilitation or exercise therapy you have had preoperatively. For most the recovery process is over a number of months, and patients find they improve for up to 9-12 months post surgery. Post-operative physiotherapy is very important to maximizing your outcome.
Most patients can return to driving within 2 weeks of an arthroscopic subacromial decompression.
This depends on your occupation. Office workers can return to work as soon as comfortable, this may be within 2-3 weeks. However manual workers often need considerably longer of work, or a graduated return to normal duties, over a period of weeks to months.
Again, this depends on what you wish to do. Overhead activities and sports usually take at least 2- 3 months to return to. Dr Prodger will advise on particular sports and leisure pursuits.
