Orthosports - Orthopaedic & Sports Medicine Physicians - Arthroscopic Subacromial Decompression

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ARTHROSCOPIC ACROMIOPLASTY

To view an animation of Shoulder Impingement, click here.

To view a video of Arthroscopic Acromioplasty, click here.

Arthroscopic acromioplasty is an operation designed to provide more room for your rotator cuff tendons to move. The acromion is the top part of the shoulder blade which can be felt at the point of the shoulder. Between this bone and the ball of the humeral head runs the rotator cuff tendons which connect important muscles from the scapula (wing bone) to the shoulder joint (humeral head). The procedure involves removing part of the under surface of the bone of the acromion, thereby increasing the subacromial space and reducing the chance of the rotator cuff tendons being rubbed or caught on the acromion itself.

There are times when the operation is needed to be done as an open procedure, which involves a wound over the front of the shoulder, detachment of the deltoid muscle, performing the procedure and then re-attachment of the deltoid muscle. Nowadays this is usually done using 'keyhole' surgery with a series of stab incisions to reduce the chance of weakness which can occur when the deltoid muscle is reattached. The results of the two procedures are very similar but the recovery is usually faster and the post operative period usually less painful using the arthroscopic method.

In most instances you will undergo shoulder arthroscopy first. Structures within the shoulder joint itself are checked and treated as necessary. The rotator cuff tendons are visualised and a decision made as to whether partial or complete tears of these tendons need treatment.

Once the problems within the joint are dealt with the arthroscope is introduced into the subacromial space for inspection of this area. The rotator cuff is again inspected from the top now rather than the bottom and the soft tissue is cleared away from the bone. A mechanised burr is typically used to remove the excessive bone from the under surface of the acromion. This allows free movement of the rotator cuff tendons. Sometimes, once the bone has been trimmed the outer end of the clavicle (collar bone) is seen to protrude into the subacromial space. In these cases and also when the joint between the clavicle and acromion is arthritic, it may be necessary to burr off part of the under side of this bone or completely remove the outer end of the clavicle. If this is done the procedure is obviously bigger and the recovery will be somewhat slower than when an acromioplasty is performed alone. Recovery is still quicker than the open procedure however.

RECOVERY

Maintaining motion prevents scarring in the subacromial space from taking place. In effect, this prevents stiffness from setting in and it is important to achieve a full range of motion as early as possible after the operation. These exercises must begin the day after the operation and the physiotherapist will show you how to do them. If the shoulder does get stiff in the early post operative period it usually does recover but may take a period of months rather than weeks to do so.

Each individual will find a different method of shoulder exercises easier. It does not matter whether you are sitting up or lying down, helping your arm with your other hand or having someone else do this for you. As long as a full range of motion is achieved 5 to 6 times a day the same end result will be achieved. It often takes several weeks for the ache in the shoulder to settle even if you have regained full motion. There is often a clicking or burning sensation in the shoulder and this only subsides when the swelling of the tendons diminishes after approximately 2 months. The shoulder will continue to improve for up to 12 months and you should be patient with this recovery period. The range of motion exercises are usually not supervised by a physiotherapist but an exercise programme will be organised for you at the 5 to 6 week mark which usually requires physiotherapy input.

Until the shoulder really settles completely it is difficult to lie on the affected side, is often painful at night and it is often difficult to use the arm out from the side of the body. Typically this means that driving is not safe.