A subacromial decompression, also known as Acromoplasty is an arthroscopic surgical procedure carried out to treat shoulder impingement.
Shoulder impingement, sometimes called Subacromial pain syndrome is a common cause of shoulder pain which occurs when the tendons or bursa in the shoulder repeatedly rub against the bone, causing pain and inflammation. It is often referred to as ‘swimmer’s shoulder’ since it is very common in swimmers; however, it also affects athletes who repetitively use the shoulders, such as baseball and tennis players. It can also affect those who frequently perform heavy lifting overhead such as construction workers. Other risk factors can include bone and joint abnormalities.
The aim of subacromial decompression is to regain pain free, full range of motion at the shoulder joint.
How is the Procedure Performed?
Subacromial decompression surgery involves removing the inflamed or tight structures and shaving away small amounts of bone, to leave a smooth wide space.
You will be given either a general anaesthetic or a combination of a nerve block and light sedation. If you have a general anaesthetic you will be asleep throughout the procedures whereas if you have a nerve block, you will not feel any pain during surgery, but maybe a slight pulling sensation.
The surgery is usually carried out arthroscopically, i.e. keyhole surgery and involves making small incisions around the shoulder, usually around 3. A tube is then inserted into the first hole where fluid is pumped to expand the shoulder joint in order for the surgeon to see better and have greater access to the acromion. The arthroscope, which is a narrow flexible tube with a tiny camera attached is fed in through the second hole to allow the surgeon to see inside. They can either see directly through the camera, or by projecting the image onto a screen in the operating theatre. Specially designed surgical instruments are then inserted into the third hole to remove any problem areas of bone and soft tissue that are found.
Subacromial decompression may also include one or all of the following:
The coracoacromial ligament is cut and removed if it is tight and contributing to the shoulder impingement.
The subacromial bursa is removed if it has become inflamed.
Any protruding bone on the acromion is shaved away to increase the subacromial space.
Any other damage which is identified during the procedure, such as a rotator cuff tear, will be repaired at the same time, in order to avoid further surgery.
In some instances, subacromial decompression may need to be carried out as an open surgery rather than arthroscopically. This will require a larger incision in order for the surgeon to see and access the joint directly.
Once surgery is complete, the excess fluid will be drained from the joint, the instruments removed and the incisions closed and dressed.
The surgery is usually carried out as a day case procedure, so it is unlikely you will need to stay in hospital overnight. However, if there are any complications or your surgery was more extensive than initially expected, your surgeon may recommend you stay until you are fit to go home.
Recovery times for subacromial decompression surgery can vary, but the majority of patients find the most improvement within 3-6 months of the procedure being carried out, although full recovery can take up to a year. Most people can make small shoulder movements fairly early in their recovery, i.e. the patient may be able to eat and dress using the affected arm approximately 2 weeks’ post-surgery, even though full movement has not yet been regained.
Patients who undergo arthroscopic subacromial decompression usually recover quicker than those who have open surgery. Most also report less pain in the initial days following the procedure.
Your recovery process will likely include physical therapy, and a physiotherapist will provide you with a set of exercises that will help reduce swelling and stiffness. You will be shown how you can carry these out at home. As you progress through your recovery, you will be given further exercises to help strengthen the shoulder and improve range of motion.
It is recommended that you avoid driving for 4-6 weeks, or until you feel you can comfortably steer and control the car. Check with your insurance company that there are no restrictions with you driving after undergoing surgery. With regard to work, this will depend on the physical nature of your job. If your job is office based, you can usually return within 1-2 weeks of surgery; however, if your role requires you to undertake heavy lifting or working with your arm above your head, you will likely need 6 weeks to recover; in some cases, longer. You may need to modify your activities for the first few weeks, although your doctor or physiotherapist will be able to offer advice on when you can return.
Sports and leisure activities should be reintroduced slowly, with a gradual build up to how much you can do. Be guided by your shoulder and think about your pain levels and strength and movement in your arm. You may not notice any discomfort whilst you are performing a particular activity until the next day, so it is important that you do not push yourself and do too much too soon. You should avoid overhead activities such as racket sports and particular swimming strokes for a minimum of 3 months after your surgery. This also applies to certain DIY work such as overhead painting.
Risks and Complications
Although subacromial decompression is a relatively safe procedure; as with any surgery, there are risks involved. These include:
- Infection (increased risk with open surgery)
- Delayed healing of the wound
- Chronic joint stiffness
- Excessive or prolonged bleeding
- Damage to nerve or blood vessels
- Chronic shoulder pain
One possible complication from open surgery is damage to the deltoid muscle. This muscle facilitates arm movements away from the body, and there is a greater risk of cutting the deltoid with open surgery.
Frozen shoulder is also a risk after subacromial decompression as people can develop notable stiffness after the procedure.
At One Healthcare we can book you in to see a specialist Orthopaedic surgeon for an initial consultation, usually within 48 hours. Shoulder subacromial decompression surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Subacromial Decompression treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance please do contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience
Mr Jai Relwani
Consultant Orthopaedic Surgeon; Clinical Lead - Shoulder & Elbow Service
One Ashford Hospital