Arthroscopic Subacromial Decompression is a relatively non-invasive procedure for the treatment of Subacromial Impingement Syndrome. Shoulder surgery has changed dramatically over the past decade. With the introduction of arthroscopic surgical techniques for shoulder pathology, minimal pain and rapid recovery have become the major benefits.
Some conditions which have been successfully treated are:
- Labral Tears
- Shoulder Instability
- Adhesive Capsulitis
- Subacromial Impingement
Subacromial Impingement is a condition where the rotator cuff tendon is pinched between the humeral head and the undersurface of the acromion. There are various causes for this condition (see Subacromial Impingement Syndrome). However, if after a course of conservative treatment, consisting of anti-inflammatory medication and physical therapy, your symptoms do not improve, Arthroscopic Subacromial Decompression may be the next step in your treatment.
Arthroscopic subacromial decompression is most commonly performed on an out-patient basis. Depending on the patient’s medical condition, and with the input of the anesthesiologist, a general anesthetic, or shoulder block (local anesthesia) will be employed to control pain during the procedure. Prior to your surgery, pre-operative blood testing will be obtained. In addition, approximately one week prior to surgery, all anti-inflammatory medications (such as aspirin, motrin, etc.) should be discontinued in order to reduce bleeding during surgery.
A number of small incisions will be made around the shoulder to gain entry into the joint. Utilizing an arthroscope and video camera, the doctor visualizes the structures inside the shoulder and confirms the diagnosis of subacromial impingement. One of the added benefits of direct visualization of the shoulder joint is that any unexpected pathology can be identified and dealt with at the time of surgery.
After the diagnostic portion of the surgery is completed, a number of highly specialized “micro motorized” instruments are inserted into the subacromial space and the bone from the underside of the acromion is removed. The bone removal is completed when the tendons of the rotator cuff are free to glide between the humeral head and the acromion without pinching or catching on the bone.
Acromial bone spur
Bone spur removed and coraco-acromial ligament (CA ligament) cut
Anerve blockis used during the operation which means that immediately after the operation the shoulder and arm may feel numb. This may last a few hours. After this the shoulder may well be sore and you will be given painkillers to help this whilst in hospital. These can be continued after you are discharged home. Ice packs may also help reduce pain. Wrap frozen peas or crushed ice in a damp, cold cloth and place on the shoulder for up to 15 minutes. In order to maintain a dry wound cover the dressing / wound with some cling film before applying the ice pack.
This is a keyhole operation usually done through two or three 5mm puncture wounds. There will be no stitches only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.
WEARING A SLING
You will return from theatre wearing a sling and/or Cold compression wrap. This is for comfort only and should be discarded as soon as possible (usually within the first 2 to 4 days). Some people find it helpful to continue to wear the sling at night for a little longer if the shoulder feels tender.
- Sleeping can be uncomfortable for a while if you try and lie on the operated arm. We recommend that you lie on your back or on the opposite side, as you prefer. Ordinary pillows can be used to give you comfort and support.
- If you are lying on your side one pillow slightly folded under your neck gives enough support for most people.
- A pillow folded in half supports the arm in front and a pillow tucked along your back helps to prevent you rolling onto the operated shoulder during the night.
- If you are lying on your back, tie a pillow tightly ion the middle (a “butterfly pillow”) or use a folded pillow to support your neck. place a folded pillow under the elbow of the operated arm to support that.
Some degree of discomfort is common after surgery. You should not have to ‘put up’ with pain. You will be given painkillers and anti-inflammatories from the hospital. The Cold compression wrap also helps reduce inflammation and pain.
You may begin driving when you feel able to handle a steering wheel easily with both arms. You should be able to get your arm above shoulder level comfortably and manipulate objects at this level. For most patients this is usually about one week after surgery. If you are unsure, check with your therapist and/or surgeon.
RETURNING TO WORK
This will depend on your occupation. If you are in a sedentary job you may return as soon as you feel able usually after one week. If your job involves heavy lifting or using your arm above shoulder height you may require a longer period of absence.
You should avoid sustained, repetitive overhead activities for three months. With regard to swimming you may begin breaststroke as soon as you are comfortable but you should wait three months before resuming front crawl. Golf can begin at six weeks. For guidance on DIY and racquet sports you should speak with your physiotherapist.
FOLLOW UP APPOINTMENT
A follow up appointment will be made for approximately three weeks after your operation. The amount of physiotherapy will depend on your individual needs.
This is variable. However experience shows us that by 3 weeks movement below shoulder height becomes more comfortable. By this stage you should have almost full range of movement although there will probably be discomfort when moving the arm above the head and when lying directly on your shoulder.
At three months after your surgery your symptoms should be approximately 80% better. It can take 6 to 9 months to fully recover and you will continue to improve for up to a year following the procedure.
Physiotherapy is essential after the operation, to encourage good movement, help with pain management and rehabilitate the muscles back to normal function. You will need to see a therapist within 2 weeks of the surgery. This should be arranged in advance of the surgery.