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Subacromial Decompression

Definition

A shoulder decompression is the removal of soft tissue and sometimes removal of some bone in the shoulder.

Shoulder Anatomy
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Reasons for Procedure

The shoulder is made of the head of the upper arm bone, the acromion process (top projection of the shoulder blade), and the collarbone. There is a space between the upper arm bone and acromion process call the subacromial space that allows the shoulder to move freely. Several muscles, ligaments, and tendons pass through this space to help stabilize and move the shoulder. A fluid filled sac called the bursa also sits in this space.

The soft tissue that passes through the acromial space can get pinched between the bones of the shoulder. Overtime, the pinching causes wear and swelling of this tissue. The swelling decreases the size of the acromial space and makes it painful to move. This is called impingement syndrome.

Shoulder decompression is done to treat impingement syndrome that has not responded to other treatment such as exercise and medication. The surgery will help to decrease pressure on soft tissue, decrease pain, and increase shoulder function.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Wound healing problems
  • Adverse reaction to anesthesia
  • Excess bleeding
  • Shoulder stiffness
  • Injury to surrounding structures like the nerve, blood vessels, and shoulder joint

Smoking, drinking, and chronic diseases may increase the risk of complications. Talk to your doctor about these and any risks before the procedure.

What to Expect

Prior to Procedure

To make sure you are ready for surgery, your doctor may do the following:

  • Physical exam and medical history
  • Blood tests
  • Imaging studies to evaluate the shoulder

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 2 weeks before the procedure.

Before the procedure, you should:

  • Arrange for a ride home from the hospital.
  • Arrange for help at home as you recover.
  • Eat a light meal the night before your surgery. Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Talk to your doctor if you take any medications, herbs, or supplements.

Anesthesia

Local anesthesia will be used to numb the area. General anesthesia will also be used. You will be asleep during surgery.

Description of the Procedure

Most procedures are done using a special tool called an arthroscope . An arthroscope is a flexible tube with a light at the end and a camera. In arthroscopic surgery, at least two small incisions are made in the shoulder. The arthroscope will be inserted through an incision and into the shoulder joint. The surgeon can view the inside of your shoulder on a monitor. An open procedure may be needed if your case is more complicated. This will require a larger incision so your surgeon can directly see the shoulder.

The shoulder joint is carefully examined. The surgeon will look for problems that may not have been visible in imaging studies. Damaged or inflamed soft tissue will be removed and/or cleaned up. This may include parts of ligaments and the bursa. The underside of the acromial bone may also be shaved to help increase the subacromial space. Bone growths, like bone spurs, will be smoothed out.

Incisions will be closed and bandaged.

How Long Will It Take?

About 1 hour

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Post-procedure Care

Your shoulder will be sore after the procedure. It will take 3-6 months for you to recover fully.

At the Care Center

Right after the procedure, the staff may:

  • Administer pain medications
  • Place a cold pack on your shoulder to reduce swelling and pain

At Home

Exercises are an important part of recovery. Your doctor will refer you to a physical therapist. You will be taught exercises to promote movement and restore muscle strength.

You may need to make some lifestyle changes during recovery:

  • Do not drive until you feel able to handle a steering wheel easily with both arms. If you are unsure, check with your doctor.
  • You will need to stay out of work at least one week. If your job involves heavy lifting or using your arm above your shoulder, you may need to stay out of work longer.
  • Avoid overhead activities for three months or as advised by your doctor.

Call Your Doctor

Call your doctor if any of these occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision sites
  • Numbness or tingling in the arm, shoulder, or hand

If you think you have an emergency, call for medical help right away.

RESOURCES

Ortho Info— American Academy of Orthopaedic Surgeons  http://www.orthoinfo.org 

Sports Med—American Orthopaedic Society for Sports Medicine  http://www.sportsmed.org 

CANADIAN RESOURCES

Canadian Orthopaedic Association  http://www.coa-aco.org 

Canadian Orthopaedic Foundation  http://www.canorth.org 

References

Arthroscopic shoulder decompression. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/orthopaedics-rheumatology/treatments-procedures/arthroscopic-shoulder-decompression. Accessed November 13, 2017.

Arthroscopic subacromial decompression. Shoulder Doc website. Available at: http://www.shoulderdoc.co.uk/article.asp?section=11. Accessed November 13, 2017.

Impingement syndrome. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/orthopaedics-rheumatology/diseases-conditions/hic-impingement-syndrome-of-the-shoulder. Accessed November 13, 2017.

Shoulder impingement/rotator cuff tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00032. Updated February 2011. Accessed November 13, 2017.

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