What is a Subacromial Decompression?
Subacromial decompression, also known as anterior acromioplasty, is an operation that involves removing a small section of bone from the shoulder. The aim of the procedure is to increase the space for the rotator cuff tendons to glide.It is generally performed arthroscopically – that is, small incisions are made around the shoulder to allow access for a camera and specialised surgical instruments. This is otherwise known as keyhole, or minimally invasive, surgery.
Who is this operation for?
Subacromial decompression is performed for patients suffering from shoulder impingement, who haven’t responded to conservative management.
Shoulder impingement is a condition whereby the tendons of the rotator cuff don’t have enough room to freely glide within the shoulder. At the shoulder, the rotator cuff tendons travel through a rigid arcade made of bone. Sufferers of shoulder impingement have an arcade that is too small for their rotator cuff tendons, so they experience pain, stiffness and/or weakness when they use the affected shoulder. In other words, it is due to the bones in the shoulder ‘impinging’ on the rotator cuff tendons.This condition can affect young people and older people alike, especially those who are involved in sports demanding repetitive overhead work.
What are the benefits of the operation?
The main benefit of the surgery is that it should improve the pain associated with shoulder impingement.
Risks of not having the surgery
Continued pain
Progression to rotator cuff tears
Complications
The incisions made for subacromial decompression are very small, so complications are uncommon.
As with any surgery, there are some risks, which include:
- Problems with anaesthetic
- Shoulder stiffness
- Injury to nerves: The musculocutaneous and axillary nerves are most at risk in this procedure. Injury to these nerves may cause pain or loss of sensation in the shoulder or forearm, or weakness of part of the arm. Injury to these nerves are uncommon, and the effects are often temporary, though they may be permanent.
- Injury to bone: rarely too much bone is removed from the shoulder
- Injury to the soft tissues in and around the shoulder joint: This may result in pain or instability in the joint. Again, the risk of this occurring is low.
- Infection: With any surgical procedure, infection is a risk. However, with the small incisions made with shoulder arthroscopy, infections are very rare.
- Damage to blood vessels: This is a very rare complication.
For more information on complications that can occur in any surgery, see Complications of Surgery.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- Shoulder x-ray
- Shoulder ultrasound
- Shoulder MRI
- Blood tests
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Get some help from your friends and family
Whilst recovery from this operation is generally quite fast, you will not be able to use that arm very well during the healing process. You may wish to organise some help from family or friends in daily tasks, such as cooking and driving in the first week or so after the operation.
About the Operation
This is generally performed as a day procedure, so you come into hospital in the morning and go home the same day.
Subacromial decompression is performed under a general anaesthetic, so you won’t be awake during the procedure. Local anaesthetic is sometimes used in addition to this to reduce pain.
Generally only 2 incisions are required for this procedure both of which are no more than a few centimetres long. The surgeon uses one of the incisions to insert the camera (arthroscope) into the shoulder, and assess all of the structures inside the joint. A burr is then used to remove approximately 4mm of bone from the acromion, the part of the scapula bone that impinges on the rotator cuff tendons.
Once the operation is finished, the incisions are stitched closed.
After the Operation
After the operation, you are cared for in the Theatre Recovery room. You will usually only spend 1-2 hours in the recovery room.
Most people wake up fully when back in their rooms on the ward. Whilst on the ward, the nurses will take care of your every need. It usually takes a few hours to recover fully from the anaesthetic, and the nurse with regularly check on your recovery.
What about pain?
At this stage, anaesthetic from the operation will still be having an effect. Your ward doctors and nurses can also prescribe additional pain-relief as needed (see Post-Operative Analgesia), however arthroscopy is generally only minimally painful.
Recovery and Rehabilitation
You will be encouraged to start using the affected shoulder from day 1 after the operation. These will involve passive and active assisted exercises that will have you moving your shoulder in different planes.
The aim is for you to have full range of motion in your shoulder by 6 weeks. After this, you will be encouraged to do shoulder strengthening exercises, leading up to repetitive overhead exercises 3 months after the operation.
F.A.Q.s | Frequently Asked Questions
What are the alternative treatments to having a Subacromial Decompression?
Are there important things I need to tell my doctors?
- Redness, swelling or warmth around the cut
- Leakage from the cut
- Fever and chills.
- Severe shoulder pain that is not relieved by prescribed painkillers.
- Further surgery planned for the future i.e. dental work, bladder catheterisation, examinations of the bowel, bladder, rectum or stomach.