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Subacromial decompression

Subacromial decompression (acromioplasty) is an operation used to treat subacromial impingement. This is when the bones and tendons in your shoulder rub against each other when you raise your arm.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

If you have subacromial impingement, a bone at the top of your shoulder rubs against the tendons in your shoulder when you raise your arm. This causes pain when you try to raise your arm, and restricts your movement.

There is normally a space between the top of your arm bone and the bone at the top of your shoulder blade, called the subacromial area. A small, fluid-filled sac in this space called a bursa allows the tendons between your upper arm and shoulder to glide freely when you move your arm.

In subacromial impingement, the amount of space between your shoulder blade and rotator cuff tendon is reduced. This may be due to irritation and swelling of the bursa. It can also be caused by the development of growths (bony spurs) on the top of your shoulder blade.

Subacromial decompression can open up this space by removing any swollen or inflamed bursa, and any bony spurs. The operation is usually done as a keyhole procedure using a narrow, flexible, tube-like telescopic camera called an arthroscope.

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Details

  • Preparation Preparing for subacromial decompression

    Your operation will be carried out by an orthopaedic surgeon (a doctor who specialises in bone surgery). He or she will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

    The operation is usually done as a day case, which means you won’t have to stay overnight in hospital.

    Subacromial decompression is usually done under general anaesthesia, which means that you will be asleep during the procedure.

    If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist or surgeon’s advice.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You may be asked to sign a consent form.

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  • Alternatives What are the alternatives to subacromial decompression?

    For some people, subacromial decompression isn’t necessary. Shoulder pain has various causes and the symptoms can often be managed with other options such as:

    • self-help treatment
    • physiotherapy
    • non-steroidal anti-inflammatory medicines
    • steroid joint injections

    Your surgeon will usually only recommend you have subacromial decompression if other treatments haven’t worked for you.

  • The procedure What happens during subacromial decompression?

    Subacromial decompression can take around an hour, depending on how complicated your operation is.

    Once the anaesthetic has taken effect, your surgeon will make small cuts in the skin around your shoulder.

    Your surgeon will look at your shoulder joint, either directly through the arthroscope, or at pictures sent from the arthroscope to a monitor. He or she will insert specially designed surgical instruments through the small cuts and reshape this part of your shoulder blade. Your surgeon may also decide to repair any damaged tendons at the same time, such as your rotator cuff tendon. This may mean your surgeon has to change from keyhole surgery to an open operation and will make a larger cut in your shoulder. See our FAQs for more information.

    At the end of the operation, your surgeon will remove the surgical instruments and close the cuts, usually with stitches.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You may need to keep your arm in a sling for a few days after your operation.

    You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your subacromial decompression.

    If you had general anaesthesia, it can temporarily affect your co-ordination and reasoning skills. Therefore you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

    If your surgeon used dissolvable stitches in your procedure, the time they will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about six weeks.

  • Recovery Recovering from subacromial decompression

    It usually takes between two and four months to make a full recovery from subacromial decompression. However, this varies between individuals, so it's important to follow your surgeon's advice. How long it takes you to recover will depend on a number of things. These include how healthy you are before the operation and how well you keep up with your physiotherapy after the operation.

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

    You may see a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) after your operation. It’s important that you do any exercises that your physiotherapist or surgeon recommends. These may help you to recover more quickly. Your surgeon or physiotherapist will tell you when to start these exercises, and how many to do.

    You may be able to return to work within a few days of your procedure. However, this will depend on how complicated your operation was and the type of job you have. Ask your surgeon for advice about returning to work and other activities.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with subacromial decompression. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

    You may have some pain and stiffness around your shoulder after surgery. This may make moving around uncomfortable at first.

    If you develop any of the following symptoms, contact your hospital immediately as it may indicate you have an infection.

    • Your wound becomes hot, red or swollen.
    • Your wound bleeds or becomes more painful.
    • You have a high temperature.

    Complications

    Complications are when problems occur during or after the procedure.

    The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection.

    A possible complication of subacromial decompression is accidental damage to your shoulder blade or another part of your shoulder joint, including nerves or blood vessels. If your nerves are damaged during subacromial decompression, this may lead to a loss of feeling over your shoulder.

  • FAQs FAQs

    Are there any exercises I can do to help my recovery?

    Answer

    It’s important to follow all the instructions and complete all of the exercises your surgeon and physiotherapist give you.

    Explanation

    Your surgeon or physiotherapist will give you a range of exercises to do after your surgery. It’s important to do these exercises as they will help you to recover more quickly. These may include exercises to:

    • stretch the muscles around your shoulder
    • improve the range of motion of your shoulder
    • improve the strength of your muscles around your shoulder

    Your physiotherapist will tell you when you can start these exercises, and how many you need to do.

    It may take several months after your operation to completely recover. However, you will probably be able to get back to your usual activities after about two to four months.

    I haven't injured my shoulder, so why is it painful?

    Answer

    Shoulder problems aren’t always caused by an injury but can also be caused by wear and tear or other conditions, such as inflammation.

    Explanation

    A number of factors can cause shoulder problems that require treatment with subacromial decompression. These may include:

    • a trauma or injury to your shoulder, such as a fall
    • arthritis
    • swelling and inflammation of the tendons or bursa in your shoulder

    Doing activities that involve repeated lifting or overhead activities, such as painting, swimming or playing golf or tennis are also common causes of shoulder pain.

    If you have pain in your shoulder, talk to your GP who will discuss your treatment options with you.

    Is arthroscopic surgery better for me than open surgery?

    Answer

    Whether you have open or arthroscopic surgery will depend on the problems you’re having with your shoulder and your medical history.

    Explanation

    It’s common for shoulder surgery to be done using an arthroscopic technique. This means your surgeon will make small cuts in your shoulder to pass specially adapted surgical equipment through to repair your shoulder. This may reduce the pain you have after surgery and the length of time you may need to spend in hospital after the operation.

    Open surgery means your surgeon makes a larger cut in your shoulder. This allows your surgeon to see your shoulder blade, rotator cuff muscles and tendons directly. Sometimes your surgeon may have to convert from using arthroscopic surgery to open surgery if your rotator cuff muscles need to be repaired as well.

    Whether you have arthroscopic surgery or open surgery, you’re likely to need the same amount of overall recovery time. The type of physiotherapy you may need will also depend on the cause of your shoulder problems, rather than the type of operation you have.

  • Resources Resources

    Further information

    Sources

    • BESS evidence and consensus based guidelines: subacromial shoulder pain. British Orthopaedic Association. www.boa.ac.uk, published September 2012
    • Holmgren T, Hallgren HB, Öberg B, et al. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ 2012; 344:e787. doi: 10.1136/bmj.e787.
    • Shoulder impingement/rotator cuff tendinitis. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published February 2011
    • Managing rotator cuff disorders. Arthritis Research UK. www.arthritisresearchuk.org, published 2010
    • Shoulder impingement syndrome treatment and management. Medscape. www.emedicine.medscape.com, published 29 November 2012
    • Shoulder arthroscopy. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published April 2011
    • Rehabilitation. Chartered Society of Physiotherapy. www.csp.org.uk, accessed 19 September 2013
    • Shoulder surgery. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published August 2009
    • Coghlan JA, Buchbinder R, Green S, et al. Surgery for rotator cuff disease. Cochrane Database of Systematic Reviews 2008, Issue 1. doi: 10.1002/14651858.CD005619.pub2.
    • Shoulder surgery exercise guide. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published 2007
    • Shoulder pain. Arthritis Research UK. www.arthritisresearchuk.org, accessed 19 September 2013
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, November 2013.

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