Subacromial decompression
Your health expert: Mr Kenneth C K Cheng, Shoulder and Upper Limb Consultant
Content editor review by Rachael Mayfield-Blake, January 2024
Next review due January 2027
Subacromial decompression is an operation on your shoulder to treat a condition called shoulder impingement. Shoulder impingement causes pain when you lift your arm out to the side at, or above, the height of your shoulder. Subacromial decompression is usually done as keyhole surgery (arthroscopy). The operation is sometimes called acromioplasty.
About subacromial decompression
A group of muscles called the 'rotator cuff' surround and support your shoulder. These help you to lift your arm up so you can reach for things above you. The tendons for these muscles lie in a narrow space between the top of your arm bone and the bone at the top of your shoulder blade.
Shoulder impingement, a common type of shoulder pain, happens if lifting your arm puts too much pressure on the tendons. When the tendons press against the shoulder blade above them, this causes pain. You may also find it harder to move your arm.
Shoulder impingement has different causes. These include:
- your tendons getting swollen or torn from overuse (if you’re doing a lot of sports) or ‘wear and tear’ as you get older
- the shape of the bone at the top of your shoulder blade (your acromion), which rubs against your tendons
- getting bony growths (spurs) on your acromion as you get older
Shoulder impingement is usually treated with rest, physiotherapy, and steroid injections first to see if your symptoms ease. But if these non-surgical treatments don’t work, you may need subacromial decompression.
Subacromial decompression surgery will smooth down the surface of your acromion so it doesn’t rub against your tendons. This should ease your pain.
Preparation for subacromial decompression
Your operation will be done by an orthopaedic surgeon (a doctor who specialises in shoulder surgery). They’ll explain how to prepare for subacromial decompression surgery. If you smoke, its best to stop because smoking can slow down your recovery.
The operation is usually done as a day-case procedure, which means you can go home on the same day. You’ll need to arrange for someone to collect you from hospital after your surgery and take you home. And ask someone to be with you for at least the first day after you come home.
You’ll probably have subacromial decompression surgery under a general anaesthetic, so you’ll be asked to follow fasting instructions. This means not eating or drinking for several hours before your surgery. Follow your anaesthetist or surgeon’s advice about how long.
Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed, so that you feel happy to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.
The subacromial decompression procedure
During subacromial decompression surgery, your surgeon will aim to make more space under your acromion so it doesn’t press against your tendons. To do this, they’ll take away some of the bone and tissue.
Subacromial decompression surgery is usually done as a keyhole procedure. This means your surgeon will use a narrow, tube-like telescopic camera called an arthroscope. It’s usually done under general anaesthesia, which means you’ll be asleep during the procedure. You may also be given a local anaesthetic into the nerves around your shoulder. This will help to ease any pain you may feel after your operation.
Your surgeon will put the arthroscope into your shoulder through small cuts in your skin and then look inside your shoulder. They’ll insert surgical instruments to carry out the subacromial decompression procedure. Your surgeon may also decide to repair any damaged tendons at the same time. This may mean they have to change from keyhole surgery to an open operation and will make a larger cut in your shoulder.
At the end of the operation, your surgeon will remove the surgical instruments and close the cuts, usually with stitches.
Aftercare following subacromial decompression
You’ll need to rest until the effects of the anaesthetic have worn off. Let your hospital team know if you’re in pain. They’ll offer you pain relief to help with any discomfort as the anaesthetic wears off.
You’ll usually be able to go home when you feel ready. You’ll need someone to drive you home, and ask a friend or relative stay with you for the first 24 hours.
Having general anaesthesia can affect your co-ordination and reasoning skills for a short time. So, don’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. Always follow your surgeon’s advice.
Before you leave hospital, you’ll be given advice about caring for your wounds and tell you what to do about any stitches you have. Your stitches may be taken out after eight to 10 days. You may need to keep your arm in a sling for 24 hours after your operation, sometimes longer.
Your shoulder joint is likely to feel sore and stiff for a while. If you use a cold compress, such as an ice pack or a bag of frozen peas wrapped in a towel, it may help to reduce swelling (if you have it). Don’t put ice directly onto your skin because it can damage it.
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. If you have any questions, ask a pharmacist.
Recovery following subacromial decompression
The subacromial decompression recovery time is usually three to four months to make a full recovery.
If you work, you’ll need to take some time off after your surgery, depending on your job – your surgeon can advise you how long. You may need to avoid heavy lifting for around two to three weeks. Follow your surgeon’s advice about going back to work and getting back to your usual activities.
You’ll usually see a physiotherapist after your operation. It’s important to do the exercises that your physiotherapist or surgeon recommends as these may help to stop your shoulder getting stiff. You’ll have exercises to do at home and you may also be offered a few sessions with a physiotherapist. These exercises may:
- stretch the muscles around your shoulder
- help you move your shoulder more easily
- make the muscles around your shoulder stronger
You’ll usually be advised to keep doing exercises for three to four months after your procedure as part of your subacromial decompression recovery. But it’s important to continue doing exercises to prevent the problem happening again.
Side-effects of subacromial decompression
You may have some side-effects after subacromial decompression.
You may have some swelling and bruising, as well as pain and stiffness around your shoulder after surgery. This may make moving around uncomfortable at first.
Complications of subacromial decompression
Possible complications of subacromial decompression include:
- an unexpected reaction to the anaesthetic
- a blood clot in the veins of your leg (deep vein thrombosis – DVT)
- a lot of bleeding (a haemorrhage)
- an infection
- accidental damage to the tissues around your shoulder joint, including nerves or blood vessels
- stiffness in your shoulder (a frozen shoulder) – this usually gets better but may need further surgery
Ask your surgeon about possible complications and how likely they are to affect you.
If you get any of the following symptoms, contact your hospital immediately. Sepsis is a life-threatening complication that can develop if you get an infection. Sepsis is a medical emergency. Call 999 or go to A&E immediately if you have any of the following symptoms.
- Slurred speech, confusion, difficulty making sense.
- Extreme shivering or muscle pain.
- Passing no pee (urine) during a day.
- Severe difficulty breathing, feeling breathless, or breathing very fast.
- It feels like you’re going to die.
- Skin changes, such as your skin looking blue, pale or blotchy, or a rash that does not fade when you roll a glass over it.
Alternatives to subacromial decompression
Shoulder impingement symptoms can often be eased with:
- self-help treatment, including rest and avoiding painful movements
- painkillers (such as paracetamol or non-steroidal anti-inflammatory medicines)
- physiotherapy
- steroid injections
Your surgeon will usually only recommend you have subacromial decompression if other treatments haven’t worked. Ask your surgeon to explain why they feel it’s the best option for you.
Looking for physiotherapy?
You can access a range of treatments on a pay as you go basis, including physiotherapy.
To book or to make an enquiry, call us on 0370 218 6528∧
Subacromial decompression is used to treat shoulder pain caused by shoulder impingement, which means your arm hurts when you lift it.
See our about subacromial decompression section for more information.
It may take you up to four months to recover fully from subacromial decompression. But you should be able to get back to some of your usual activities after a few weeks.
See our recovery from subacromial decompression section for more information.
Your shoulder may feel a bit stiff and sore after your surgery, but over-the-counter painkillers should help to ease any pain.
See our
See our recovery from subacromial decompression section for more information.
Shoulder arthroscopy
Rotator cuff injury
A rotator cuff injury is when you have inflammation or a tear in the muscles and tendons (connecting tissue) in your shoulder.
Frozen shoulder
Physiotherapy
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