Shoulder Impingement Surgery (Subacromial Decompression Surgery)

houlder impingement surgery, also known as subacromial decompression surgery or acromioplasty, is an outpatient procedure designed to alleviate pain associated with shoulder impingement, a common condition that causes weakness in the shoulder and pain when the arm is raised above the head. During the surgery, which is typically performed arthroscopically, a physician will decompress the tight space around the rotator tendon. This enables normal, pain-free motion in the shoulder joint.

What Is Shoulder Impingement Surgery?

Shoulder impingement surgery is a minimally invasive arthroscopic procedure. It involves releasing the tight ligament of the coracoacromial arch and shaving the undersurface of the acromion, to create more space for the rotator cuff tendons while reducing swelling of the tendon. By expanding the shoulder joint, the procedure aims to relieve pressure on the soft tissues, remove bone spurs, and clean up the joint to facilitate normal function without compression.

This keyhole surgery is often performed as a same-day procedure for cases unresponsive to conservative measures, such as steroid injections or physiotherapy. While the success rate is approximately 80%, it may take several months to a year for the patient to feel the full benefits and regain optimal shoulder function.

Why Is Shoulder Impingement Surgery Performed?

Shoulder impingement surgery primarily focuses on fixing areas within the subacromial space, such as the coracoacromial arch and acromion bone, which can compress the rotator cuff tendons. By releasing the ligament of the coracoacromial arch and shaving under the acromion, the surgery helps create more room for the tendons to move freely without impingement.

If you are struggling with any of the following issues, you may be a suitable candidate for shoulder impingement surgery:

  • Your condition has not responded to conservative measures such as physiotherapy and steroid injections.
  • You're experiencing persistent shoulder pain, weakness, or difficulty raising your arm above the head.
  • You've been diagnosed with impingement syndrome.
  • You are experiencing structural issues, such as bone spurs or abnormalities in the acromion shape.
  • You have limited range of motion in the shoulder joint due to impingement.
  • You are experiencing rotator cuff problems, such as a torn tendon.
  • You have shoulder instability from a loose shoulder joint or a dislocated shoulder socket.
  • Your shoulder impingement is causing bone growths or inflammation.

A physician may initially suggest conservative treatments to address shoulder pain and inflammation, including over-the-counter NSAIDS or specific stretches. They may also try subacromial joint injections of corticosteroids and anesthetics to alleviate symptoms. However, if your symptoms do not improve after six weeks, it's best to schedule a consultation with an orthopedic surgeon.

How To Prepare For Shoulder Impingement Surgery

To prepare for your shoulder impingement surgery, we encourage you to adhere to the following protocol:

  • Disclose all medications you currently take, including prescriptions, over-the-counter drugs (such as allergy pills or cough syrup), inhalers, patches, vitamins, or herbal remedies. Do not take aspirin or non-steroidal anti-inflammatory medications one week before surgery. Your physician may advise you to stop other medications leading up to your procedure.
  • In order to avoid any complications with anesthesia, consult with your surgeon on what to eat and drink before your visit. Refrain from eating or drinking anything after midnight the day before surgery. If you are unable to follow the given instructions, you may have to postpone your surgery.
  • Prepare your home to aid daily activities after surgery, using the arm and hand on the non-surgical side.
  • Wear an oversized button-up shirt so you don't have to pull your shift over your head.
  • Contact a friend or relative to drive you home from the hospital following your procedure since you may still feel the effects of anesthesia.
  • Complete all pre-operative tests or lab work prescribed by your physician and schedule a time to talk about the ins and outs of the procedure.

What Happens During Shoulder Impingement Surgery?

Shoulder impingement surgery aims to create additional space beneath the acromion, a substantial bony projection on the shoulder blade. The surgery, conducted under general anesthesia, uses arthroscopy: a slender tube equipped with a camera inserted through small incisions. This innovative approach allows the surgeon to visualize the interior of the shoulder joint. Your physician will insert surgical instruments through the incisions, including a shaver, to gently remove excessive bone and tissue from the underside of the acromion.

The surgery typically lasts about an hour. If necessary, repairs, such as addressing rotator cuff tears, shaving down bone growth, and managing shoulder instability, may be performed through additional small incisions. The surgeon will close the incisions with sutures or staples, and cover them with a dressing (bandage). Postoperative care involves monitoring the healing process until the sutures or staples are removed.

Are There Risks Associated With Shoulder Impingement Surgery? 

Before you undergo shoulder impingement surgery, review the following risks that may occur:

  • Allergic reactions to medications or anesthesia. Consult with your anesthetist to discuss any potential issues.
  • There is a small risk of infection from the incisions made during surgery.
  • Excessive bleeding or blood clots near the injection area.
  • Shoulder stiffness, worsened pain, or frozen shoulder, which only occurs in around 1% of cases.
  • A small risk of damaged nerves or blood vessels around the shoulder, typically less than 1% of cases.

Post Shoulder Impingement Surgery & Recovery

After surgery, you will be taken to a recovery area where you will wait for your anesthesia to subside. You can typically go home on the same day of surgery. However, it's essential to coordinate with a friend or family member who can take you home, since you could still potentially feel the lingering effects of the anesthetic.

Your shoulder may feel sore and stiff following surgery. Use ice and anti-inflammatory medication to reduce swelling. Your doctor may also prescribe medication to alleviate pain and a small device to wear at home called a local anesthesia infusion device (LAID).

Recovery typically takes 1 to 6 months, and a physiotherapist will provide you with recommended exercises to improve shoulder mobility and strength. You may also need a sling for a week or two to aid your recovery. Adhere to all guidance your healthcare professionals and physical therapists provide for the best results.

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