Surgery for Impingement Syndrome, Subacromial Decompression

ExitCare ImageSubacromial decompression surgery is for patients with rotator cuff tendinitis, subacromial bursitis (inflamed fluid filled sac between the shoulder joint and top of the shoulder blade), or impingement syndrome (inflamed rotator cuff tendons, due to pinching). Surgery is for patients with continued shoulder pain, despite at least 3 months of rehabilitation treatment. The shoulder pain is so severe that it affects patients' daily activities or greatly decreases their quality of life. Patients who will benefit most from surgery are those whose shoulder bone (acromion) has a curve, hook, or bump (spur), or those who have a partial rotator cuff tear. There are 3 purposes of surgery. First, the inflamed bursa is removed. Second, the shoulder bone defect (curve, hook, spur) is removed. Third, the coracoacromial ligament is cut. This surgery is intended to reduce pain, by increasing space in the area, so that the rotator cuff is less likely to be pinched.

REASONS NOT TO OPERATE

  • Infection of the shoulder joint.

  • Patient is unable or unwilling to complete the postoperative program. This includes keeping the shoulder in a sling or immobilizer (if open surgery is performed), or performing the needed rehabilitation.

  • Emotional or psychological conditions that contribute to the shoulder condition.

  • Patients who have rotator cuff inflammation due to other causes. This includes impingement caused by shoulder instability, weak shoulder blade muscles (scapula), shoulder arthritis, stiff or frozen shoulder, or a large os acromionale (failure of the shoulder bone growth plates to fuse properly).

RISKS AND COMPLICATIONS

  • Infection.

  • Bleeding.

  • Injury to nerves (numbness, weakness, paralysis).

  • Continued or recurring pain.

  • Detachment of the deltoid shoulder muscle (if open surgery is performed).

  • Stiffness or loss of shoulder motion.

  • Decrease in athletic performance.

  • Shoulder weakness.

  • Fracture of the shoulder bone.

  • Pain in the joint connecting the shoulder bone and collarbone.

  • Removal of too much or too little shoulder bone.

TECHNIQUE

Technique used may vary between surgeons. In general, the surgery is performed with a flexible tube and tools inserted in a few small slits near the joint (arthroscopic). It may also be completed through an open cut (incision). The goal of the procedure is to remove the bursa, remove the shoulder bone deformity, and cut the coracoacromial ligament. Electricity will be used to sear the small capillaries (cauterize), to stop small amounts of bleeding. Other tools used are an electric or motorized shaver, to remove the bursa, and a small power drill (burr) to remove the deformity of the shoulder bone.

If the procedure is completed with an open incision, the surgeon will detach the deltoid shoulder muscle from the shoulder bone and cut the coracoacromial ligament. The deformity of the shoulder bone is then removed, using a saw or chisel (osteotome). A file (rasp) may be used to smooth the edges. Finally, the bursa is removed with scissors, and the deltoid muscle is reattached to the shoulder bone.

HOME CARE INSTRUCTIONS

  • Postoperative care depends on the surgical technique used (arthroscopic or open).

  • Follow the instructions given to you by your surgeon.

  • Keep the wound clean and dry for 10 to 14 days after surgery, especially if open surgery is performed.

  • Wear a sling, brace, or immobilizer as prescribed by your surgeon. This often lasts a couple days for arthroscopic procedures, or 6 to 8 weeks for open procedures, because the deltoid muscle must heal.

  • You will be given pain medicines by your caregiver or surgeon. Take only as much medicine as you need.

  • You may be advised to perform motion exercises immediately after surgery. These may be performed at home or with a therapist.

  • Postoperative rehabilitation and exercises are very important to regain motion, and later, strength.

RETURN TO SPORTS

  • 6 weeks is the minimum waiting time required before returning to play. Open procedure surgeries are often longer.

  • Return to sports depends on the type of sport and the position played.

  • A therapist must assess your strength and range of motion before athletics may be resumed.

SEEK MEDICAL CARE IF:

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • Signs of infection (headache, muscle aches, dizziness, a general ill feeling with fever).

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

Do not eat or drink anything before surgery. Solid food makes general anesthesia more hazardous.