What is a Subacromial Decompression

A subacromial decompression is a type of shoulder surgery used to help free up a shoulder impingement or subacomial impingement.  The subacromial space is a narrow gap between the head of the humerus (upper arm bone) and a part of the shoulder blade called the acromion.  One of the rotator cuff tendons runs through this gap, protected from the bone by a bursa which is a fluid filled sac that acts as a buffer, protecting the tendon from wear and tear on the bone as we move our shoulder.

When you lift your arm this gap narrows as the head of the humerus rotates.  Normally, this doesn’t present a problem.

Some movements can cause irritation and inflammation of the tendons and / or bursa causing them to get pinched or impinged as we raise our arm. 

Anyone who makes repetitive overhead movements can aggravate the tendon causing inflammation.  Sports people such as swimmers, tennis players and baseball players can all be susceptible to this condition, known as a shoulder impingement or impingement syndrome.

Sometimes bony spurs can develop on the underside of the acromion, effectively narrowing the gap through which the tendon runs.  Swelling of the tendons or bursa and these bony growths can all cause the subacromial space to narrow resulting in impingement syndrome. 

Shoulder Impingement Surgery

A subacromial decompression is one way of opening up this space by surgically removing part of the bone or bursa to widen the space through which the tendons run.  In the past this has necessitated open surgery with a large incision being made cutting through the deltoid muscle and requiring a lengthy recuperation process.

With advances in modern surgery a subacromial decompression is now  carried out artroscopically, (as an arthroscopic surgery, using keyhole surgery).  Two or three small incisions can be made in the shoulder through which is inserted an Arthroscope.  This is a small camera which allows the surgeon to see inside the joint.  Using miniature surgical instruments the surgeon is then able to remove a small part of the bone to free up the shoulder impingement.

It is normal for the surgeon to inspect the shoulder joint and carry out any minor repairs at the same time as an arthroscopic decompression.  Labral tears  and damage to tendons can often be treated at the same time, reducing the chance of further surgery. 

Arthroscopic shoulder surgery is a relatively simple procedure and te whole procedure takes about an hour.  Although it is carried out under general anesthetic, it is normally seen as day surgery with you being allowed home the same day.
After Subacromial Decompression Surgery.

Once you have recovered from the effects of the general anesthetic you will be allowed home.  It is common to have your arm in a sling for a few days following surgery and you may need pain relief to help cope with soreness from the operation itself.  Use of the sling should be kept to a minimum as shoulder mobility is important in maintaining overall shoulder health and speeding up recovery.

The stitches from the operation will normally dissolve in around six weeks.  It can take anything from two to six months to recover from a subacromial decompression, depending on the severity and type of injury that caused the impingement originally.

One of the most important factors in recovery from shoulder surgery is how quickly you start physical therapy and how well you follow the advice of your physiotherapist.

You will be given gentle exercises to do to start off with, often non weight bearing or low resistance exercises aimed at keeping the shoulder joint mobile to avoid developing a frozen shoulder.  These will gradually increase in resistance and range of movement as your shoulder regains its strength. 

Although it is important to carry out the exercises it is equally as important not to overdo things.  Any movement that causes pain should be avoided.

As with any surgery there is a small risk of possible side effects.  Accidental damage to another part of the shoulder is a possible side effect of any shoulder surgery.  Accidental damage to the shoulder blade or nerves or blood vessels can occur but is rare.  Nerve damage during surgery can lead to a loss of feeling across the shoulder.

Shoulder impingement can come about for a number of different reasons and the majority of people who suffer a shoulder impingement can recover without surgery.  Treatment with NSAIDs (non-steroidal anti-inflammatory drugs) steroid injections into the joint and physiotherapy are usually tried before surgery is considered.  A subacromial decompression is usually only recommended when other treatments have failed to work.

The success rate for this type of operation is very high with over 90% of patients reporting significantly improved shoulder function and pain reduction.
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