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Arthroscopic subacromial decompression and acromioplasty

Overview of the surgery

This procedure is the treatment of choice in those suffering from subacromial bursitis. If the patient has already tried injection and physiotherapy but did not provide a long lasting relief of pain, then this surgery will improve the condition and can give long-lasting relief of symptoms.

The aim is to clear out all the inflamed bursal tissue. Once the bursal excision is done, to prevent further occurrence, the small space between the acromion (part of shoulder blade bone) and the upper end of arm bone is widened. This is done by shaving about 0.5 - 1cm of the shoulder blade bone acromion. Once the space is increased the shoulder movements are passively performed and ensured that there is no more of impingement of tissues in the subacromial space.

Surgical steps

In the past this procedure was done with a large incision in the shoulder joint. Currently it is done through two or three tiny incision of around 0.5cm around the shoulder joint. A tubular camera is first introduced into the shoulder joint to look for any other reason for pain in the shoulder joint. Then the tubular camera is introduced through these small incisions into the space beneath the acromion bone. All inflamed tissue will be excised with the help of 4.2mm wide tubular soft tissue shaver and also with the help of radiofrequency probe. The radiofrequency probe generates heat and can excise the tissue in a controlled fashion. Once the soft tissue clearance is done a special 5mm tubular burr is introduced through the same portal and the acromion bone is excised for a depth of about 0.5 to 1cm. Once the procedure is completed the small skin cuts are closed with one or two stitches.

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Postoperative

By doing arthroscopically the space is much better visualized than by doing through a open technique. Because the incision is small and minimal tissue disruption is done during the surgery the postoperative pain is less and the recovery is quick. Usually the shaving of bone heals in about 6 weeks time and the patients will be back to normal function in around 6 weeks to 3 months. The surgery is performed as a day case procedure. Physiotherapist will see you after the surgery and teach you of the exercises that has to be performed to get the function back quickly.

Success

The surgery is pretty safe. The success rate is in the order of 85-90%.

Complications

The complications are rare, but one should be aware that bleeding from the wound, swelling of the shoulder is part of the procedure and these will settle down in few days time. Occasionally infection can occur, and then it needs to be treated as needed. Getting shoulder movement can be an issue in about 10%; usually systematic physiotherapy will resolve the problem. Sometimes, if recalcitrant to physiotherapy manipulation under anaesthetic of the shoulder joint may be needed in order to speed up the rehabilitation.