Subacromial decompression is a common surgical procedure performed to alleviate shoulder pain. This surgery aims to create more space within the shoulder joint, which can become constricted and cause discomfort. It is a well-established treatment option when non-surgical methods have not provided sufficient relief for persistent shoulder issues.
What is Subacromial Decompression?
Subacromial decompression is a surgical procedure that increases space within the subacromial area of the shoulder. This space is located beneath the acromion, a bony projection from the shoulder blade forming a roof over the joint. Within this narrow region, the rotator cuff tendons, responsible for shoulder movement and stability, pass through, along with a fluid-filled sac called the bursa.
The goal of this surgery is to relieve pressure on these structures. This is achieved by removing bone spurs, also known as osteophytes, that may have formed on the underside of the acromion. Inflamed or thickened bursal tissue can also be removed. This allows the rotator cuff tendons to glide more freely, reducing friction and irritation.
Why is Subacromial Decompression Performed?
Subacromial decompression is performed to treat shoulder impingement syndrome, a condition where the rotator cuff tendons become pinched and irritated as they pass through the subacromial space. This impingement often causes pain when lifting the arm, especially above shoulder height. The pain may also worsen at night.
This condition can arise from various factors, including repetitive overhead arm movements common in certain sports or occupations. Anatomical variations, such as a curved or hooked acromion, can predispose to impingement. Over time, bone spurs may develop on the acromion, narrowing the subacromial space and pinching tendons.
Shoulder impingement can be accompanied by or lead to other related issues, such as rotator cuff tendinitis (inflammation of the rotator cuff tendons) or bursitis (inflammation of the bursa). Subacromial decompression is considered when conservative treatments, such as rest, physical therapy, anti-inflammatory medications, and steroid injections, have failed to alleviate symptoms. The surgery aims to address the underlying mechanical issue causing persistent pain and limitation.
How Subacromial Decompression is Performed
Subacromial decompression is most commonly performed using an arthroscopic, or “keyhole,” technique. This minimally invasive approach involves general anesthesia. A regional nerve block might also be administered to help manage pain after the surgery.
The surgeon makes two or three small incisions around the shoulder. Through one incision, a narrow, tube-like instrument called an arthroscope is inserted. This instrument contains a camera that transmits real-time images to a monitor. Other miniature surgical instruments are inserted through additional small incisions.
During the procedure, the surgeon removes bone spurs from the underside of the acromion using a high-speed burr. Inflamed or thickened bursal tissue is also removed, often with a shaving device. This process effectively widens the subacromial space, reducing pressure on the rotator cuff tendons. After withdrawal of instruments, the small incisions are closed with stitches.
Recovery and Rehabilitation
Following subacromial decompression, patients can expect initial pain, swelling, and bruising. Pain medication will be prescribed, and ice application is recommended. Patients typically wear a sling for a short period, often for comfort and protection.
Physical therapy is an important component of the recovery process, often beginning within days or weeks after surgery. The rehabilitation program focuses on regaining range of motion, improving shoulder strength, and restoring normal function. Early exercises may include gentle pendulum swings and passive or active-assisted movements to prevent stiffness. As recovery progresses, strengthening exercises for the rotator cuff and shoulder blade muscles are introduced.
Adherence to the physical therapy program is important for optimal outcomes, as it helps prevent complications like shoulder stiffness. Recovery varies, but it typically takes three to four months to feel significant improvement, with continued progress possible for up to a year. Return to work and daily activities depends on the nature of the job, with light desk work possibly resuming within a week, while jobs requiring physical activity or heavy lifting may require several months off.
Potential Risks
While subacromial decompression is generally considered a safe procedure, like all surgeries, it carries potential risks. General surgical risks include adverse reactions to anesthesia, bleeding, infection, and the formation of blood clots.
Specific risks related to shoulder surgery include persistent pain or incomplete relief of symptoms. Some patients may experience stiffness in the shoulder, sometimes developing into “frozen shoulder.” Rare complications can also include damage to surrounding nerves or blood vessels, or a fracture of the acromion.