Sub-acromial Decompression (Shoulder)

Shoulder pain is a very common symptom. Subacromial decompression (acromioplasty) is an operation on your shoulder to treat a condition called shoulder impingement.
About your shoulder joint

The shoulder is a ball and socket joint. A bone (acromion) and a ligament (coraco-acromial) above the shoulder together form an arch. There’s normally a space between the top of your arm bone and the bone at the top of your shoulder blade, called the subacromial area. A small, fluid-filled sac (bursa) sits within the space allowing the tendons between your upper arm and shoulder to glide freely when you move your arm.

What is shoulder impingement

Shoulder impingement occurs when the amount of space between your shoulder blade and rotator cuff tendons is reduced. This may be due to irritation and swelling of the bursa. The acromion rubs against the tendons in your shoulder when you raise your arm. This causes pain when you try to raise your arm, and restricts your movement.

Your surgeon may mention the words ‘rotator cuff’. This is the name given to the muscles and tendons surrounding the top of your upper arm bone, attaching it to your shoulder blade.

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How you can access our services

Self pay patients can pay the hospital direct for rapid access to premium services. Pricing for sub-acromial decompression starts from £4,203.00. You will have a number of treatment options which may affect your final bill. Please contact us if you wish to discuss this further.

As an NHS patient you can choose to receive your treatment at St Hugh's through the Choose & Book system. This does not cost a penny and there is no additional cost to the NHS.

We partner all major health insurers. Where your policy provides cover you can visit us as a private patient for rapid access to premium services.


What are the alternatives to sub-acromial decompression?

For some people, sub-acromial decompression isn’t necessary. Your Doctor may suggest alternatives such as rest, physiotherapy or steroid injections into your shoulder. However, if there is no improvement then surgery may be necessary.


About Sub-acromial Decompression

Sub-acromial decompression (acromioplasty) is an operation on your shoulder to give pain relief by opening up the space, removing the inflamed bursa and shaving the bone on the under-surface of the acromion.


Complications of sub-acromial decompression

Complications are when problems occur during or after the operation. Complications of sub-acromial decompression can include the following:

Pain
Persistent pain or stiffness in and around the shoulder. The healthcare team will give you medication to control the pain and it is important that you take it as you are told so you can move around as advised.

Infection
These are usually only superficial wound infections. Occasionally deep infection may occur although this is rare. Your surgeon may prescribe you antibiotics during and after surgery to help prevent this.

Nerves and Blood Vessels
Damage to the nerves and blood vessels, although this is rare.

Blood Clots
Developing a blood clot, usually in a vein in your leg - deep vein thrombosis (DVT).

What happens during Sub-acromial Decompression

The operation is done by keyhole surgery (arthroscopy), a surgical procedure that allows your doctor to look at the inside of a joint in your body through a thin viewing instrument called an arthroscope.

Sub-acromial decompression is usually done under general anaesthesia, which means that you will be asleep during the procedure. You may also be given a local (regional) anaesthetic into the nerves around your shoulder.

Two or three 5mm puncture wounds are made around the shoulder to allow entry of the arthroscopic instruments; one of these is a camera, which allows the surgeon to thoroughly inspect the inside of the shoulder joint. A burr (a surgical drill) is used in the shoulder to shave away part of the coraco-acromial ligament and any overhang of bone (acromial spur). This allows the tendons to move more freely and thus break the cycle of rubbing and swelling. If necessary, the inflamed bursa can also be removed.

Your surgeon may also decide to repair any damaged tendons at the same time. This may mean your surgeon has to change from keyhole surgery to an open operation and will make a larger cut in your shoulder.

What to expect afterwards

When you wake up after your operation, the nerve block may make your arm feel numb and weak for 12-48 hours. The nerve block is likely to significantly reduce or completely remove your pain helping you get over the worst of the pain from the operation. The blocks are normally very effective and last into the next day. Your arm will then start to return to normal sensation.

It is important to take painkillers regularly, continuing for at least 2-3 days, even if you are comfortable, as the pain can sometimes return suddenly. Remember that painkilling tablets can take up to an hour to work. Your healthcare team will advise you further.

You may be given a sling to wear. The sling is for comfort only. You can take it on and off as you wish once the nerve block has worn off. Normally it is discarded after a few days. You may find it helpful to wear the sling at night for the first few nights, particularly if you tend to lie on your side. Your healthcare team will advise you further.

You should be able to go home the same day. However, your doctor may recommend that you stay a little longer. If you do go home a responsible adult should take you home in a car or taxi and stay with you for 24 hours.

The healthcare team will give you advice on wound care and tell you if you need to have any stitches removed or dressings changed.

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How will I progress?

This can vary considerably and for some it is not a quick fix operation. The overall results are good but do not be disappointed if some pain is still a feature for several weeks following surgery. The discomfort from the operation will gradually lessen over the first 6 weeks. You should be able to move your arm comfortably below shoulder height by 2–4 weeks and above shoulder height by 6 weeks.

You may see a physiotherapist before and after your operation. It is really important that you do any exercises that your physiotherapist or surgeon recommends. These may help you to recover more quickly. Your surgeon or physiotherapist will tell you when to start these exercises, and how many to do.

When can I return to my leisure activities?

Your ability to start these activities will be dependent on the pain, movement and strength that you have in your shoulder. Nothing is forbidden, but it is best to start with short sessions involving little effort and then gradually increase the effort or time for the activity.

However, be aware that sustained or powerful overhead movements (e.g. trimming a hedge, some DIY, racket sports etc.) will put stress on the sub-acromial area and may take longer to become comfortable.

When can I return to work?

This will depend on the type of work you do and the extent of the surgery. If you have a job involving arm movements close to your body you may be able to return within a week. Most people return within a month of the operation but if you have a heavy lifting job or one with sustained overhead arm movements you may require at least 6 weeks or sometimes longer. Please discuss this further with your healthcare team or physiotherapist if you feel unsure.

When can I drive?

You can drive as soon as you have regained sufficient pain free movement in your shoulder and you feel able and safe to steer and control your vehicle. This normally is after a week. Check you can manage safely and it is advisable to start with short journeys.

What can I do to make my recovery easier?

It is important that you are as fit and healthy as possible before your operation. You can also prepare your home for when you return from hospital.

Are there things that I should avoid?

There are no restrictions (other than the pain) to movement in any direction. Do not be frightened to start moving the arm as much as you can. You cannot damage the surgery that has been done. Gradually the movements will become less painful.

Avoid heavy lifting for 1 week to 3 weeks.

Be aware that activities at or above shoulder height stress the area that has been operated on. Do not do these activities unnecessarily. Try and keep your arm out of positions which increase the pain.



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