Arthroscopic Subacromial Decompression (ASD)

Arthroscopic subacromial decompression is a common procedure undertaken to address the symptoms of subacromial impingement, which is not responsive to non-operative treatments. It can also be undertaken as part of a larger operation such as a rotator cuff repair.

The aim of the surgery is to initially arthroscopically examine the shoulder to confirm the diagnosis and make sure that there are no other possible causes for the pain. Once this has been verified, surgery is undertaken with the aim of increasing the size of the subacromial space so that the rotator cuff tendons do not rub against the overlying bone, the acromion. If this rubbing or ‘impingement’ persists, then long term damage or even a tear to the rotator cuff can develop

A subacromial decompression (acromioplasty) is usually performed as a ‘key-hole’ procedure through 2 or 3 small incisions. Any inflamed tissue can be removed and then a small amount of the acromion bone is shaved away to create more space for the rotator cuff tendons. In some instances there may be an associated bony acromial spur that can also be removed. Where appropriate, other procedures such as a rotator cuff repairs or ACJ excisions can also be performed at the same time. Sometimes, an open acromioplasty will be necessary. This allows direct visualisation of the acromion and when used, it is often done in conjunction with a larger open operation that is otherwise not amenable to arthroscopic techniques.

Information for patients / operative Information

Risks and complications

• Infection
• Bleeding
• Nerve injury
• Stiffness
• Continued discomfort

Before admission

• Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
• No food for 6 hours, or drink for 4 hours, prior to surgery.
• Please avoid smoking for 12 hours prior to surgery.

In Hospital

• A subacromial decompression is usually performed as a day case procedure or as a single overnight stay.
• Two to three incisions, each approximately 1 cm in length, are made around the shoulder. These are closed with dissolving sutures and Steri-strips.
• Splash proof dressings will be applied but the wound should remain dry for 10 days.
• Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

• Swelling; immediately after an arthroscopic procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A Cryocuff or alternative cold therapy compress, can be helpful in minimising swelling and inflammation. The Cryocuff will usually be issued to you upon discharge
• Pain; an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
• Bleeding; there may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

• A sling will be provided to help rest the shoulder. This is usually used for the first 7 - 14 days post surgery. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling should be removed 24 hours after your operation.
• The wound should be kept dry for 10 days.
• At ten days the dressings and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound. If not, please consult Mr Falworth or your GP for further advice.
• The most important part of your post-operative care is to start an early physiotherapy exercise programme, which the ward physiotherapist will have commenced prior to your discharge from hospital. This will maximise the benefit of your operation and will continue as an outpatient.

Post-operative appointments

• You will be reviewed in clinic approximately 3 weeks following your surgery.

Estimated return to functional activities