Shoulder > Impingement Syndrome > Treatments

   Subacromial Decompression

Treatment Introduction

If shoulder impingement syndrome does not respond to conservative treatment of rest, anti-inflammatory medication, and physical therapy, your physician may recommend a subacromial decompression to alleviate pain. In this procedure, the underside of the acromion bone, the bone that comprises the "roof" of your shoulder, is removed arthroscopically to reduce pressure on the rotator cuff tendons and bursa that lie beneath it. In some patients, the acromion may be shaped in such a way that a larger piece may have to be removed or reshaped to reduce impingement.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your subacromial decompression. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown, and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Subacromial decompression is almost exclusively performed arthroscopically, with surgical instruments inserted into your shoulder through tiny incisions, and takes one to two hours to complete. You usually are able to go home the same day after your surgery.

   You usually are given general anesthesia for this procedure, and you may also be given an interscalene block, also referred to as regional anesthesia, that will numb your shoulder and neck area. This is administered with an injection in the side of your neck.

   Several tiny (3 1/2 to 4 millimeter) incisions are made in your shoulder, through which the arthroscope is inserted. The arthroscope transmits images to a TV camera so that your surgeon can view the structures inside your shoulder.

   Small surgical instruments are inserted into your shoulder through the incisions and the underside of the acromion is removed, along with any bone spurs that may have formed. The undersurface of the acromion is flattened with a motorized burr.

   The incisions are closed with a suture and you are taken to the recovery room.

Recovery Room

When you awaken in the recovery room following subacromial decompression, your shoulder usually is wrapped in gauze, immobilized in a sling, and may be covered with an ice pack. You may feel a moderate amount of pain. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days and when to return for a follow-up appointment – usually in one or two weeks. You should try to move your fingers while you are in the recovery room to improve circulation. Moving your wrist may be painful and you usually should not try to move your elbow. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you usually are allowed to go home. You will be unable to drive a car, so be sure to have arranged a ride home.

Following subacromial decompression to repair impingement syndrome, you will need to take steps to reduce the pain and inflammation in your shoulder. Rest, icing, and anti-inflammatory painkillers such as ibuprofen or aspirin can ease pain and swelling. Immobilizing the shoulder in a sling for two or three days will help keep it stabilized. Larger tears may require you to wear the sling for a few weeks. You usually are instructed to remove the sling for part of each day to perform gentle motion exercises that will keep your shoulder from tightening up. Here is what you can expect and how you can cope with a sling immobilizing your shoulder:

   The first concern is to monitor swelling for the first 48 hours while wearing your sling. Physicians generally prescribe ice packs to be applied for 15 to 20 minutes at a time, three or four times a day.

   If the swelling has decreased after 72 hours, you may be able to apply heat to help reduce pain. You should not apply heat to swollen areas because heat increases blood flow to the skin, which can prolong the healing process.

   Physicians generally recommend that you wear the shoulder sling day and night for about two or three days.

   You can usually remove the gauze bandage and bathe regularly after two days. If surgeons had to make a 1 1/2-inch "mini-incision" to suture your rotator cuff tear, you may have to keep the bandage on and sponge bathe for about seven days. You can take your sling off for brief periods while you bath, but remember to avoid moving your injured shoulder.

   Some bleeding and fluid drainage is normal for the first two days. Call your physician if bleeding continues past a couple days.

   When your shoulder starts to heal, your physician may recommend that you remove the sling for short periods to perform some light, early-motion exercises.

   You should move your fingers and hands in the sling as much as possible to help circulate blood.

   If you develop a rash or irritated skin around your sling, call your physician.

   If you notice any abnormal wear or discomfort in the sling, contact your physician as early as possible. In general, do not try to "grin and bear it" if discomfort does not go away within a few days. Slings should not irritate your skin.

   You may feel some stiffness in your shoulder. If the stiffness does not ease after two or three days, call your physician.

Physical therapy following subacromial decompression to correct shoulder impingement usually progresses through four phases. The time you spend in each phase depends on the severity of your injury and your body’s ability to heal.

   The first phase focuses on decreasing inflammation in your shoulder. Your therapist usually helps you move your arm and stretch your shoulder.

   When you feel comfortable moving your arm with your own strength, you can work on restoring a full range of motion and strengthening the hands, wrist, and elbow.

   The third phase focuses on shoulder strengthening exercises. These may begin with isometric exercises, which strengthen the muscles without motion, and progress to resistive exercises that may involve pulleys or weights.

   When the muscles in the injured shoulder are about as strong as the uninjured muscles, phase four of rehabilitation becomes more activity oriented. You usually perform sport-specific exercises and coordination drills under the supervision of a therapist or coach.

Patients generally progress quickly through the four phases of rehabilitation. Active people can usually return to their sports within three months if impingement syndrome was the only diagnosis treated.

RELATED TOPIC

   Shoulder strengthening exercises

The best way to prevent impingement syndrome from recurring is to make the strengthening exercises you learned in rehabilitation part of your everyday routine. You should remember to stretch your shoulder and warm up before exercising. Sports that involve repeated overhead motion, like baseball and tennis, inevitably strain your shoulder. To prevent injury, you need to keep all the rotator cuff muscles toned and flexible with an exercise program. You also may need to alter your work environment to avoid repeated overhead activities. Physicians generally recommend that you ice your shoulder after activities. Competitive athletes may need to use anti-inflammatory medication, like aspirin and ibuprofen, after sports activities that cause swelling in their shoulders. If you feel pain in your shoulder after you have had surgery to correct shoulder impingement, you should cut back your activity level and return to your physician for a check-up.

RELATED TOPICS

   Shoulder strengthening exercises

   Shoulder stretching exercises