Shoulder & Elbow : Sub-Acromial Decompression Surgery

What is a sub-acromial decompression?

A Sub-Acromial Decompression is an operation which relieves pressure on the rotator cuff muscles in the shoulder.

What are the rotator cuff muscles?

Your shoulder is the most mobile joint in your body and is therefore dependent on strong muscles to allow movement and provide stability. The most important of these muscles are your rotator cuff muscles. These are four muscles which originate from your shoulder blade (scapula) and combine together to form a hood covering the ball of your shoulder joint. These four rotator cuff muscles are individually called Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. These muscles and their tendons (tendons attach muscles to bone) can become irritated and trapped as they pass underneath the acromion. The acromion is the arch of bone at the end of your shoulder blade which acts as a bony roof over the rotator cuff muscles.

Sometimes bony spurs or a thickening can develop underneath the acromion and the end of the collar bone (clavicle). This narrows the space around the rotator cuff muscles and can irritate them causing pain. You may find that when you reach up, or behind your back, the pain is worse. A Sub-Acromial Decompression operation relieves pressure on these muscles by smoothing out the under surface of the acromion.

How is a Sub-Acromial Decompression carried out? The operation is carried out under a general anaesthetic, usually as a day case. This means that you will usually go home on the day of your operation. Some patients who have other medical conditions may require an overnight stay in hospital. The operation is usually carried out as key-hole (arthroscopic) surgery. An arthroscopy is an operation using a specially designed small telescope linked to a TV camera which allows your surgeon to look inside your shoulder joint. This allows the surgeon to examine the shoulder joint and then use very small instruments to smooth the bone. Arthroscopic surgery will leave you with 2 to 4 small scars on the back, side and front of your shoulder.

Very occasionally there are technical reasons why we cannot carry out the operation arthroscopically. In this case it will be done in the traditional way - called an open procedure. An open procedure involves an incision along the front of your shoulder and will leave a scar about 4 - 7cms in length. This is usually along the bra or vest strap line, or over the top of your shoulder.

What happens if I decide not to have a Sub-Acromial Decompression?

If you decide you would rather not have this operation other treatment options are:

  • Physiotherapy: to try and relieve any symptoms - you may have already tried this if you have reached the stage of discussing surgery.

  • Steroid injections: these may help settle any pain down but will generally give only short term relief. Again you may already have tried these.

  • Pain relief: you may find you can manage your symptoms with adequate pain relief, or by modifying your activities.

What are the benefits of having a Sub-Acromial Decompression?

The benefits of this operation are to decrease your pain and in doing so improve your movement. It is normal to be sore after the operation but you will be given painkillers to help with this. It may take up to 6 weeks for the post-operative soreness of your shoulder to settle down, but there can be some discomfort present for up to three months and you may still be seeing improvements up to 6 months after your surgery. Most people have good results following surgery but there is a chance that you may have developed permanent changes or small tears in the rotator cuff muscles which could cause some persistent discomfort.

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