Acromial decompression surgery is a procedure performed by an orthopedic surgeon to treat pain from the acromioclavicular joint, a joint at the top of the shoulder. Pain can be from impingement and/or arthritis changes to the joint. The impingement of the rotator cuff or subacromial bursa by the bones making up the shoulder joint occurs in the subacromial space--the space where the rotator cuff and subacromial bursa are located.
Shoulder Impingement Syndrome
Shoulder impingement syndrome is a condition of pain when either the supraspinatus muscle of the rotator cuff or the subacromial bursa become entrapped. The subacromial bursa is soft tissue located above the rotator cuff. This entrapment usually occurs between the acromion and the greater tuberosity of humerus bone. The humerus is the upper arm bone, and the greater tuberosity is a bony prominence on the humerus where some of the rotator cuff muscles attach. The acromion is a bony prominence of the scapula bone located near the "socket" of the shoulder joint and makes up part of the acromioclavicular joint. The impingement can be due to arthritis or mechanical irritation. The impingement leads to pain and decreased range of motion of the shoulder due to the pain.
Conservative Treatment
Conservative treatment of shoulder impingement is typically tried prior to surgery. Wheeless' Textbook of Orthopaedics states that surgery is usually done after six months of non-operative treatment has not improved the patient's symptoms. Non-operative treatment involves physical therapy to improve strength and range of motion. Steroid injections into the joint can be attempted. Non-steroidal anti-inflammatories may help with symptom relief.
Arthroscopy
Arthroscopic acromioplasty is a procedure where small incisions are made in the shoulder that serve as port sites for a camera and surgical instruments. Water is infused into the joint and the surgeon is able to directly visualize the acromioclavicular joint and surrounding structures. The surgeon takes a shaver tool and is able to grind down the acromion and/or clavicle and any other bone or soft tissue structure that may be leading to the impingement.
Open Acromioplasty/Subacromial Decompression
Open acromioplasty/distal clavicle resection, or a subacromial decompression surgery, involves making an incision in the skin overlying the acromion. The acromioclavicular joint is exposed by surgical dissection or retracting tissues out of the surgeon's field of view. The surgeon may then remove a portion of the acromion, clavicle, or soft tissue structure if it appears the culprit for the impingement symptoms. A clavicle portion 0.5 to 1cm in size, according to the "AAOS Comprehensive Review" edited by Dr. Jay Lieberman of the University of Connecticut, is usually an appropriate amount to have removed during the surgery.
Complications
Surgery does have possible long-term complications. If there is an excessive amount of bone removed, there can be instability in the shoulder. Generally surgeons remove less than 1 cm total of the clavicle. There can also be damage to the ligaments that surround the acromioclavicular joint, leading to instability. With any surgery there are risks of bleeding, infection and the need for further surgery.
Rehabiliation/Recovery
Rehabilitation after surgery involves initial placement of the shoulder in a sling for early healing. Early range of motion exercises and formal physical therapy is then done to improve strength and range of motion of the shoulder. Typical post-operative recovery is two to four months. Sometimes it takes a year to have pain relief after surgery.
References
- "AAOS Comprehensive Orthopaedic Review"; Dr Jay Lieberman (editor); 2008.
- Wheeless' Textbook of Orthopaedics: Shoulder Impingement Syndrome
- American Academy of Orthopaedic Surgeons: Shoulder Impingement
